Each technology should be evaluated on its own merit and, importantly, in appropriate context for your organization given other resources.
The world has plenty of technophiles and technophobes. On one extreme, there are individuals who embrace any technology for its mere sake and welcome any opportunity to play with a new gadget. On the other end are those who resist change and insist on doing things the way they’ve always done them. Although technology generally presents an upward trajectory in its application and ability to help us solve problems, attitudes too far in either direction do not serve the pharmacist nor pharmacy manager very well. Dispensing technologies must be evaluated carefully.
Cheung et al. evaluated the use of automated dose dispensing (ADD) in community and in hospital pharmacies. Automated dose dispensing is otherwise known as multi-dose dispensing, and it provides patients with robot-dispensed unit doses in which all medications intended for 1 dosing moment are gathered in disposable containers and labeled with patient data, medicine contents, and the date and time for intake. ADD is intended to improve medication safety and treatment adherence, particularly among elderly patients taking multiple medications.
Preliminary studies suggest that these systems minimize dispensing errors and save time for pharmacy staff. However, ADD may also introduce new types of errors such as increased risk of patients receiving inappropriate medications and incorrectly formulated products (e.g., incorrect crushing of medication). In their study, Cheung et al. evaluated medication incidents submitted to their national registry (the Dutch Central Medication Incidents Registration). In those incidents, they looked at the individual discovering the incident, the phase of the medication process in which the incident occurred, the immediate cause of the incident, the nature of the incident from the health care provider’s perspective, the nature of the incident from the patient’s perspective, and any consequent harm to the patient. In just over 1 year, they examined 15,113 incidents: 3,685 from community pharmacies and 11,428 from hospitals.
According to the study, approximately 0.4% of all incidents were related to ADD in the hospital, whereas more than 6% of all incidents in community pharmacy were related to ADD. The immediate cause of an incident was often a change in the patient’s medicine regimen or location. Most reported incidents occurred in either of 2 phases: entering the prescription into the pharmacy information system or filling the ADD container with the medications. From the patient’s perspective, there were often too few medications in the ADD container. Sources of incidents from the provider’s perspective were dispersed across many different possible reasons. Fortunately, approximately half of the incidents were caught and never reached the patient, and very few resulted in any harm.
Each technology should be evaluated on its own merit and, importantly, in appropriate context for your organization given other resources. The advantages and limitations of a technology will vary not only from one practice setting to another, but even from one location to another in the same practice setting. Pharmacy managers need to conduct research on the past history of an emerging technology and also consider their organization’s structure, capacity, personnel, ability to change, ability to cope with mistakes, and existing technology within the organization that can either sync up with or clash with the new technology. The manager’s ability to select the right technology and harness it will determine its success and, ultimately, the quality of patient care.
Additional information about Managing Technology that Supports the Medication Use Process can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.
ABOUT THE AUTHOR
Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy.
Cheung KC, van den Bernt PM, Bouvy ML, Wensing M, De Smet PA. Medication incidental related to automated dose dispensing in community pharmacies and hospitals: A reporting system study. PLoS One. 2014;9(7). doi: 10.1371/journal.pone.0101686.