(Management Case Study) Implementation of a Comprehensive Automated Dispensing Cabinet (ADC) Maintenance Program

Purpose: The Institute for Safe Medication Practices (ISMP) provides guidelines for safe use of automated dispensing cabinets (ADCs). Select ISMP recommendations include assigning appropriate minimum and maximum periodic automatic replenishment (PAR) levels designed to address drug shortages and the risk of multifold overdosing, and regularly analyzing ADC activity to determine the quantity and variety of medications available based on patient need. In pursuit of world-class pharmacy recognized for excellence, an ADC maintenance program was established with goals of utilizing data and analytics tools to optimize ADC inventory and eliminate stock-outs, reducing stock-out refill turnaround times and improving workflow efficiency.

Methods: Lyndon B. Johnson (LBJ) Hospital is a community-owned, 215-bed academic hospital within Harris Health System that utilizes ADCs for decentralized medication distribution. In 2018, the average stock-out percentage was over 2%, and average unfiltered stock-out refill turnaround time was over 30 hours, which contributed to delays in patient care. In early 2019, a site assessment was performed by our ADC vendor, which uncovered opportunities for improvement in areas that increase the potential for stock-outs, frequent refills, and stagnant inventory. A retrospective pilot study was completed later that year to assess the change in the rate of stock-outs and achieve ADC optimization. A macro report was created and included admitted patient census data, active medication orders, and frequency of administration, to determine the number of medication units necessary to care for each patient for one day. This was used daily to identify the quantity necessary for a minimum of three days’ supply and maximum of five days’ supply for each medication, and par levels were adjusted accordingly. As a result of the significant reduction in stock-outs achieved, this report became an integral part of our ADC maintenance program established in 2020. Other key components include addition of an ADC maintenance technician, routine use of reports available from vendor to optimize ADCs, staff reeducation, use of critical low functionality, and quarterly periodic automatic replenishment (PAR) level review.

Results: Since implementation of our comprehensive ADC maintenance program, LBJ pharmacy has maintained an average medication stock-out percentage of less than the industry benchmark of 1.0%, with an average medication stock-out percentage of 0.25% in 2021. The daily average number of stock-outs was about 61 per day prior to implementation, which decreased to an average of 5 stock-outs per day afterward. Average medication refill turnaround time was 5.4 hours prior to implementation, which has continued to trend downwards. In April 2022, average medication refill turnaround time was less than 60 minutes due to heightened focus. Additional benefits realized include reduction in total inventory located in ADCs and reduction in number of outdates/expired medications.

Conclusion: Despite challenges stemming from supply chain and logistics disruptions, national backorders and medications shortages, our comprehensive ADC maintenance program has proven to be beneficial in reducing number of stock-outs, and average stock-out replenishment turnaround time. As a result of time and efficiencies gained, our staff are now able to prioritize other patient care activities. Opportunities to optimize the program will be identified as we seek to continuously improve the patient experience by ensuring that medications are readily available when needed for administration.