Automated Dispensing Cabinets: Restocking and the Role of Pharmacy Technicians
An increasingly large share of medication doses in healthcare facilities are now dispensed via automated dispensing cabinets (ADCs).
During regular operational assessments of hospital pharmacies, College hospital operations advisors are evaluating ADC-related practices against the hospital assessment criteria, and it is a common area identified for further improvements. Areas evaluated during the assessment include appropriate storage, use of overrides and processes for pharmacist review.
ADCs can help with medication safety by enabling more accurate medication tracking and record-keeping, helping to reduce drug diversion and improving efficiency for pharmacy and nursing staff. However, there can be risks to patients if medication is stored incorrectly, labelling is wrong or discrepancies between barcodes and systems are not properly managed.
While this article focuses on restocking activities, additional articles in the future will focus on other elements of working with ADCs and pharmacy informatics.
Restocking and Professional Accountability
As part of their role, pharmacy technicians must understand and navigate the complex automated systems playing a bigger role in pharmacy operations. This requires critical thinking, technical expertise and the ability to troubleshoot system issues.
It also requires pharmacy technicians to continue to apply their knowledge, skills and judgment as healthcare professionals. Technology is a very useful tool, but it is not a substitute for decision-making or your professional judgment. Automation does not replace professional accountability.
When restocking, pharmacy technicians (or any other pharmacy personnel) must ensure:
- Medications are accurate and appropriately stocked (e.g., correct bin)
- Any discrepancies are identified and resolved (e.g., barcode not scanning)
- ADC contents and system data are consistent (e.g., expiry on the screen matches the earliest expiry of the medication)
- Functionality of the cabinet is not impeded (e.g., by exceeding the Periodic Automatic Replenishment (PAR) level)
- The use and protection of individual login credentials in order to support auditability, accountability and patient privacy (e.g., not disclosing login information, logging out when tasks have been completed)
Restocking presents an important opportunity to identify and prevent potential errors. In busy healthcare environments, frontline staff rely heavily on the accuracy of automated systems. That trust is only possible with the vigilance and professional judgment of the pharmacy technician.
Pharmacy technicians play a critical role in the medication-use process and serve as an essential safety checkpoint before the medications are accessed by nurses and administered to patients.
Restocking Scenarios
Scenario 1: When you are restocking a medication, the barcode does not scan. What should you do?
- Try scanning another item and proceed if it appears to be the same drug.
- Set aside the item and return it to the pharmacy for re-barcoding.
- Continue restocking and assume the system will correct it later.
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Answer: B. If a barcode cannot scan, it cannot be verified within the system. Without confirmation, restocking it introduces risk into the medication use process.
Scenario 2: The medications inside the designated bin are not the same as the one you have in your hand to restock. What should you do?
- If the scanned barcode is accepted, restock it anyway and notify someone later.
- Do not restock. Report the issue to pharmacy leadership or a super user right away.
- Pause and investigate. Try to verify what the system is expecting, what is in the bin and what you are holding.
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Answer: C. This could be a potential process or system error, such as incorrect medication already in the bin, barcode misassignment or discrepancies between the Pharmacy Practice Management System (PPMS) and the ADC.
You must reconcile all three elements before proceeding. If, after investigation, you cannot determine the issue, then you may need to escalate it.
Scenario 3: The ADC is not directing you to a bin during restocking. What should you do?
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Answer: Before assuming a system failure, consider whether you are rushing and could have missed the correct location, whether there is a mechanical issue with the cabinet or if there is a system communication problem. Pause and reassess before escalating.
Human factors often contribute to perceived system errors. Taking a moment to reassess may prevent an unnecessary escalation or avoid taking an ADC out of service, which could affect patient care. However, if the issue persists, it should be reported to the appropriate system administrator for investigation.
The information presented in this article may include general examples, options and potential risks to consider but is not intended to supersede any legal advice. While it guides you to the appropriate legislative or regulatory reference, you must use your own professional knowledge, skills, and judgment to make appropriate decisions. The information is not directing you to a specific course of action, is not to be construed as legal advice or opinion and is not to be taken as a position of the Ontario College of Pharmacists. Examples and scenarios provided are for illustrative purposes only.