Automatic dispensing cabinets and governance of controlled drugs: an exploratory study in an intensive care unit
Open accessAbstract
BACKGROUND: Governance of controlled drugs (CDs) in hospitals is resource intensive but important for patient safety and policy compliance. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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The safety concerns identified can be addressed through effective models of training, continuous cycles of optimisation, and improved monitoring through report utilisation.
“All these concerns can be addressed through effective models of training, continuous cycles of optimisation and improved monitoring through report utilisation.10,34,43”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [34]
The Results (Monitoring; page unavailable) describe pharmacists using ADC reports to monitor controlled-drug discrepancies, and the Methods (Observations; page unavailable) document nurse training. The Discussion (page unavailable) describes monitoring and resolving discrepancies as ongoing. The paper does not establish that effective training models and continuous optimisation cycles can address all the safety concerns identified, so the sentence overstates its findings. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe time taken for nurses to undertake CD counts was perceived to have reduced significantly, however, this was not quantified.
“The time taken for nurses to undertake CD counts was perceived to have reduced significantly, however, this was not quantified.34”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [34]
Challenges associated with inventory management of medicines requiring special storage requirements have been described in published literature.
“Challenges associated with inventory management of medicines which require special storage requirements have been described in published literature.”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [34]
Nurses and pharmacists perceived ADCs to be beneficial in controlled drug safeguarding, documentation, monitoring, and reporting.
“Benefits regarding CD governance was observed as well, where nurses and pharmacists perceived ADCs to be beneficial in CD safeguarding, documentation, monitoring, and reporting.34”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [34]
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Jung, Y. Y., Walsh, Á., Patel, J., & Lai, K. (2025) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2025.100599 · Cited by 7 · see citing works
“10,34,43 Safety concerns associated with the unnecessary use of override functions was a key concern.”
- Authors
- Lichtner, V., Prgomet, M., Gates, P., & Franklin, B. D.
- Affiliations
- University of Leeds (GB)
- Macquarie University (AU)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Lichtner, Valentina
- Venue
- European Journal of Hospital Pharmacy
- Publisher
- BMJ
- Published
- 2021-05-11
- Volume
- 30
- Issue
- 1
- Pages
- 17-23
- ISSN
- 2047-9956 (ISSN-L)
- 2047-9964
- PMC
- PMC9811539
- OpenAlex
- W3162284770
- Cited by
- 15
- References
- 0
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 3
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Hospital Pharmacy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Health and Medical Research Council (APP1094878: 2015-2020)
- H2020 Marie Skłodowska-Curie Actions (740131)
- 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 › Health Professions › Occupational Therapy › Safe Handling of Antineoplastic Drugs
- Keywords
- controlled substances, automated dispensing cabinets, intensive care unit, children's hospitals, drug safety, access control, medication documentation, electronic alerts, workarounds
- MeSH terms
- Child, Hospitals, Humans, Intensive Care Units, Medication Systems, Hospital, Pharmacy Service, Hospital, Patient Safety
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