Ed Platt reflects on Belfast Health and Social Care Trust’s recent research that demonstrates the benefits of introducing Omnicell automated dispensing cabinet to manage controlled drugs in hospital pharmacy.

Omnicell’s innovative solution drives significant efficiencies in patient safety, time savings, error reduction and staff satisfaction.

"The Omnicell team welcomes Belfast Health & Social Care Trust’s (BHSCT) recent study into the impact of installing a seven-cell Omnicell automated dispensing cabinet (ADC) for the safe management of controlled drugs in its pharmacy department at Royal Victoria Hospital (RVH). BHSCT is the largest integrated health and social care Trust in the UK, delivering care to approximately 340,000 Belfast citizens.

The use of ADCs to safely manage controlled drugs in hospital wards has had proven benefits on patient care and medication safety but BHSCT was keen to evaluate whether these benefits could be replicated in a hospital pharmacy. Though UK hospital pharmacies have sought to increase the use of robotic technology, they have less often been used to dispense controlled drugs due to difficulties in complying with legislative storage and record keeping requirements. As a result controlled drugs have often continued to be managed through traditional lock and key cupboards and paper ledgers for documentation.

As the Trust’s study states, ADCs utilise technology to increase efficiencies and effectiveness on hospital wards and reduce the rate and risk of adverse drug events. Through installing an Omnicell ADC within the central pharmacy, BHSCT aimed to establish whether the technology could improve medicine safety, increase efficiencies and improve the experience of staff delivering the service. The project hypothesis was that the installation of an ADC would see a reduction in controlled drug errors along with a decrease in dispensing times, which would be achieved by reconfiguring process steps. The report goes into great detail regarding the method for setting up this experiment. In total, 131 staff had received training on the ADC by the time of project Go-Live. The Omnicell ADC was then installed in November 2019. This is a pioneering study because BHSCT are the first Trust to install an ADC in a pharmacy in Northern Ireland.

To really understand the impact of installing an ADC, the BHSCT team collected various dispensing data during the pre-ADC period, which established some important findings. Analysis of the dispensing period revealed that there were five core steps in the preparation of a controlled drug item:

• Labelling
• Assembly 
• Product release 
• CD register entry 
• CD stock check verification

Prior to the installation of the ADC, it was found that the average time to dispense a controlled drug medication was 6 minutes and 18 seconds.

There are two distinct dispensing processes for controlled drugs within the pharmacy: items required for ward stock replenishment (typical supply is an original pack); and supply for discharge prescriptions, which must be the exact quantity for seven days as per regional policy. The average length of time to dispense an original pack of a controlled drug for ward stock was 5 minutes and 47 seconds. The average length of time to dispense a 7-day supply of a controlled drug was 8 minutes and 12 seconds due the additional steps of packing down into individually labelled containers. Analysis of the individual dispensing steps found that 43% of the total time was required to complete the controlled drug register entry and verify stock balance.

Three weeks after installing the ADC, more dispensing data was collected and the positive impact of Omnicell’s technology was immediately recognised. The innovative solution reduced the number of steps in the dispensing process from five to four, that is:

• Labelling 
• ADC input (formerly CD register and stock check verification)
• Assembly 
• Product release

As a result, there was a massive reduction in average time taken to dispense a controlled drug to just 2 minutes and 41 seconds (a reduction of 57%). The average time required to dispense a controlled drug for ward stock was 2 minutes and 8 seconds, which is a 63% reduction in dispensing time. The time taken to dispense a discharge item was on average of 3 minutes and 35 seconds, a reduction of 56%. It is so encouraging to see this data showing that switching from a paper-controlled drug register to an ADC is significant in terms of efficiency gains. Further analysis of the dispensing steps using Omnicell’s ADC found on average 36 seconds per transaction was saved during the selection and assembly phase. This can be attributed to our ADC technology, which uses a series of guiding lights to direct the dispenser to the required locked bin location. 

The primary objective of BHSCT’s project was medication safety and therefore patient safety; the layout of the ADC was enhanced to optimise risk minimisation strategies, this included configuring all controlled drug items to individual bins or zones. Omnicell was proud to supply this ADC system to RVH Pharmacy, the first in the UK to implement this design approach.

There was also a significant reduction in the number of controlled drug-related errors. In the pre-ADC period, an error rate of 24 errors per 1000 items dispensed was calculated; analysis of the errors recorded found that 82% were attributed to documentation, subtraction errors in running balance or omitted entries. It took 135 minutes to correct the documentation errors. In the period immediately following implementation of the ADC, the electronic controlled drug register was reviewed and an error rate of 9 errors per 1000 items dispensed was calculated. The errors recorded were only categorised as operational, for example, wrong quantity selected on pharmacy dispensing system or counting errors. These errors were communicated to the team and operating protocols were revised to ensure staff were clear on management of procedural issues. The interface between the pharmacy dispensing system and electronic controlled drug register eliminated previously noted documentation errors. 

The BHSCT extended hours seven-day pharmacy service is delivered by the RVH Pharmacy department with staff from four pharmacy departments contributing to the weekend and evening rotas. The study finds that prior to the implementation of the ADC staff reported that controlled drug tasks were difficult and stressful particularly at weekends. Contributing factors were a high-volume workload, and range and complexity of controlled drug dispensing, which led to documentation and discrepancy errors. There was staff dissatisfaction with the manual dispensing process and recognition of the potential risk of picking the wrong injection, including incorrect ampoule size or strength. All of these factors influenced the department’s ability to achieve key performance targets for dispensing times. 

Following implementation of Omnicell’s ADC, staff reported liking the layout of the cabinet, noting it was easy to use and felt safer as every item had a specific location within the cabinet. There was huge satisfaction that paper registers were no longer required. Encouragingly, staff perceptions were that the ADC enables them to perform their duties more safely and accurately.

Omnicell is proud to be part of a project that has achieved its aim of demonstrating how ADC technology can safely and effectively manage the dispensation of controlled drugs in a hospital pharmacy. Approximately 1,200 controlled drug items are dispensed each month in RVH pharmacy, meaning that the ADC is contributing to dispensing time savings of 67.3 hours per month or 808 hours per year. This is overwhelmingly positive because it allows the release of staff to other duties including face-to-face patient care.

We are heartened to see such a significant positive return on investment from BHSCT’s study, with more staff being trained on how to use the ADC and a future plan already being laid out to install controlled drug ADCs in all hospital pharmacies in the Trust. Omnicell is always delighted to work with likeminded partners who share a vision for improving patient safety, increasing efficiencies and reducing staff stress levels through innovative technological solutions."