title: An automated dispensing system for improving medication timing in the emergency department.
abstract: BACKGROUND
  Numerous medical conditions require timely medication administration in the emergency department (ED). Automated dispensing systems (ADSs) store premixed common doses at the point-of-care to minimize time to administration, but the use of such automation to improved time to medication administration has not been studied. Since vancomycin is a commonly used empiric antimicrobial, we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the ED. The study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing appropriateness.
  
  
  METHODS
  The institional review board approved the retrospective quality improvement study took place in a single, urban academic tertiary care ED with an annual census of 80 000. Study subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30, 2008 and the same time period in 2009. The primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing appropriateness.
  
  
  RESULTS
  Sixty-three patients had weight and dosing information available (29 before and 34 after intervention) and were included in the study. Before intervention, no patient received vancomycin in less than 60 minutes, while after intervention 14.7% of the patients received it in less than 60 minutes (difference in proportions 14.7%, 95% CI 0.39%-30.0%,P=0.04). A similar proportion of the patients received correct dosing before and after intervention (44.8% vs. 41.2%, difference in proportions 3.7%, 95% CI -20.0%-26.7%,P=0.770).
  
  
  CONCLUSIONS
  The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ward
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Boyd
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Harger
authors.forename: John M
authors.initials: JM
authors.lastname: Deledda
authors.forename: Carol L
authors.initials: CL
authors.lastname: Smith
authors.forename: Susan M
authors.initials: SM
authors.lastname: Walker
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Hice
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Wright
keywords: Automatic dispensing system; Efficiency; Pharmaceutical; Process improvement