Introducing Unit Dose Dispensing in a University Hospital – Effects on Medication Safety and Dispensing Time

Hanne Katriina Ahtiainen,1,2 Carita Lindén-Lahti,1,2 Susanna Heininen,1 Anna-Riia Holmström,1 Lotta Schepel2,3 1Faculty of Pharmacy, University of Helsinki, Helsinki, Finland; 2HUS Pharmacy, Helsinki University Hospital, Helsinki, Finland; 3Quality and Patient Safety Unit, Joint Resources, Helsinki University Hospital, Helsinki, FinlandCorrespondence: Hanne Katriina Ahtiainen, 00014 University of Helsinki, PL 56 (Viikinkaari 5), Helsinki, Finland, Email [email protected]: Unit dose (UD) medications reduce manual steps in the medication management and use process and enable electronic documentation by barcode scanning. This study aimed to explore the effects of introduced unit doses on medication safety and time spent on medication dispensing.Patients and Methods: Direct before-and-after observations were conducted in an inpatient internal medicine ward at Helsinki University Hospital. The prevalence of medication and procedural errors and time nurses spent dispensing medications at patient-specific doses were observed 10 weekdays before and after introducing unit doses of selected medications. To complement the observations, a separate survey was used to investigate nurses’ perceptions of medication dispensing. Quantitative analysis was performed.Results: During the observations, medications were dispensed for 208 patients (n=1359 medications) before and 221 patients (n = 1171) after introducing unit doses. After UD implementation, 45.3% (n=530/1171) of the medications were dispensed as UDs. Medication and procedural errors were reduced (from 3.2% to 1.7% and 37.4% to 13.9%, respectively; p< 0.05). Barcode scanning-related problems decreased from 21.4% to 1.8% (p< 0.05) after implementation. The unit doses did not change the median time used to dispense medications to the patient, although the time used to dispense a single medication increased. In the survey, nurses reported improvements in barcode scanning but also indicated problems with handling unit doses and were worried about increased plastic waste.Conclusion: Piloted unit doses decreased medication and procedural errors. Barcode scanning improved, which supported electronic closed-loop medication management in the study hospital. Unit doses in a fully automated process should be further studied for their effects on the dispensing time. In addition, controlling the amount of plastic waste in the unit dose dispensing should be considered.Keywords: medication error, unit dose, automation, barcode scanning, medication systems, hospital, drug dispensing