Implementation and evaluation of an automated dispensing system.

An institution's experience in replacing a traditional unit dose cassette-exchange system with an automated dispensing system is described. A 24-hour unit dose cassette-exchange system was replaced with an automated dispensing system (Pyxis's Medstation Rx) on a 36-bed cardiovascular surgery unit and an 8-bed cardiovascular intensive care unit. Significantly fewer missing doses were reported after Medstation Rx was implemented. No conclusions could be made about the impact of the system on the reporting of medication errors. The time savings for pharmacy associated with the filling, checking, and delivery of new medication orders equated to about 0.5 full-time equivalent (FTE). Medstation Rx also saved substantial nursing time for acquisition of controlled substances and for controlled-substance inventory taking at shift changes. A financial analysis showed that Medstation Rx could save the institution about $1 million over five years if all personnel time savings could be translated into FTE reductions. The automated system was given high marks by the nurses in a survey; 80% wanted to keep the system on their unit. Pilot implementation of an automated dispensing system improved the efficiency of drug distribution over that of the traditional unit dose cassette-exchange system.

Experience with selective reporting of susceptibility to antimicrobial agents.

Experience with a system of selective and hierarchical reporting of susceptibility to antimicrobial agents in the hospital setting is described. In March 1985 and January 1987 the medical records of all patients with susceptibility test results were reviewed; there were a total of 488 susceptibility reports. Antimicrobial therapy was evaluated for appropriateness on the basis of the reported susceptibility test results. Susceptibility reports would not have affected the choice of antimicrobial agents in the majority of cases because patients had already been discharged, infection had not been documented, or appropriate therapy had already been started. In approximately 40% of cases in which susceptibility reports could have influenced prescribing, physicians chose appropriate initial therapy after susceptibility results became available. If only the instances in which susceptibility reports could have influenced prescribing are considered, then therapy was appropriately changed 12.5% of the time in March 1985 and 24.2% of the time in January 1987. Selective reporting of susceptibility to antimicrobial agents should be viewed as an adjunct to, not a substitute for, other interventions to promote appropriate prescribing in cases of infection.