Cottney Alan
East London NHS Foundation Trust.
BMJ Qual Improv Rep. 2014 Apr 25;3(1). doi: 10.1136/bmjquality.u204237.w1843. eCollection 2014.
Information technology (IT) systems are being utilised with increasing frequency at the prescribing and dispensing stage of the medicines-use process in UK hospitals. However, much less development has taken place with regard to the implementation of IT systems at the administration stage of medicines-use. A technology that has been implemented widely at the administration stage in North American hospitals is the automated dispensing cabinet (ADC), which has been shown to reduce nurse medication administration errors and reduce the time that nurses spend administering medication. The current project was undertaken to assess whether these benefits would be realised with the introduction of an ADC on an inpatient ward in a UK mental health hospital. Nurses were observed administering medication before and after the implementation of an ADC on a ward at East London NHS Foundation Trust (ELFT). The findings from these observations showed that the use of the ADC led to a reduction in the medication administration error rate from 8.9% to 7.2%; however, this reduction was solely accounted for by a reduction in errors of negligible clinical severity. The types of administration errors noted after implementation of the ADC remained largely unchanged from beforehand. The ADC was found to reduce the amount of time that nurses spent administering medication from 2.94 min per dose to 2.37 min per dose. It is estimated that this reduction could generate around 66 min of additional free nursing time per ward per day. As a standalone device, the ADC was found to improve the efficiency of the medicines-use process, but had little meaningful effect on medication administration error rate at ELFT. However, it could be anticipated that additional benefit with regard to reducing medication administration errors may be demonstrated if the ADC was used in combination with other IT systems, such as electronic prescribing.
在英国医院的药品使用过程中，信息技术（IT）系统在处方和配药阶段的使用频率越来越高。然而，在药品使用的给药阶段，IT系统的实施进展要少得多。在北美医院的给药阶段广泛应用的一项技术是自动发药柜（ADC），它已被证明可以减少护士给药错误，并减少护士花费在给药上的时间。当前项目旨在评估在英国一家精神卫生医院的住院病房引入自动发药柜是否能实现这些益处。在东伦敦国民保健服务基金会信托（ELFT）的一个病房实施自动发药柜前后，观察护士给药情况。这些观察结果表明，使用自动发药柜使给药错误率从8.9%降至7.2%；然而，这种降低完全是由于临床严重程度可忽略不计的错误减少所致。实施自动发药柜后记录的给药错误类型与之前基本保持不变。发现自动发药柜将护士给药时间从每剂2.94分钟减少到每剂2.37分钟。据估计，这种减少每天可为每个病房带来约66分钟的额外自由护理时间。作为一个独立设备，自动发药柜被发现提高了药品使用过程的效率，但对ELFT的给药错误率几乎没有显著影响。然而，可以预期，如果将自动发药柜与其他IT系统（如电子处方）结合使用，在减少给药错误方面可能会有额外的益处。
