Wang Yi-Chen, Tsan Chin-Yuan, Chen Meng-Chun
Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan.
Department of Nursing, National Taiwan University Hospital, Yunlin Branch, Yunlin County, Taiwan.
JMIR Form Res. 2021 Sep 17;5(9):e24542. doi: 10.2196/24542.
A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs.
This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation.
We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation.
The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item "I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented" (score=4.24). The item with the lowest score was "I have to wait in line to get my patient medications" (score=3.32).
The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this.
自动配药柜（ADC）是一项在美国医院中已广泛应用的技术，已被证明可减少护士给药错误以及护士花费在给药上的时间。
本研究旨在确定ADC系统对护士给药的影响以及ADC实施前后的安全性。
我们在台湾台北的国立台湾大学医院进行了一项为期24个月的纵向研究。通过临床观察和问卷调查来评估护士在使用ADC前后在住院病房准备、发放和归还药物的时间差异。对ADC实施前后一年内在医疗事件系统中记录的用药错误进行评估。
病房的药物准备时间显著增加（所有P<0.005）。平均每位患者需要2分钟的准备时间。只有1个科室的药物归还时间有所增加，但不显著。给药阶段发生了9起（45%）不良事件，配药阶段发生了11起（55%）事件。虽然在ADC实施期间报告的事件平均数量有所减少，但差异不显著。至于发给护士的问卷，总体平均得分为3.90；得分最高的项目是“与ADC实施前相比，我现在等待药房送来药物的时间减少了”（得分=4.24）。得分最低的项目是“我必须排队领取患者的药物”（得分=3.32）。
在系统完全实施和整合后的9个月里，护士对使用ADC总体感到满意。人们认识到ADC在药品库存管理方面有好处；然而，这是以增加护理时间为代价的。总体而言，尽管对工作流程有影响，但护士们仍然支持其对患者的益处。他们在本研究中对ADC系统的接受证明了这一点。
