Unit dose drug dispensing systems in hospitals: a systematic review of medication error reduction and cost-effectiveness

• Published in: European journal of hospital pharmacy. Science and practice p. ejhpharm-2024-004444
• Main Authors: Gallina, Matteo, Testagrossa, Mirko, Provenzani, Alessio
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 26.02.2025; BMJ Publishing Group LTD
• Subjects: Automation; Bar codes; Boolean; Cost control; Drug administration; Drug dosages; Drug Packaging; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; Electronic Prescribing; English language; Health care expenditures; Hospital Distribution Systems; Information Technology; Intervention; MEDICAL ERRORS; Medical Subject Headings-MeSH; Order entry; Patient safety; Performance evaluation; Pharmacists; Quality of Health Care; Robotics; Safety; Subject heading schemes; Systematic review; Automation; Drug Packaging; Hospital Distribution Systems; MEDICAL ERRORS; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; Safety; Electronic Prescribing; Quality of Health Care; Robotics; Information Technology
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2024-004444

BackgroundMedical errors pose significant risks to patient safety and public health. Automated unit dose drug dispensing systems (UDDSs) have emerged as valuable tools to reduce medication errors while optimising economic and logistical resources.ObjectivesThis systematic review aims to evaluate studies specifically focused on the impact of automated UDDSs in reducing medication errors and streamlining processes.MethodsA literature search was performed on PubMed, Scopus, and Web of Science, focusing on peer-reviewed articles published between 2019 and 2024. The search, concluded on 24 September 2024, included studies conducted in inpatient hospital settings that assessed automated UDDS effects on medication errors, therapy management and inventory control. Outcomes examined included effects on patient safety, cost-effectiveness and inventory management. Results were synthesised qualitatively.ResultsFrom 3346 references, four studies met the inclusion criteria: a cost-effectiveness analysis, an uncontrolled before-and-after study, and two observational studies. UDDS improved medication processes, reducing drug-related problems, medication handling and dispensing time by 50% per patient per day. Integrated with barcode scanning, UDDS lowered medication administration errors (MAEs) from 19.5% to 15.8% and harmful MAEs from 3.0% to 0.3%. Overall, medication errors dropped by 45–70%, enhancing safety and reducing manual handling risks. UDDS demonstrated cost-effectiveness by significantly reducing MAEs. The study estimated a reduction in MAEs, with a cost-effectiveness ratio of €17.69 per avoided MAE. For potentially harmful MAEs, the cost-effectiveness ratio was estimated at €30.23 per avoided error. These findings suggest substantial long-term savings potential, though the exact magnitude may vary depending on hospital size and implementation specificsConclusionsAutomated UDDSs improve patient safety by significantly reducing medication errors and delivering cost savings through better inventory management. Challenges such as high initial costs and workflow adjustments can be mitigated through gradual implementation and staff training. Further integration with other healthcare technologies, such as barcoding, real-time tracking, artificial intelligence (AI)-driven error prevention tools and fully automated restocking systems could enhance UDDS benefits and further support hospital processes.