title: Effects of a direct refill program for automated dispensing cabinets on medication-refill errors.
abstract: OBJECTIVE
  The effects of a direct refill program for automated dispensing cabinets (ADCs) on medication-refill errors were studied.
  
  
  METHODS
  This study was conducted in designated acute care areas of a 386-bed academic medical center. A wholesaler-to-ADC direct refill program, consisting of prepackaged delivery of medications and bar-code-assisted ADC refilling, was implemented in the inpatient pharmacy of the medical center in September 2009. Medication-refill errors in 26 ADCs from the general medicine units, the infant special care unit, the surgical and burn intensive care units, and intermediate units were assessed before and after the implementation of this program. Medication-refill errors were defined as an ADC pocket containing the wrong drug, wrong strength, or wrong dosage form.
  
  
  RESULTS
  ADC refill errors decreased by 77%, from 62 errors per 6829 refilled pockets (0.91%) to 8 errors per 3855 refilled pockets (0.21%) (p < 0.0001). The predominant error type detected before the intervention was the incorrect medication (wrong drug, wrong strength, or wrong dosage form) in the ADC pocket. Of the 54 incorrect medications found before the intervention, 38 (70%) were loaded in a multiple-drug drawer. After the implementation of the new refill process, 3 of the 5 incorrect medications were loaded in a multiple-drug drawer. There were 3 instances of expired medications before and only 1 expired medication after implementation of the program.
  
  
  CONCLUSIONS
  A redesign of the ADC refill process using a wholesaler-to-ADC direct refill program that included delivery of prepackaged medication and bar-code-assisted refill significantly decreased the occurrence of ADC refill errors.
authors.affiliation: Department of Pharmacy, St. Jansdal Hospital, Postbus 138, 3840 AC Harderwijk, The Netherlands pieter.helmons@gmail.com
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Helmons
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Dalton
authors.forename: Charles E
authors.initials: CE
authors.lastname: Daniels
mesh_terms: D000046:Academic Medical Centers; D001331:Automation; D004349:Drug Packaging; D004356:Drug Storage; D064420:Drug-Related Side Effects and Adverse Reactions; D001330:Electronic Data Processing; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000737:chemistry; D010607:Pharmacy Service, Hospital / Q000379:methods* / Q000592:standards
chemical_list: D004364:Pharmaceutical Preparations