Thinking about a better Automated Dispensing Unit (ADU)

Automated Dispensing Units (ADUs), also referred to as Automated Dispensing Cabinets (ADCs), are nothing new to hospital pharmacy. Over 80% of hospital pharmacies use ADUs. The most common is a product from Cardinal called Pyxis MedStation. Others include Omnicell SinglePointe, McKessen AutoDose-Rx and medDISPENSE (part of Emerson Electric Co.). Currently Pyxis is the clear front runner, and for good reason. They offer a great product.

ADUs provide varying degrees of access to medications for distribution to patients. The machines are located on the nursing units for obvious reasons and offer great advantages to pharmacy. Some of these advantages include:

• Saving time: Having medications available on the nursing units saves pharmacy from having to dispense all medication dosages from a centralized location.
• Decreased turn-around time: ADUs decrease the time it takes for an order to go from the physician’s hand to the patient.
• Increased safety. ADUs offer barcoded removal and replinishment of medication. It’s now hader for a nurse to give the wrong medication.
• Increased security for medication storage. ADUs typically require password or fingerprint verification for entry. In addition, third party software such as Pandora can be used to stifle diversion.
• Inventory control. ADUs can be tied directly to the pharmacy distribution system and offer a slew of reports for tracking medication use and following trends. For example, we use AutoPharm software from Talyst in combination with Pyxis to manage our inventory.

ADUs are filled with medications in ready to use, unit-dosed packages. Pharmacies don’t always receive medications in unit of use packaging and will often times unit-dose the items from bulk containers prior to placing them in the dispensing machines. Our bulk packager of choice is AutoPack from Talyst. There are other, similar products on the market, but none offer the same cluster of conveniences as Talyst.

Talyst has a system similar to AutoPack called InSite that is used specifically in Long Term Care (LTC) facilities and prison systems. With InSite loose tablets are placed in a medication canister fitted with a computerized chip used to identify the medication contained inside. Instead of unit dosing the bulk tablets prior to placing them in an ADU, the canisters are placed directly into InSite where they are unit-dosed on demand. For all intents and purposes, InSite becomes the ADU (more information can be found at the Talyst website). In LTC this eliminates the need for the familiar “punch cards” thus reducing waste, and makes access to medications much easier for nursing. The system reminds me a lot of our AutoPack unit.

As I look at the InSite system I wonder if a similar system could be used in the acute care setting. Some customization would be necessary, but it would eliminate the intermediate step of having to unit-dose bulk medications prior to loading them in the ADU. Currently we not only unit-dose medications on demand, but store them in our automated carousel as well. Placing the packager on the floor would eliminate the need to store the unit-dosed items in the pharmacy. We currently stock our ADUs with enough medication for between 14 and 30 days, so placing an entire bottle of something in a canister for use on the floor wouldn’t be excessive. Of course this is dependent on the medication, the nursing unit and typical use patterns.

I immediately see three advantages to using an on demand unit-dose dispensing system on the nursing unit:

1. Decrease the amount of technician and pharmacist time in the pharmacy. The process of unit-dosing a medication in the pharmacy currently consists of a technician filling the medication canister, a pharmacist checking the canister, the technician unit-dosing the item and finally the pharmacist signing off on the final product (not including the pull and check prior to loading in the ADU). The item is then taken to the floor and placed in the ADU. If the bulk packager was taken out of the pharmacy and placed on the nursing unit, the process would look something like this: the technician would fill the canister, the pharmacist would check it and it would be taken to the floor and placed in the packager at the nurses station. The location of the canister in the packager is irrelevant because the canister and medication are identified via the embedded computer chip. In other words, you can’t put the canister in the wrong location.

2. Increased storage space. There would be no need to store unit-dosed medications in the pharmacy that were already available in bulk on the nursing unit.

3. Increased safety by eliminating a step in the distribution process. If you want to increase efficiency and increase safety, simplify the process. Adding steps can only increase your risk for mistakes. See the AHRQ website for an interesting piece on safety and unit-dose packaging.

A system like this would not be without it’s difficulties. Adding yet another dispensing machine to each nursing unit would be costly as well as create integration issues. Also the space needed for this scenario will likely be larger than current methods. However, the dynamics of a system that provides the access of a current AUD like Pyxis, combined with the on demand unit-dose dispensing capabilities of a system like InSite would be pretty slick. It’s just a thought.