Impact assessment of an automated drug-dispensing system in a tertiary hospital
Open accessAbstract
OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.
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Savings were calculated according to mean gross salary and reported as follows: full-time nurse (R$ 5869; USD 2523), administrative/hospitality assistant (R$ 1598; USD 687), materials supervisor (R$ 3526; USD 1516), and pharmacy assistant (R$ 1710; USD 735) per year during the first year after introducing the ADC.
“Savings were calculated according to mean gross salary and reported as follows: full-time nurse (R$ 5869; USD 2523), administrative/hospitality assistant (R$ 1598; USD 687), materials supervisor (R$ 3526; USD 1516), and pharmacy assistant (R$ 1710; USD 735) per year during the first year after introducing the ADC.23”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [23]
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Experimental — accuracy not yet measuredDe-Carvalho et al. reported a reduction in nursing time spent on stock inventory counting with 6 h saved daily post-ADC implementation.
“De-Carvalho et al. reported a reduction in nursing time spent on stock inventory counting with 6 h saved daily post-ADC implementation.23”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [23]
The Results section (Healthcare professional time; page unavailable) reports that nurses spent significantly less time on drug inventory activities after implementation. It reports 6.5 work hours saved per day overall, across professional groups—not 6 hours of nursing time saved on stock inventory counting. (LLM, conf=0.90)
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 [23]
The Discussion (page unavailable) says automated dispensing provides pharmacists more time for clinical work, and the Introduction describes a potential benefit to patient care. But this study measured work time rather than pharmacy staff reports, and it does not establish that the overall quality of care delivered to patients improved. (LLM, conf=0.86)
Experimental — accuracy not yet measuredChallenges 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 [23]
The Methods > Intervention passage says controlled drugs were kept in lockable drawers and describes inventory adjustments caused by how peripheral stock was managed. It does not specifically identify inventory-management challenges for medicines requiring special storage, so the claim is more specific than the paper's account. No page number is available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBenefits in cost savings were also described as a reduction in staffing costs.
“Benefits in cost savings were also described as a reduction in staffing costs [13,23,38,54,59,63].”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [23]
This was explained as a redistribution of time, where time spent by nurses and administrative assistants on medication related activities decreased; however, it was noted that the time spent on stock refill and inventory activities performed by pharmacy assistants increased.
“This was explained as a redistribution of time, where time spent by nurses and administrative assistants on medication related activities decreased; however, it was noted that the time spent on stock refill and inventory activities performed by pharmacy assistants increased.23”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [23]
New activities and associated tasks arise from the use of ADCs.
“it is essential that organisations understand that new activities and associated tasks also arise from the use of ADCs.”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [23]
Tasks shown to take more time post-ADC implementation include item refilling and reorganising stock inventory (undertaken by pharmacy staff) and retrieval of items causing nursing queues at the cabinet.
“The types of tasks which have been shown to take more time post ADC implementation included item spent refilling and reorganising stock inventory; both of which are undertaken by pharmacy staff,23 and retrieval of items causing nursing queues at the cabinet.22”
From Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review (2025) · cites this paper as [23]
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Cites
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Cited by
Sorted by citations
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
“29 The types of tasks which have been shown to take more time post ADC implementation included item spent refilling and reor-ganising stock inventory; both of which are undertaken by pharmacy staff, 23 and retrieval of items causing nursing queues at the cabinet.”
Influential
- Authors
- de-Carvalho, D., Alvim-Borges, J. L., & Toscano, C. M.
- Affiliations
- Hospital Sírio-Libanês (BR)
- Corresponding author
- Alvim-Borges, José Luiz
- Venue
- Clinics
- Publisher
- Elsevier BV
- Published
- 2017
- Volume
- 72
- Issue
- 10
- Pages
- 629-636
- ISSN
- 1807-5932 (ISSN-L)
- PMC
- PMC5666447
- OpenAlex
- W2768668763
- Cited by
- 31
- References
- 1
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 5 · 2019: 2 · 2018: 1
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Occupational Therapy › Safe Handling of Antineoplastic Drugs
- Keywords
- automated drug dispensing, automated dispensing cabinets, patient safety, medication errors, cost analysis, intensive care unit, hospital pharmacy, nursing workload, pharmacy assistants, investment payback, tertiary care hospital
- MeSH terms
- Brazil, Cost-Benefit Analysis, Equipment and Supplies, Hospital, Humans, Intensive Care Units, Medication Systems, Hospital, Pharmacy Service, Hospital, Retrospective Studies, Time Factors, Reproducibility of Results, Health Care Costs, Tertiary Care Centers
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