The evaluation of an automated drug distribution system using a health technology assessment approach

Aim: This study assessed the potential of Meditrol, an automated, ward based dispensing system from the USA. The system was claimed to reduce drug administration errors (DAEs), reduce staff costs, prevent pilfering and provide drug use information. Methods: The study was conducted in a 625 bed NHS trust hospital. A health technology assessment (HTA) approach was used to examine clinical, economic and social impacts. A before and after study design was used. DAE rate was measured using an observation method. Impact on pharmacy and nursing time was measured using activity sampling, direct timing and examination of establishment changes. A variety of inventory parameters were calculated, including 'absolute consumption discrepancy', the sum of drug losses and gains (as opposed to the net discrepancy where these cancel out). Information management was examined using a case study technique. Staff attitudes were explored using structured interviews. Results: DAE rate was unchanged (3.5 ± 0.7%). Nurses spent an additional 68 minutes (22%) per ward per day on drug rounds (p = 0.03). Pharmacists spent an additional 30 minutes (120%) on each ward per day. An additional 7.5 FTEs were employed in the pharmacy. The quantity of drugs on the wards was reduced by 48% (significant at 5% level), but the cost was unchanged. Absolute consumption discrepancy was 40 ± 3% before and 34 ± 8% after implementation. Information was not used during the study period. Staff attitudes were positive initially, though mainly negative afterwards. Conclusions: The Meditrol system did not provide the benefits expected. There is little scope in the UK for funding systems by improved efficiency and inventory management. Further research should quantify the benefits of improved safety and information. This study measured proxy outcomes, later stages should examine real ones. Drug distribution systems should be considered in the NHS R&D process and attention should be directed to the examination of established technologies