Department of Management, Leeds University Business School, University of Leeds, Leeds, UK
Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Eur J Hosp Pharm. 2023 Jan;30(1):17-23. doi: 10.1136/ejhpharm-2020-002552. Epub 2021 May 11.
Governance of controlled drugs (CDs) in hospitals is resource intensive but important for patient safety and policy compliance.
To explore whether and how storing CDs in an automated dispensing cabinet (ADC) in a children's hospital intensive care unit (ICU) contributes to the effectiveness and efficiency of CD governance.
We conducted a mixed-methods exploratory study, comprising observations, interviews and audits, 3 months after ADC implementation. We observed 54 hours of medications activities in the ICU medication room (with 42 hours of timed data); interviewed nurses (n=19), management (n=1) and pharmacy staff (n=3); reviewed 6 months of ICU incident reports pertaining to CD governance; audited 6 months of CD register data and extracted logs of all ADC transactions for the 3 months following implementation. Data analysis focused on four main CD governance activities: safekeeping/controlling access, documenting use, monitoring, and reporting/investigating.
Nurses and pharmacists perceived spending less time on CD governance tasks with the ADC. The ADC supported CD governance through automated documentation of CD transactions; 'blind counts'; automated count discrepancy checks; electronic alerts and reporting functionalities. It changed quality and distribution of governance tasks, such as removing the requirement for 'nurses with keys' to access CDs, and allowing pharmacists to generate reports remotely, rather than reviewing registers on the ward. For CDs in the ADC, auditing and monitoring appeared to be ongoing rather than periodic. Such changes appeared to create positive reinforcing loops. However, the ADC also created challenges for CD governance. Most importantly, it was not suitable for all CDs, leading to workarounds and parallel use of a safe plus paper registers.
ADCs can significantly alter CDs governance in clinical areas. Effects of an ADC on efficiency and effectiveness of governance tasks appear to be complex, going beyond simple time savings or more stringent controls.
医院对管制药物（CDs）的管理需要耗费大量资源，但对于患者安全和政策合规至关重要。
探讨在儿童医院重症监护病房（ICU）的自动配药柜（ADC）中储存 CDs 是否有助于提高 CDs 管理的效率和效果，并研究其具体作用方式。
我们开展了一项混合方法的探索性研究，在 ADC 实施 3 个月后，通过观察、访谈和审核的方式收集数据。我们观察了 ICU 配药室的 54 小时药物管理活动（其中 42 小时为定时数据）；访谈了护士（n=19）、管理层（n=1）和药剂师（n=3）；审查了与 CDs 管理相关的 6 个月 ICU 事件报告；审核了 6 个月的 CDs 登记数据，并提取了实施后 3 个月内所有 ADC 交易记录。数据分析集中于四项主要的 CDs 管理活动：保管/控制存取、记录使用情况、监测以及报告/调查。
护士和药剂师认为使用 ADC 后，用于 CDs 管理的时间减少了。ADC 通过自动记录 CD 交易、“盲数”、自动核对计数差异、电子警报和报告功能支持 CDs 管理。它改变了管理任务的质量和分布，例如，不再需要“有钥匙的护士”来存取 CDs，并且允许药剂师远程生成报告，而不是在病房查看登记簿。对于 ADC 中的 CDs，审计和监测似乎是持续进行的，而不是定期进行的。这些变化似乎形成了积极的强化循环。然而，ADC 也给 CDs 管理带来了挑战。最重要的是，它并不适用于所有 CDs，导致需要采用替代方法，并且需要同时使用安全柜和纸质登记簿。
ADC 可以显著改变临床区域的 CDs 管理方式。ADC 对管理任务的效率和效果的影响似乎很复杂，不仅仅是简单的节省时间或更严格的控制。
