As is the case with many hospitals and health systems across the US, Lakeland Regional Medical Center (LRMC) in Lakeland, Florida, relies significantly on automated dispensing cabinets (ADCs) to enable safe, expeditious medication distribution to our patients. At present, LRMC employs 97 ADCs in the hospital with six more scheduled for immediate installation. Since LRMC began adopting ADCs in 2000, their use has permeated every area of the hospital, from the 24 devices now housed in the ED to the specialty-equipped ADCs located in our surgery areas and cath labs, not to mention our general medical floors. The primary advantages of ADCs in our facility include significant time savings for nursing through fast and efficient dispensing functionality, maintenance of accurate inventory counts, and diversion minimization.
Although ADCs tend to be straightforward and user friendly, like all pharmacy automation, they require standardized and effective cleaning and maintenance activities in order to function as desired. This necessitates the establishment of roles and responsibilities, and a system by which to document any spills or other contamination of individual ADCs, as well as any breakdown or maintenance events. Appropriately used and maintained, ADC technology should provide years of quality performance.
Cleaning Responsibility and Scheduling
At LRMC, we employ designated pharmacy technicians who are responsible for delivering medications to and stocking the ADCs, as well as an ADC super-user technician who is our point person for any ADC issues. During the course of restocking, the pharmacy technician will perform a general review of the machine and alert the ADC technician to any major issues. The ADC technician maintains a master checklist to record when cleanings occur and whether there were any complications. In the event the ADC technician is called to address a problem with a specific ADC, a general cleaning will be performed at that time.
Although cleanings are performed as often as needed, each ADC is cleaned at least once a quarter when the ADC technician is optimizing stock. However, due to the fact that LRMC runs a 24/7 pharmacy operation, care must be taken that cleanings, whether scheduled or impromptu, take place at the convenience of nursing. Thus, scheduled cleanings are performed during off-peak hours; for impromptu cleanings, our technicians know to defer to the needs of nursing at all times.
Routine Cleaning and Maintenance
All keyboards and handheld scanners should be wiped down with an antibacterial solution during each cleaning. Many hospitals employ clear keyboard covers to prevent debris from falling between keys and to facilitate cleaning. Liquid medication spills are quite rare with ADCs, but if a liquid medication is spilled on or within an ADC, pharmacy should be notified for cleanup and to acknowledge the wasted medication.
Accounting for ADC cleanliness can easily be coupled with ADC stock optimization activities, as the contents and condition of each enclosure can be assessed at that time. Labels can be replaced and any dust or debris can be removed. During this same activity, it is important to check the status of back-up batteries. The ADC vendor can advise on the replacement periods for these batteries, but maintaining back-up power is essential in the event of an outage.
Repairs also are generally rare, but it is important to remain in contact with a vendor representative in the event of a malfunction. Many vendors offer maintenance contracts that cover the life cycle of the devices. Fortunately, we have experienced a quick turnaround on service calls with our ADC vendor; usually we can have a technician at our facility within 4 hours. That being said, it would be wise to establish a parts depot for basic elements (scanners, power cables, keyboards, etc). With our usage (almost 100 devices), invariably pieces go missing or need replacement. Also maintain a supply of extra bins, brackets, dividers, and drawers for your ADCs. As for the software, we keep a master information log for each cabinet’s display terminal for easy retrieval if the ADC is completely shut down and a new computer needs to be installed. As with other maintenance issues, our ADC technician manages ADC supplies.
LRMC is committed to utilizing the benefits of ADC technology in the foreseeable future. As our fleet grows, we will continue to expand our control over the integrity of the devices. Clean and well-maintained dispensing equipment provides the pharmacy—and the entire health care institution—with a safe and reliable method for fast and efficient medication distribution.
Alison Kagel, CPhT, has been a pharmacy technician at Lakeland Regional Medical Center in Lakeland, Florida, for almost 12 years. She is a nationally registered pharmacy technician through the Pharmacy Technician Certification Board.