Use of automated dispensing cabinets (ADCs) is common in many facilities. They can increase convenience and medication availability for the patient, but are they safe? As consultant pharmacists, our goal is to work with each facility to ensure they follow a process that increases efficiency and patient safety. How do you handle risky situations such as overrides or the removal of medications without an order? Do you have high-alert medications?
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Are automated dispensing cabinets (ADCs) risky?

Use of automated dispensing cabinets (ADCs) is common in many facilities.  They can increase convenience and medication availability for the patient, but are they safe?  As consultant pharmacists, our goal is to work with each facility to ensure they follow a process that increases efficiency and patient safety.  How do you handle risky situations such as overrides or the removal of medications without an order?  Do you have high-alert medications?

The Institute for Safe Medication Practices (ISMP) recently published an article discussing the potential risks of ADC use.  These cabinets can be used in a variety of setting for multiple purposes.  They are not always used to decentralize drug distribution.  Sometimes they are used for controlled substances, PRN and first dose medications.  In many cases, ADCs are interfaced to electronic health records, allowing for pharmacist order verification prior to removal of the drug.  Pharmacist review is an important step that adds a layer of safety and minimizes the risk of potential duplicative therapy, contraindications, unsafe dosing, allergies, and other medication-related concerns.  Additionally, ADCs can be configured to have locked or lidded compartments that allow for separate storage of controlled substances and high-alert medications.

Although we have come a long way since they were first used in the 1980s, some of the risks remain.  ISMP focuses on three unsafe practices that can lead to patient harm.

  1. Overuse of overrides: This usually refers to the removal of medication from the ADC without a pharmacist review.  This is a fairly common scenario that is often treated as routine, but should be considered risky.  Although not all circumstances will allow enough time for pharmacist review, the practice of overrides should be the exception and not the rule.
  2. Removal of drugs without an order: This is a scenario that should be reserved for rare circumstances when a lifesaving medication is needed in a true emergency. However, ISMP notes that most reported cases have happened at times when medications were removed ahead of time for an anticipated order such as for moderate sedation medications in an endoscopy practice. Not only does this practice bypass a pharmacist review, it also bypasses a prescriber’s order.
  3. Removal of an ordered drug from a non-profiled ADC: This allows the picking of drugs from the entire ADC contents rather than patient specific medications. This is more common in ambulatory healthcare facilities where pharmacy services are not available.

What are some safety measures you can take according to ISMP?

  1. Require an order prior to removal of a drug from the ADC.
  2. Establish a policy for handling overrides.
  3. Implement strategies to minimize risks when an override is used.
  4. Review, at least annually, which drugs are allowed in the ADC and provide additional safeguards for look-alike-sound-alike and high-alert medications.
  5. Provide education to all practitioners on safe use of ADCs and remind staff of the increased risk to patients as well as liability to the user, when ADC are used inappropriately.

If you currently have an ADC or are considering one for your facility, contact us and will make sure you have appropriate systems in place to increase patient safety and maintain regulatory compliance.

The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies  We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.

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