Impact of automated dispensing solutions in long-term care facilities and closed-door pharmacies: A mixed methods study of medication management.

BACKGROUND: Financial, operational, and clinical workflow impacts of deploying an automated dispensing cabinet (ADC) in long-term care (LTC) facilities based on actual observations have not been documented in peer-reviewed literature. OBJECTIVES: To evaluate the impact of a closed-door pharmacy (CDP) implementing an ADC with unique secure, removable, and transportable locked pockets in an unstudied setting (LTC facilities) for management of first and emergency dose medications. PRACTICE DESCRIPTION: This study was conducted in 1 CDP and 2 LTC facilities. PRACTICE INNOVATION: Enhancing emergency medication management and inventory tracking in an unstudied setting through implementation of an ADC system featuring unique electronically encoded medication storage pockets that can be prepared in the CDP, locked and securely transported to the LTC, and when inserted into ADC it informs staff of its presence, position, and contents. EVALUATION METHODS: Mixed methods, pre- and poststudy to assess the impact of replacing manual emergency medication kits with an ADC. Outcomes were evaluated using rapid ethnography with workflow modeling; inventory and delivery reports; a nursing perception survey; and transactional data from the ADC during postimplementation phase. RESULTS: Pharmacy technician preparation time and pharmacist checking time decreased by 59% and 80%, respectively, and standing inventory was reduced by more than $10,000 combined for the CDP and 2 LTCs by replacing emergency medication kits with the ADC. In the LTCs, this change led to a 71% reduction in emergency medication retrieval time, an increase in emergency medication utilization, and a 96% reduction in the cost of unscheduled deliveries. Over 70% of the nurses surveyed favored replacement of the emergency medication kits with the ADC system. CONCLUSION: Replacing manual emergency medication kit with the described ADC system improved workflow efficiency in the CDP and LTC. It also significantly reduced unscheduled (STAT) deliveries and standing inventory and increased the availability of medications commonly used.

A Comparative Study of the Health Care Delivery Systems in the Indian Ocean: What can Comoros Islands Learn from Mauritius and Seychelles?

In recent years, there have been significant efforts to examine the organization and performance of health systems. This study's main purpose is to compare health systems and analyze the health status of the citizens of Comoros, Mauritius, and Seychelles, with the intention of providing policy recommendations for Comoros. Peer-reviewed studies and reports published by non-governmental organizations and international agencies were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into the World Health Organization (WHO) building blocks framework. The literature review demonstrates that health outcomes have dramatically improved over the past decades in Mauritius and Seychelles but not in Comoros. As of 2015, Mauritius and Seychelles were among the few African countries to have achieved almost all the Millennium Development Goals, whereas Comoros still struggles to reduce child mortality and improve maternal health. In contrast, the total health expenditure of the three island states, as a percentage of gross domestic product (GDP), seemed similar over the studied time period.