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Automated Dispensing Cabinet Optimization in a Level 2 Trauma Center

Introduction
Opportunities have been identified regarding timely delivery of medications due to lack of ADC inventory related to stock outs or other variances in pharmacy workflow (i.e. compounding and distribution times). These opportunities for improvement impact patient care and result in both nursing and pharmacy staff frustration. Additionally, there are significant costs associated with unused medications stored in ADCs, taking up valuable real estate that would otherwise house more opportune inventory. This situation has created a need for more efficient management of the ADC inventory. Currently, research in the topic area is sparse. We hypothesize that the systematic management and oversight of ADC inventory will demonstrate a significant improvement in key performance indicators and provide insight to the current gaps in knowledge.
Methods
This study will be a continuous quality improvement project with a combination of retrospective data review and prospective optimization interventions of automated dispensing cabinets (Pyxis®). Interventions include review and adjustment of ADC par levels, removal of unused/stagnate medications, standardization of stock, and continual review of ADC inventory turns and associated optimization opportunities. The primary outcomes are the change in vend/fill ratio from baseline, change in medication stockout percentage from baseline.
Results
There was no significant difference in vend/fill ratio after the optimization phase compared with baseline [Difference 0.13 (11.56 ± 6.1 vs. 11.43 ± 5.41) respectively, (p=0.84)]. Medication stockout percentage was also found to be similar with baseline [Difference -0.05 (0.71% ± 0.12 vs. 0.76% ± 0.08) respectively, (p=0.37)]. For secondary outcomes, the change in blind stockout percentage from baseline was -0.04 [0.13 ± 0.02 vs. 0.17 ± 0.02, (p=0.004)] and the change in medications dispensed per day from baseline was 317 [2656 ± 143 vs. 2339 ± 200, (p=0.0002)].
Conclusion
Optimization of automated dispensing cabinets yielded marginal improvements in vend/fill ratio and stockout percentage and significantly improved overall efficiency through an increase in the number of medications stocked in ADCs and number of medications dispensed per day from ADCs. Evaluation of more clinically significant performance indicators may better characterize the benefits from the optimization process.