Safety, time and cost evaluation of automated and semi-automated drug distribution systems in hospitals: a systematic review
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OBJECTIVES: To systematically review automated and semi-automated drug distribution systems (DDSs) in hospitals and to evaluate their effectiveness on medication safety, time and costs of medication care. METHODS: A systematic literature search was conducted in MEDLINE Ovid, Scopus, CINAHL and EMB Reviews covering the period 2005 to May 2016. Studies were included if they (1) concerned technologies used in the drug distribution and administration process in acute care hospitals and (2) reported medication safety, time and cost-related outcomes. RESULTS: Key outcomes, conclusions and recommendations of the included studies (n=30) were categorised according to the dispensing method: decentralised (n=19 studies), centralised (n=6) or hybrid system (n=5). Patient safety improved (n=27) with automation, and reduction in medication errors was found in all three systems. Centralised and decentralised systems were reported to support clinical pharmacy practice in hospitals. The impact of the medication distribution system on time allocation such as labour time, staffing workload or changes in work process was explored in the majority of studies (n=24). Six studies explored economic outcomes. CONCLUSIONS: No medication distribution system was found to be better than another in terms of outcomes assessed in the studies included in the systematic review. All DDSs improved medication safety and quality of care, mainly by decreasing medication errors. However, many error types still remained-for example, prescribing errors. Centralised and hybrid systems saved more time than a decentralised system. Costs of medication care were reduced in decentralised systems mainly in high-expense units. However, no evidence was shown that implementation of decentralised systems in small units would save costs. More comparable evidence on the benefits and costs of decentralised and hybrid systems should be available. Changes in processes due to a new DDS may create new medication safety risks; to minimise these risks, training and reallocation of staff resources are needed.
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Benefits in cost saving were observed from reduced ward stock supply and annual spend on expired medicines, decreased stockouts, and decreased stock orders from central pharmacy.
“Benefits in cost saving were observed from reduced ward stock supply and annual spend on expired medicines, decreased stockouts, and decreased stock orders from central pharmacy [8,9,19,37,38,56,63].”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [8]
The review reports smaller ward storage, reduced expired-drug waste (Other outcomes; Other Medication storage), and some savings from lower drug-storage costs (effects of drug distribution systems on costs of care). Our copy does not report reduced annual spending on expired medicines, fewer stockouts, or fewer stock orders from the central pharmacy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAs a result of ADC implementation, pharmacy staff reported more time available for clinical activities, leading to an improvement in the overall quality of care delivered to patients.
“As a result of ADC implementation pharmacy staff reported more time available for clinical activities, leading to an improvement in the overall quality of care delivered to patients.8,23,27,28,32,52,54”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [8]
While there were reduced errors, changes in procedures and systems may incur a new set of risks.
“It was highlighted that while there were reduced errors, changes in procedures and systems may incur a new set of risks.8,15”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [8]
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References 58 · Cited by 78
Research works printed but not linked: 49
- Rochais É, Atkinson S, Bussières J-F. Nursing perception of the impact of medication carts on patient safety and ergonomics in a teaching health care center. J Pharm Pract 2013;26:131-7. · DOI
- Cottney A. Improving the safety and efficiency of nurse medication rounds through the introduction of an automated dispensing cabinet. BMJ Qual Improv Rep 2014;3:1-4. · DOI · Paper page
- Jiménez Muñoz AB, Muiño Miguez A, Rodriguez Pérez MP, et al. Comparison of medication error rates and clinical effects in three medication prescription- dispensation systems. Int J Health Care Qual Assur 2011;24:238-48. · DOI
- Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med 2010;362:1698-707. · DOI
- Paoletti RD, Suess TM, Lesko MG, et al. Using bar-code technology and medication observation methodology for safer medication administration. Am J Health Syst Pharm 2007;64:536-43. · DOI
- Bates DW, Cullen DJ, Laird DJ. Incidence of adverse drug events and potential adverse drug events. JAMA 1995;274:29-34. · DOI · Paper page
- Leape LL, Bates DW, Cullen DW. Systems analysis of adverse drug events. JAMA 1995;274:35-43. · DOI · Paper page
- Rodriguez-Gonzalez CG, Martin-Barbero ML, Herranz-Alonso A, et al. Use of failure mode, effect and criticality analysis to improve safety in the medication administration process. J Eval Clin Pract 2015;21:549-59. · DOI
- Aspden P, Wolcott JA, Bootman JL, et al. Preventing medication errors. Washington, DC: The National Academies Press, 2007: 1-141.
- Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2008. Am J Health Syst Pharm 2009;66:926-46. · DOI
- Anacleto TA, Perini E, Rosa MB, et al. Medication errors and drug-dispensing systems in a hospital pharmacy. Clinics 2005;60:325-32. · DOI
- Pepper GA. Errors in drug administration by nurses. Am J Health Syst Pharm 1995;52:390-5. · DOI
- Chapuis C, Roustit M, Bal G, et al. Automated drug dispensing system reduces medication errors in an intensive care setting. Crit Care Med 2010;38:2275-81. · DOI
- Tsao NW, Lo C, Babich M, et al. Decentralized automated dispensing devices: systematic review of clinical and economic impacts in hospitals. Can J Hosp Pharm 2014;67:138-48. · DOI · Paper page
- Hawkins B. ASHP guidelines on the safe use of automated dispensing devices. Am J Health Syst Pharm 2010;67:483-90. · DOI
- Zaidan M, Rustom F, Kassem N, et al. Nurses' perceptions of and satisfaction with the use of automated dispensing cabinets at the heart and cancer centers in Qatar: a cross-sectional study. BMC Nurs 2016;15. · DOI
- Acheampong F, Anto BP, Koffuor GA. Medication safety strategies in hospitals--a systematic review. Int J Risk Saf Med 2014;26:117-31. · DOI
- Gray JP, Ludwig B, Temple J, et al. Comparison of a hybrid medication distribution system to simulated decentralized distribution models. Am J Health Syst Pharm 2013;70:1322-35. · DOI
- Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9. · DOI · Paper page
- Lahtela A, Jylhä V, Saranto K. Effects of automated dose-dispensing system on medication management process. 3rd International Conference on Advances in Human-Oriented Personalized Mechanisms, Technologies and Services, Nice, 2010:56-60.
- Ardern-Jones J, Hughes DK, Rowe PH, et al. Attitudes and opinions of nursing and medical staff regarding the supply and storage of medicinal products before and after the installation of a drawer-based automated stock-control system. Int J Pharm Pract 2009;17:95-9. · DOI
- Balka E, Kahnamoui N, Nutland K. Who is in charge of patient safety? Work practice, work processes and utopian views of automatic drug dispensing systems. Int J Med Inform 2007;76(Suppl 1):S48-S57. · DOI · Paper page
- Barber N, Cornford T, Klecun E. Qualitative evaluation of an electronic prescribing and administration system. Qual Saf Health Care 2007;16:271-8. · DOI
- Chapuis C, Bedouch P, Detavernier M, et al. Automated drug dispensing systems in the intensive care unit: a financial analysis. Crit Care 2015;19. · DOI · Paper page
- Cousein E, Mareville J, Lerooy A, et al. Effect of automated drug distribution systems on medication error rates in a short-stay geriatric unit. J Eval Clin Pract 2014;20:678-84. · DOI · Paper page
- Dib JG, Abdulmohsin SA, Farooki MU, et al. Effects of an automated drug dispensing system on medication adverse event occurrences and cost containment at SAMSO. Hosp Pharm 2006;41:1180-5. · DOI
- Dussart C, Dussart S, Almeras D, et al. Assessing user satisfaction and hospital pharmacy practice: application to an individualized dispensing system in a French military teaching hospital. J Eval Clin Pract 2009;15:252-6. · DOI
- Fanning L, Jones N, Manias E. Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study. J Eval Clin Pract 2016;22:156-63. · DOI
- Franklin BD, O'Grady K, Donyai P, et al. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study. Qual Saf Health Care 2007;16:279-84. · DOI
- Franklin BD, Jacklin A, Barber N. The impact of an electronic prescribing and administration system on the safety and quality of medication administration. Int J Pharm Pract 2008;16:375-9. · DOI
- Hull T, Czirr L, Wilson M. Impact of medication storage cabinets on efficient delivery of medication and employee frustration. J Nurs Care Qual 2010;25:352-7. · DOI · Paper page
- Lathrop K, Lund J, Ludwig B, et al. Design, implementation, and evaluation of a thrice- daily cartfill process. Am J Health Syst Pharm 2014;71:1112-9. · DOI
- Oldland AR, Golightly LK, May SK, et al. Electronic inventory systems and barcode technology: impact on pharmacy technical accuracy and error liability. Hosp Pharm 2015;50:34-41. · DOI
- Rochais E, Atkinson S, Guilbeault M, et al. Nursing perception of the impact of automated dispensing cabinets on patient safety and ergonomics in a teaching health care center. J Pharm Pract 2014;27:150-7. · DOI
- Rodriguez-Gonzalez CG, Herranz-Alonso A, Martin-Barbero ML, et al. Prevalence of medication administration errors in two medical units with automated prescription and dispensing. J Am Med Inform Assoc 2012;19:72-8. · DOI
- Roman C, Poole S, Walker C, et al. A 'time and motion' evaluation of automated dispensing machines in the emergency department. Australas Emerg Nurs J 2016;19:112-7. · DOI · Paper page
- Romero AV, Malone DC. Accuracy of adverse-drug-event reports collected using an automated dispensing system. Am J Health Syst Pharm 2005;62:1375-80. · DOI
- Skibinski KA, White BA, Lin LI-K, et al. Effects of technological interventions on the safety of a medication-use system. Am J Health Syst Pharm 2007;64:90-6. on August 20, 2023 by guest. Protected by copyright. http://ejhp.bmj.com/ Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2018-001791 on 19 March 2019. Downloaded from Systematic review 40 · DOI
- Temple J, Ludwig B. Implementation and evaluation of carousel dispensing technology in a university medical center pharmacy. Am J Health Syst Pharm 2010;67:821-9. · DOI
- Al Adham M, Abu Hamad B. Drug dispensing systems in Gaza hospitals: a comparative study. East Mediterr Health J 2011;17:722-9. · DOI
- Risør BW, Lisby M, Sørensen J. Complex automated medication systems reduce medication administration errors in a Danish acute medical unit. Int J Qual Health Care 2018;30:457-65. · DOI
- Risør BW, Lisby M, Sørensen J. Comparative cost-effectiveness analysis of three different automated medication systems implemented in a Danish hospital setting. Appl Health Econ Health Policy 2018;16:91-106. · DOI
- Noparatayaporn P, Sakulbumrungsil R, Thaweethamcharoen T, et al. Comparison on human resource requirement between manual and automated dispensing systems. Value Health Reg Issues 2017;12:107-11. 50. · DOI
- de-Carvalho D, Alvim-Borges JL, Toscano CM. Impact assessment of an automated drug-dispensing system in a tertiary hospital. Clinics 2017;72:629-36. 47. · DOI · Paper page
- Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration--2014. Am J Health Syst Pharm 2015;72:1119-37. · DOI
- McLeod M, Ahmed Z, Barber N, et al. A national survey of inpatient medication systems in English NHS hospitals. BMC Health Serv Res 2014;14:1-11. · DOI
- Kohn LT, Corrigan JM, Molla S. To err is human: building a safer health system. Washington, DC: National Academy Press, 2010: 50-104.
- Helmons PJ, Dalton AJ, Daniels CE. Effects of a direct refill program for automated dispensing cabinets on medication-refill errors. Am J Health Syst Pharm 2012;69:1659-64. · DOI
- European Directorate for the Quality of Medicines & HealthCare (EDQM). Automated dose dispensing (ADD). Guidelines on best practice for the ADD process, and care and safety of patients, 2018. Available: https://www. edqm. eu/ en/ news/ new-automated- dose-dispensing-add-guidelines on August 20, 2023 by guest. Protected by copyright. http://ejhp.bmj.com/ Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2018-001791 on 19 March 2019. Downloaded from
- Authors
- Ahtiainen, H. K., Kallio, M. M., Airaksinen, M., & Holmström, A.-R.
- Affiliations
- University of Helsinki (FI)
- Helsinki University Hospital (FI)
- Corresponding author
- Ahtiainen, Hanne Katriina
- Venue
- European Journal of Hospital Pharmacy
- Publisher
- BMJ
- Published
- 2019-03-19
- Volume
- 27
- Issue
- 5
- Pages
- 253-262
- ISSN
- 2047-9956 (ISSN-L)
- 2047-9964
- PMC
- PMC7447254
- OpenAlex
- W2924256545
- Cited by
- 78
- References
- 58
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 15 · 2023: 16 · 2022: 7 · 2021: 13 · 2020: 4 · 2019: 1
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Hospital Pharmacy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- drug safety, medication errors, timing of drug administration, prescribing errors, clinical pharmacy, hospital pharmacy automation
- MeSH terms
- Automation, Cost-Benefit Analysis, Pharmaceutical Preparations, Humans, Medication Errors, Medication Systems, Hospital, Pharmacy Service, Hospital, Quality of Health Care, Time Factors, Patient Safety
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