Identify which automated dispensing cabinet (ADC) best meets the needs of your hospital.
Seven years ago, Wyoming Medical Center (WMC), a 200-bed hospital in Casper, Wyoming, switched ADC vendors. Three ADC vendors were invited to submit proposals that included their best pricing options, and each provided a demonstration of their ADC. Our primary focus in evaluating vendors was the level of service they were able to provide in our area. Because our facility is located in a rural environment, when ADCs were down and required repair, it was not uncommon for the vendor’s maintenance representative to be hundreds of miles away and therefore unable to provide service on a timely basis. Too often, a cabinet would be down for a day or more, which significantly affected workflow and had the potential to impact patient safety as well. Because we use ADCs to store 99% of our doses, ensuring they are in working order is a high priority.
Additional considerations in choosing a new ADC included ensuring robust reporting capabilities and sufficient data storage capacity. The new ADCs permit enhanced reporting, which has helped us improve efficiencies and provided data to support our requests for additional staff. For example, one way we justify our staffing is by demonstrating that we have reduced drug costs. With most doses housed in ADCs, we use the reports to streamline inventory levels and turnover. The resulting increases in inventory turns have led directly to cost savings. Moreover, the new ADCs offer longer data storage capacity. With our previous configuration, we were required to back up our data on a daily basis; the new ADCs are designed to store years of data with no daily backup required.
In the selection process, medication safety and security also were reviewed. The new ADCs utilize lights to guide nurses to the appropriate medication and prevent the selection of the wrong drug. To further increase safety, it is important to eliminate the use of open matrix drawers that can increase the chance of picking errors; no open matrix drawers are permitted at WMC. Finally, the new ADCs utilize bar code scanning upon stocking, which has significantly improved our stocking accuracy rate. Since implementing the new ADCs seven years ago, we have not had any ADC mis-fills. The Institute for Safe Medication Practices and the American Society of Health-System Pharmacists both recommend medications be scanned prior to stocking the ADCs to ensure the right drug and dose are placed in the right pocket.
Develop a cleaning process for ADCs.
Regular ADC cleaning is an important component of ensuring safe ADC use. At WMC, both housekeeping staff and pharmacy technicians clean ADCs. Regardless of who is assigned to clean the ADCs, it is vital that these staff members are properly trained. Training is provided by the pharmacy informatics coordinator and a senior technician. Essential components of the cleaning process include:
Implement an effective ADC maintenance and repair strategy.
Consider a Shared Services Contract
As a rural facility, ensuring timely service when an ADC requires maintenance can be challenging. Rather than relying on a vendor to maintain and troubleshoot our cabinets, when we switched vendors we negotiated a shared services contract with our new vendor. Upon implementing the cabinets, two of our staff members flew to the vendor’s headquarters and received extensive training on how to troubleshoot and maintain the cabinets in-house. Thereafter, we trained all of our pharmacy technicians to troubleshoot and perform routine maintenance. We found that no special skills were required to maintain the ADCs beyond the initial training.
The obvious benefit to this approach is that we do not need to outlay the significant costs associated with a maintenance contract. If a repair is required that we cannot perform ourselves, we would pay the vendor to come to our facility and service the ADC; however, in the past seven years we have yet to encounter a problem we could not solve in-house. One of our senior technicians developed step-by-step picture guides for the technicians to use when repairing the ADCs, and these have proved particularly helpful. In addition, our shared services contract includes access to a 24-hour phone helpline that we can call for assistance with any repair. Utilizing this service has been especially useful when we have exhausted all repair options in-house; the service representative has been able to guide us through all necessary procedures over the phone.
Maintain an ADC Spare Parts Depot
In order to properly service and maintain our ADCs in-house, it is crucial that we are able to replace parts on a timely basis. Therefore, we made the decision to develop an on-site ADC spare parts depot. We now have a replacement part in-house for every ADC component that may require replacement, as well as multiple parts of the most commonly replaced items. The most common replacements typically involve simple drawer swaps and PC box repairs. If more complex repairs are required—for example, addressing a computer malfunction—we will set aside time to complete the repair.
Maintaining an active relationship with our service and sales representative has been instrumental in keeping our parts depot well stocked. The depot inventory is managed using a spreadsheet that tracks repair cases and service concerns. Every time a repair occurs, we record the issue, which vendor representative was contacted and notified about the repair, what repairs were made, any parts that were used and then reordered for restock, and the final resolution. Once the new part comes in, we restock it, ship the faulty part back to the vendor, and mark the case closed on the spreadsheet.
Ensure Staff Buy-in
Initially, when we implemented this model, there was some resistance from technicians who believed that the additional repair and maintenance duties would be time-prohibitive. However, as our in-house ADC repair expertise grew, the technicians began to enjoy these tasks and found sufficient time to complete them. The benefits of utilizing a shared service contract and implementing an on-site ADC parts depot have been threefold: we have reduced costs by performing our own repairs, our in-house ADC knowledge and expertise has increased, and all required repairs are performed in a timely manner.
Ronald A. Maxwell, PharmD, is the pharmacy informatics coordinator at Wyoming Medical Center in Casper, Wyoming. He received his PharmD from the University of Wyoming in 2000. Ronald’s professional interests include using pharmacy informatics to improve safe medication processes and drug utilization evaluation.