Automated dispensing cabinets [ADCs], such as Pyxis systems, are the most widely used medication safety technology. Automated dispensing cabinets are medication distribution systems with technology integration that enable multiple functions such as computerized dispensing, inventory control, computerized order entry, barcoded medication administration, and documentation. ADCs have been established in hospitals throughout the United States and are now the gold standard for medication administration and have improved the medication administration process. The cabinets contain secure medication bins that allow nurses to access medication at the point of care. Medication bins within the cabinets are refilled daily by a pharmacist if inventory drops to a minimum level. Collaboration between nursing and pharmacy, compliance with nursing best practices, and continuing education are all essential to optimize medication safety and use of an ADC. 

ADCs are not completely failsafe, but they are required to be used in conjunction with other safety protocols. Whether any instance of medication error represents deviation from standard of care requires evaluation of whether the other required safety protocols were followed. Such analysis will also determine the person(s) responsible for the medication error. 

The process for medication removal from an ADC consists of the following steps:

• Check the doctor’s order

• Use a unique fingerprint ID to log in and to access the medication 

• Select the correct patient from patient list

• Select the correct medication from list

• Once drawer opens, remove medication from bin/pocket 

• Enter the count of remaining medications in the bin/pocket

• Check/verify/read the medication label 

• Close the bin/pocket

• Log out of dispensing machine

Automated Dispensing Cabinets-Benefits of Use

ADCs can reduce the risk of medication errors, but only when specific safeguards are consistently available and used.  The many benefits of ADC use include improved drug security, inventory control, and the potential to limit practitioner access to high-alert drugs. Many high-risk medications have clinical warnings/labels, and/or safety updates that can be implemented through an ADC system.

Automated Dispensing Cabinets—Configuration/Drawers 

Locked-lidded ADC drawers provide a high level of security by allowing access to only one pre-selected medication at a time.  

Automated Dispensing Cabinets—Withdrawal of Medications

The Joint Commission [TJC] allows two exceptions to the requirement for pharmacist review: urgency and physician control of the medication. During an emergency, patient care takes priority over everything including the usual procedure for logging into the medical record and awaiting verification before administration.  Many hospitals create solutions to give ED nurses quick access to medications in such situations. 

Automated Dispensing Cabinets—Overrides

An override occurs when a nurse withdraws a medication that has not been reviewed and released by a pharmacist. When an override is required, double-checking high-alert medications by another healthcare provider is critical to prevent a potentially fatal error. In an emergency, a nurse can remove medications from an ADC using the override process. To avoid errors, the override process should be used infrequently and should be reserved for emergent situations.

Automated dispensing cabinet medical expert witness specialties include emergency medicine and emergency nursing.

IF YOU NEED AN emergency medicine or emergency nursing MEDICAL EXPERT, CALL MEDILEX AT (212) 234-1999.

Image: XT Anesthesia Workstation, an automated dispensing cabinet (ADC) used in hospital operating rooms. Sharon.mahood Creative Commons Attribution-Share Alike 4.0