Implementation of distributed automated medication dispensing units in a new hospital: Nursing and pharmacy experience

Abstract

Aims and objectives: To explore the structures, processes and outcomes involved in an Automated Medication Dispensing system implementation and its impact on patient safety.Background: Increasing digitalisation of medication prescribing, dispensing, administration and stock management has occurred over the past two decades. While automated medication dispensing units aim to provide safe, high-quality, patient-centred care, the implementation may result in unintended consequences leading to suboptimal outcomes.Design: This study uses a qualitative approach guided by Donabedian's structure, process and outcome framework.Methods: Twenty-six registered nurses and pharmacy assistant staff, from clinical areas equipped with automated medication dispensing cabinets, participated in semi-structured interviews. In-depth, thematic analysis explored the structures and processes. Together with interview data, content analysis of text data generated by internal risk management and critical incident reporting systems was undertaken to evaluate outcomes. Findings were considered in light of the Interactive Sociotechnical Analysis approach to health information technology. The COREQ checklist was used in preparation of this article.Results: Pharmacy assistants reported better satisfaction with the system at implementation than nurses. Training provided for nurses and their involvement in system implementation was reported as insufficient; however, nurses' use of and satisfaction with the system improved over time. A recursive relationship between the changes imposed by the system and nurses' creative problem solving (workarounds) used to manage these changes, impacted work productivity for nurses and safety for patients. Conclusions:The individualised nature of "workarounds" employed offered both risks and opportunities which require further identification, investigation and management.Relevance to clinical practice: Nurses are the majority of the health workforce.Digitalisation of traditionally paper-based activities in health care, impacting nursing work, requires similar strategies to any practice change.

Käyttäjien kokemuksia älylääkekaapeista vuodeosastoilla: Kehitysehdotuksia työprosessien sujuvoittamiseksi ja potilasturvallisuuden parantamiseksi

“…Vaikka älylääkekaappeja onkin ollut käytössä esimerkiksi Yhdysvalloissa jo 1980-luvulta [7] ja Suomessakin vuodesta 2011 asti [2], on älylääkekaappien käyttäjäkokemuksiin ja työprosesseihin liittyvää tutkimusta tehty suhteellisen vähän erityisesti potilastietojärjestelmään liitetyistä älylääkekaapeista. Sekä Suomessa että maailmalla tehtyjen aiempien tutkimusten mukaan sairaanhoitajat ovat olleet pääosin tyytyväisiä älylääkekaappeihin [8][9][10][11], mutta haasteita on aiheuttanut esimerkiksi hoitajajonon syntyminen kaapeille [8,10,11] sekä ruuhka erityisesti aamulääkkeiden jaon aikana [10].…”

“…Lisäksi useassa tutkimuksessa on havaittu, että lääkkeiden jakoprosessia ei suoriteta täysin ohjeistuksen mukaisesti [8][9][10]12]. Ristiriitaisia tuloksia on siitä, onko kaappien käyttöönotto nopeuttanut [5,9,13] vai hidastanut lääkkeidenjakoa [8,14].…”

“…Myös aiemmat tutkimukset ovat nostaneet esiin älylääkekaappien aiheuttavan jonottamista [8,10,11]. Ruuhkaan on ehdotettu ratkaisuksi kaappien käyttöasteiden optimointia ja tarvittaessa kaappiyksiköiden lisäämistä [11] sekä toisten vähemmän ruuhkaisten lääkehuoneiden kaappien käyttämistä [10].…”

Deep Learning and Detection Technique with Least Image-Capturing for Multiple Pill Dispensing Inspection

“…In addition, because performing simple tasks repetitively cause fatigue, mistakes may occur in pill classification, which may lead to medical accidents. Recently, automated equipment such as automatic drug dispensing machines [1][2][3] have gained popularity and are being used in pharmacies and hospitals to sort and package pills. An automatic drug-dispensing machine sorts and packs drugs based on prescriptions input from a computer program.…”

Pill Detection Model for Medicine Inspection Based on Deep Learning

“…In recent years, automated equipment, such as automated medication dispensing machines [1][2][3], have rapidly spread in pharmacies and hospitals where multiple dispensing tasks need to be performed, such as sorting and packaging pills. An automated medication dispensing machine is a device that sorts and packs drugs based on a prescription that is input from a computerized program.…”