Automated unit dose dispensing systems producing individually packaged and labelled drugs for inpatients: a systematic review.

OBJECTIVES: Pharmacy automation is increasing in hospitals. The aim of this systematic review was to identify and evaluate the literature on automated unit dose dispensing systems (UDDS) producing individually packaged and labelled drugs for inpatients. METHODS: The search was conducted on eight electronic databases, including Scopus, Medline Ovid, and Cinahl, and limited to peer reviewed articles with English abstracts published 2000-2020. Studies were included in the review if drug dispensing was performed by an automated UDDS where individually packaged and labelled unit doses were subsequently assembled patient specifically for inpatients. All outcomes related to UDDS functionality were included with specific interest in medication safety, cost-efficiency and stock management. Outcomes were categorised and results synthesised qualitatively. RESULTS: 664 publications were screened, one article identified manually, resulting in eight included articles. Outcomes of the studies were categorised as medication administration errors (MAEs), dispensing errors, costs and cost-effectiveness. Studies showed that automated UDDS reduced significantly MAEs of inpatients compared with traditional ward stock system (WSS), especially when UDs were dispensed patient specifically by unit dose dispensing robot. Patient specific drug dispensing with automated UDDS was very accurate. Of three different automated medication systems (AMSs), patient specific AMS (psAMS) was the most cost-effective and complex AMS (cAMS) the most expensive system across all error types due to the higher additional investments and operation costs of automated dispensing cabinets (ADCs). None of the studies investigated the impact on the medication management process such as efficiency, costs and stock management as primary outcome. CONCLUSIONS: UDDS improved patient safety. However, automation is a costly investment and the implementation process is complex and time consuming. Further controlled studies are needed on the clinical and economical outcomes of automated UDDS to produce reliable knowledge for hospital decision makers on the cost-benefit of the investment and to support decision making.

Safety, time and cost evaluation of automated and semi-automated drug distribution systems in hospitals: a systematic review.

OBJECTIVES: To systematically review automated and semi-automated drug distribution systems (DDSs) in hospitals and to evaluate their effectiveness on medication safety, time and costs of medication care. METHODS: A systematic literature search was conducted in MEDLINE Ovid, Scopus, CINAHL and EMB Reviews covering the period 2005 to May 2016. Studies were included if they (1) concerned technologies used in the drug distribution and administration process in acute care hospitals and (2) reported medication safety, time and cost-related outcomes. RESULTS: Key outcomes, conclusions and recommendations of the included studies (n=30) were categorised according to the dispensing method: decentralised (n=19 studies), centralised (n=6) or hybrid system (n=5). Patient safety improved (n=27) with automation, and reduction in medication errors was found in all three systems. Centralised and decentralised systems were reported to support clinical pharmacy practice in hospitals. The impact of the medication distribution system on time allocation such as labour time, staffing workload or changes in work process was explored in the majority of studies (n=24). Six studies explored economic outcomes. CONCLUSIONS: No medication distribution system was found to be better than another in terms of outcomes assessed in the studies included in the systematic review. All DDSs improved medication safety and quality of care, mainly by decreasing medication errors. However, many error types still remained-for example, prescribing errors. Centralised and hybrid systems saved more time than a decentralised system. Costs of medication care were reduced in decentralised systems mainly in high-expense units. However, no evidence was shown that implementation of decentralised systems in small units would save costs. More comparable evidence on the benefits and costs of decentralised and hybrid systems should be available. Changes in processes due to a new DDS may create new medication safety risks; to minimise these risks, training and reallocation of staff resources are needed.

Effect of storage on the dissolution rate of a fast-dissolving perphenazine/ß-cyclodextrin complex.

OBJECTIVE: In general, the chemical and physical stability of amorphous cyclodextrin complexes and how storage affects their dissolution rate have not been widely reported. The aim of this study was to evaluate the solid-state stability of a fast-dissolving perphenazine/ß-cyclodextrin (ß-CD) complex, which has been found to be well absorbed after sublingual administration to rabbits. In addition, the dissolution rate of plain ß-CD in crystalline and amorphous forms was determined. METHODS: The amorphous perphenazine/ß-CD complex powders were prepared by spray-drying and freeze-drying, and their stability was examined after storage at 40°C, 75% relative humidity (RH) or at room temperature, 60% RH for up to 82 days. KEY FINDINGS: Perphenazine was found to be chemically stable in all samples. The dissolution rate of perphenazine remained practically unchanged at both storage conditions, although partial crystallization was observed in both spray-dried and freeze-dried samples at 40°C, 75% RH. Interestingly, it was also observed that the dissolution rates of crystalline and amorphous ß-CD were similar. CONCLUSION: The results suggest that CD complexation may represent a suitable alternative for preparing intraorally dissolving formulations because the fast dissolution rate of the drug was maintained even though changes in the crystal structure were observed during storage.