Objective: To investigate and describe how an acute care, multi-site teaching hospital implements a new technology called the Automated Medication Dispensing Cabinet (ADC) that will be used by nurses. Design and methods: Qualitative, descriptive, single-case study method using the Ottawa Model of Research Use as a framework to guide data collection and analysis. The project was evaluated from the beginning, through the planning stages until a cabinet vendor was chosen. Results: A multidisciplinary committee was created to implement the ADCs across the organization. Clinical nurses, the intended users, were not directly involved in the implementation; usability testing was not done; they were not prepared for all the needed training costs and no evaluation was planned. Conclusions: An implementation framework was not used to guide the ADC project and several key area surrounding implementation were missed. Recommendations were made to improve future implementation projects in heath organizations.

Objective: To investigate and describe how an acute care, multi-site teaching hospital implements a new technology called the Automated Medication Dispensing Cabinet (ADC) that will be used by nurses. Design and methods: Qualitative, descriptive, single-case study method using the Ottawa Model of Research Use as a framework to guide data collection and analysis. The project was evaluated from the beginning, through the planning stages until a cabinet vendor was chosen. Results: A multidisciplinary committee was created to implement the ADCs across the organization. Clinical nurses, the intended users, were not directly involved in the implementation; usability testing was not done; they were not prepared for all the needed training costs and no evaluation was planned. Conclusions: An implementation framework was not used to guide the ADC project and several key area surrounding implementation were missed. Recommendations were made to improve future implementation projects in heath organizations.

Objective: To investigate and describe how an acute care, multi-site teaching hospital implements a new technology called the Automated Medication Dispensing Cabinet (ADC) that will be used by nurses. Design and methods: Qualitative, descriptive, single-case study method using the Ottawa Model of Research Use as a framework to guide data collection and analysis. The project was evaluated from the beginning, through the planning stages until a cabinet vendor was chosen. Results: A multidisciplinary committee was created to implement the ADCs across the organization. Clinical nurses, the intended users, were not directly involved in the implementation; usability testing was not done; they were not prepared for all the needed training costs and no evaluation was planned. Conclusions: An implementation framework was not used to guide the ADC project and several key area surrounding implementation were missed. Recommendations were made to improve future implementation projects in heath organizations.

Os medicamentos representam uma conquista revolucionária do homem para a prevenção de doenças crônicas e agudas. Os riscos superam os benefícios quando inadequadamente empregados. Utilização irracional e erros que podem causar eventos e reações adversas são responsáveis anualmente por mais de 100 mil mortes, de 4ª a 6ª causa de morte somente nos Estados Unidos. Com a implementação do sistema de dispensação de medicamentos por dose unitária em hospitais, a administração de doses erradas foi reduzida em mais de 80%. A inadequada adesão ao tratamento das doenças crônicas é um problema mundial de grande magnitude. Nos países desenvolvi¬dos a adesão média é de 50% e nos países em desenvolvimento, este percentual é ainda menor. O presente estudo teve como objetivo desenvolver um Sistema de Dispensação de Medicamentos com Controle de Uso (SDMCU) para pacientes do município de Luiz Antônio-SP que usam cinco ou mais medicamentos diferentes continuamente. Empregaram-se cartelas e sachês personalizados e individualizados visando a utilização racional dos medicamentos com efetiva adesão ao tratamento farmacológico. Esperou-se a prevenção e redução dos problemas relacionados aos medicamentos contribuindo para o aprimoramento da qualidade da assistência à saúde da população. Foram entrevistados e acompanhados 24 pacientes por um período de 4 meses. Neste período foram recolhidos as cartelas e os sachês usados. Foram também mensurados parâmetros clínicos antes e após a implantação do SDMCU como métodos de medida de aderência.. Os parâmetros clínicos mensurados foram pressão arterial, glicemia, hemoglobina glicosilada, colesterol e triglicérides. Teste de Morisky e Green foi usado antes e após o SDMCU para avaliar o grau de adesão ao tratamento farmacológico. Também foram aplicados instrumentos para avaliar o grau de satisfação dos usuários da farmácia municipal de Luiz Antônio SP e do SDMCU. Antes do SDMCU 100% dos pacientes foram considerados como não aderentes pelo Critério 2 do Teste de Morisky e Green. Após o SDMCU, do total de pacientes, 33,3% foram considerados como não aderentes e 66,7% foram considerados aderentes pelo Critério 2. Pelo Critério 1, os com menor adesão contaram 0% e os com maior adesão 100%. O grau de satisfação dos pacientes com a farmácia municipal foi baixo; numa escala de 0 a 8 pontos apenas 20,8% dos entrevistados tiveram a pontuação máxima de 5. Em relação ao SDMCU 87,5% (n=21) obtiveram pontuação máxima, ou seja, estavam muito satisfeitos com o novo método de dispensação de medicamentos. Antes da intervenção apenas 3 (12,5%) e 9 (37,5%) pacientes apresentavam pressão arterial sistólica e diastólica normal respectivamente; após o uso do SDMCU esses números passaram a 13 (54,2%) e 21 (87,5%) respectivamente. No total 10 (41,7%) pacientes obtiveram uma melhora na pressão arterial sistólica e 12 (50%) obtiveram uma melhora na pressão diastólica. A glicemia que estava normal (abaixo do limite) em 11 (45,8%) pacientes antes do SDMCU passou para 23 (95,8%) pacientes após a intervenção, ou seja, 12 (50%) obtiveram uma diminuição no nível glicêmico. Apenas 2 (15,4%) pacientes dos 9 (69,2%) apresentavam valores de hemoglobina glicosilada acima de 7% antes do SDMCU obtiveram um nível abaixo desse limite após o SDMCU, porém 5 (38,46%) pacientes dos 13 (100%) diabéticos tiveram uma redução de mais de 1% no valor da A1c. Dos 24 pacientes acompanhados apenas 4 (16,7%) tinham um valor de colesterol acima da referência; após a intervenção esse número passou a ser de 1 (4,17%) paciente. Os valores de triglicérides melhoraram em 10 (41,7%) pacientes; de 16 (66,7%) com valores acima da referência, antes do SDMCU, apenas 6 (25%) continuaram com os mesmos números após a intervenção. A simplificação da terapia com menos horários de tomadas ao dia ajudou os pacientes a lembrarem de tomar seus medicamentos e a serem menos descuidados quanto ao horário de tomá-los. O SDMCU mostrou-se eficaz na adesão ao tratamento farmacológico baixando os níveis dos parâmetros clínicos e satisfazendo as necessidades individuais dos pacientes. / Medicines are a revolutionary conquest of man for the prevention of acute and chronic diseases. Risks outweigh benefits when used improperly. Irrational utilization and errors that can cause adverse reactions and/or events are responsible annually for more than 100 thousand deaths, been the 4th to 6th leading cause of death only in the United States. With the implementation of medication unit dosis dispensing systems in hospitals the administration of wrong dose was reduced by over 80%. The poor adherence to treatment of chronic diseases is a worldwide problem of great magnitude. In developed countries the mean average is around 50% and in developing countries, this percentage is even lower. This study aimed to develop a medication system for dispensing and controlling use (SDMCU) for patients that use five or more different drugs, continuously, in the municipality of Luiz Antônio-SP. Medications blisters and sachets personalized and individualized were prepared in order to accomplish rational use of medicines with an effective pharmacological treatment. It was expected prevention and reduction of drugs related problems (DRP) as a contribution to improve the population quality of healthcare. We have interviewed 24 patients with follow up for a 4-month period. At this time used blisters and sachets were collected. It was also measured clinical parameters before and after the implementation of SDMCU as a method to estimate adhesion. The clinical parameters determined were blood pressure, blood glucose, glycosylated hemoglobin, cholesterol and triglycerides. Morisky and Green Test was used before and after use of SDMCU to assess the grade of adherence to pharmacological treatment. Instruments were also used to assess the degree of satisfaction of SDMCU users and Luiz Antonio´s healthcare unit pharmacy. Before the SDMCU 100% of patients were considered as non-adherent by Criterion 2 of the Morisky and Green Test. After use of SDMCU, 33.3% out of total patients were considered as non-adherent and 66.7% were considered adherent by Criterion 2. By Criterion 1 patients with higher adherence accounted for 100%. The patients degree of satisfaction with local pharmacy was low, on a scale of 0 to 8 points, only 20.8% of respondents had scored the maximum of 5. On the SDMCU 87.5% (n = 21) have obtained maximum scores, ie were very pleased with the new system of medicines dispensing. Before the intervention only 3 (12.5%) and 9 (37.5%) had normal systolic and diastolic blood pressure respectively. After the use of SDMCU these numbers have reached 13 (54.2%) and 21 (87, 5%) respectively. Overall, 10 (41.7%) patients have achieved an improvement in systolic blood pressure and 12 (50%) have achieved an improvement in diastolic pressure. In 11 (45.8%) patients, before the use of SDMCU, the blood glucose was normal (below the limit). After the intervention, 23 (95.8%) patients had normal levels of glucose in the blood. It means that 12 (50%) have achieved a decrease in glucose level to the normal. Glycosylated hemoglobin in only 2 (15.4%) out of 9 patients (69.2%) had a value above 7% before the SDMCU had achieved a level below this limit after SDMCU. In 5 (38.46%) patients out of 13 (100%) had a reduction of more than 1% in the value of A1c. Only 4 (16.7%) out of 24 patients had a value of cholesterol above the reference at the beginning of the study. After the intervention it has rested only one (4.17%) patient with cholesterol above normal level. The values of triglycerides improved in 10 (41.7%) patients, 16 (66.7%) with values above the reference before the SDMCU, only 6 (25%) continued with the same numbers after the intervention. Simplification of medication use practice, with less frequency daily, for taken them, have helped patients to remember to take their medications and to be more careful about the time of taking them. The SDMCU was effective pharmacological treatment by normalizing the levels of clinical parameters and satisfying the needs of individual patients.

Os medicamentos representam uma conquista revolucionária do homem para a prevenção de doenças crônicas e agudas. Os riscos superam os benefícios quando inadequadamente empregados. Utilização irracional e erros que podem causar eventos e reações adversas são responsáveis anualmente por mais de 100 mil mortes, de 4ª a 6ª causa de morte somente nos Estados Unidos. Com a implementação do sistema de dispensação de medicamentos por dose unitária em hospitais, a administração de doses erradas foi reduzida em mais de 80%. A inadequada adesão ao tratamento das doenças crônicas é um problema mundial de grande magnitude. Nos países desenvolvi¬dos a adesão média é de 50% e nos países em desenvolvimento, este percentual é ainda menor. O presente estudo teve como objetivo desenvolver um Sistema de Dispensação de Medicamentos com Controle de Uso (SDMCU) para pacientes do município de Luiz Antônio-SP que usam cinco ou mais medicamentos diferentes continuamente. Empregaram-se cartelas e sachês personalizados e individualizados visando a utilização racional dos medicamentos com efetiva adesão ao tratamento farmacológico. Esperou-se a prevenção e redução dos problemas relacionados aos medicamentos contribuindo para o aprimoramento da qualidade da assistência à saúde da população. Foram entrevistados e acompanhados 24 pacientes por um período de 4 meses. Neste período foram recolhidos as cartelas e os sachês usados. Foram também mensurados parâmetros clínicos antes e após a implantação do SDMCU como métodos de medida de aderência.. Os parâmetros clínicos mensurados foram pressão arterial, glicemia, hemoglobina glicosilada, colesterol e triglicérides. Teste de Morisky e Green foi usado antes e após o SDMCU para avaliar o grau de adesão ao tratamento farmacológico. Também foram aplicados instrumentos para avaliar o grau de satisfação dos usuários da farmácia municipal de Luiz Antônio SP e do SDMCU. Antes do SDMCU 100% dos pacientes foram considerados como não aderentes pelo Critério 2 do Teste de Morisky e Green. Após o SDMCU, do total de pacientes, 33,3% foram considerados como não aderentes e 66,7% foram considerados aderentes pelo Critério 2. Pelo Critério 1, os com menor adesão contaram 0% e os com maior adesão 100%. O grau de satisfação dos pacientes com a farmácia municipal foi baixo; numa escala de 0 a 8 pontos apenas 20,8% dos entrevistados tiveram a pontuação máxima de 5. Em relação ao SDMCU 87,5% (n=21) obtiveram pontuação máxima, ou seja, estavam muito satisfeitos com o novo método de dispensação de medicamentos. Antes da intervenção apenas 3 (12,5%) e 9 (37,5%) pacientes apresentavam pressão arterial sistólica e diastólica normal respectivamente; após o uso do SDMCU esses números passaram a 13 (54,2%) e 21 (87,5%) respectivamente. No total 10 (41,7%) pacientes obtiveram uma melhora na pressão arterial sistólica e 12 (50%) obtiveram uma melhora na pressão diastólica. A glicemia que estava normal (abaixo do limite) em 11 (45,8%) pacientes antes do SDMCU passou para 23 (95,8%) pacientes após a intervenção, ou seja, 12 (50%) obtiveram uma diminuição no nível glicêmico. Apenas 2 (15,4%) pacientes dos 9 (69,2%) apresentavam valores de hemoglobina glicosilada acima de 7% antes do SDMCU obtiveram um nível abaixo desse limite após o SDMCU, porém 5 (38,46%) pacientes dos 13 (100%) diabéticos tiveram uma redução de mais de 1% no valor da A1c. Dos 24 pacientes acompanhados apenas 4 (16,7%) tinham um valor de colesterol acima da referência; após a intervenção esse número passou a ser de 1 (4,17%) paciente. Os valores de triglicérides melhoraram em 10 (41,7%) pacientes; de 16 (66,7%) com valores acima da referência, antes do SDMCU, apenas 6 (25%) continuaram com os mesmos números após a intervenção. A simplificação da terapia com menos horários de tomadas ao dia ajudou os pacientes a lembrarem de tomar seus medicamentos e a serem menos descuidados quanto ao horário de tomá-los. O SDMCU mostrou-se eficaz na adesão ao tratamento farmacológico baixando os níveis dos parâmetros clínicos e satisfazendo as necessidades individuais dos pacientes. / Medicines are a revolutionary conquest of man for the prevention of acute and chronic diseases. Risks outweigh benefits when used improperly. Irrational utilization and errors that can cause adverse reactions and/or events are responsible annually for more than 100 thousand deaths, been the 4th to 6th leading cause of death only in the United States. With the implementation of medication unit dosis dispensing systems in hospitals the administration of wrong dose was reduced by over 80%. The poor adherence to treatment of chronic diseases is a worldwide problem of great magnitude. In developed countries the mean average is around 50% and in developing countries, this percentage is even lower. This study aimed to develop a medication system for dispensing and controlling use (SDMCU) for patients that use five or more different drugs, continuously, in the municipality of Luiz Antônio-SP. Medications blisters and sachets personalized and individualized were prepared in order to accomplish rational use of medicines with an effective pharmacological treatment. It was expected prevention and reduction of drugs related problems (DRP) as a contribution to improve the population quality of healthcare. We have interviewed 24 patients with follow up for a 4-month period. At this time used blisters and sachets were collected. It was also measured clinical parameters before and after the implementation of SDMCU as a method to estimate adhesion. The clinical parameters determined were blood pressure, blood glucose, glycosylated hemoglobin, cholesterol and triglycerides. Morisky and Green Test was used before and after use of SDMCU to assess the grade of adherence to pharmacological treatment. Instruments were also used to assess the degree of satisfaction of SDMCU users and Luiz Antonio´s healthcare unit pharmacy. Before the SDMCU 100% of patients were considered as non-adherent by Criterion 2 of the Morisky and Green Test. After use of SDMCU, 33.3% out of total patients were considered as non-adherent and 66.7% were considered adherent by Criterion 2. By Criterion 1 patients with higher adherence accounted for 100%. The patients degree of satisfaction with local pharmacy was low, on a scale of 0 to 8 points, only 20.8% of respondents had scored the maximum of 5. On the SDMCU 87.5% (n = 21) have obtained maximum scores, ie were very pleased with the new system of medicines dispensing. Before the intervention only 3 (12.5%) and 9 (37.5%) had normal systolic and diastolic blood pressure respectively. After the use of SDMCU these numbers have reached 13 (54.2%) and 21 (87, 5%) respectively. Overall, 10 (41.7%) patients have achieved an improvement in systolic blood pressure and 12 (50%) have achieved an improvement in diastolic pressure. In 11 (45.8%) patients, before the use of SDMCU, the blood glucose was normal (below the limit). After the intervention, 23 (95.8%) patients had normal levels of glucose in the blood. It means that 12 (50%) have achieved a decrease in glucose level to the normal. Glycosylated hemoglobin in only 2 (15.4%) out of 9 patients (69.2%) had a value above 7% before the SDMCU had achieved a level below this limit after SDMCU. In 5 (38.46%) patients out of 13 (100%) had a reduction of more than 1% in the value of A1c. Only 4 (16.7%) out of 24 patients had a value of cholesterol above the reference at the beginning of the study. After the intervention it has rested only one (4.17%) patient with cholesterol above normal level. The values of triglycerides improved in 10 (41.7%) patients, 16 (66.7%) with values above the reference before the SDMCU, only 6 (25%) continued with the same numbers after the intervention. Simplification of medication use practice, with less frequency daily, for taken them, have helped patients to remember to take their medications and to be more careful about the time of taking them. The SDMCU was effective pharmacological treatment by normalizing the levels of clinical parameters and satisfying the needs of individual patients.

Este trabalho foi realizado no período de 06 de abril de 2004 a 21 de julho de 2004, com o objetivo de descrever a estrutura e funcionamento do sistema informatizado para controle da dispensação de medicamentos na Divisão de Assistência Farmacêutica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, bem como avaliar os resultados obtidos com a sua implantação em relação aos serviços de enfermagem e farmacêutico. Foi aplicado um formulário padronizado a 58 enfermeiros, 10 farmacêuticos e 15 auxiliares de farmacêutico que participaram da fase de estruturação, para avaliar a sua opinião quanto aos aspectos relativos à requisição de medicamentos, à forma de apresentação dos medicamentos dispensados pela farmácia hospitalar e à operacionalização do sistema. Como resultados observou-se que para estes profissionais, as principais vantagens obtidas foram: a eliminação da transcrição manual para requisição do medicamento prescrito, a rapidez, a melhor identificação das doses prescritas pelo médico, a embalagem dos medicamentos contendo toda a identificação necessária e a conferência do medicamento requisitado e dispensado através da leitura óptica do código de barras. Os resultados deste estudo permitiram-nos concluir que a grande maioria dos entrevistados considerou o sistema informatizado de dispensação de medicamentos de boa qualidade. A análise dos dados aqui descritos, embora possa não englobar algumas dimensões importantes na busca de uma terapia medicamentosa mais racional, forneceu subsídios que podem contribuir para a expansão e o aperfeiçoamento do sistema, visando dar suporte à realização de estudos de utilização de medicamentos e proporcionar novas perspectivas de trabalho e produtividade. / The present study was conducted from April 6 to July 21, 2004 with the objective of describing the structure and functioning of the informatized system for the control of the delivery of medications at the Division of Pharmaceutical Assistance of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, and to assess the results obtained with its implantation regarding the nursing and pharmaceutical services. A standardized form was distributed to 58 nurses, 10 pharmacists and 15 pharmacist assistants who participated in the structuring phase in order to obtain their opinion regarding the requisition of medications, the form of presentation of the medications distributed by the hospital pharmacy, and the operationalization of the system. As a result, we observed that according to these professionals, the major advantages of the system are: the elimination of manual transcription for the requisition of the prescribed medication, the rapidity, the better identification of the doses prescribed by the doctors, the packaging of the medications containing all the necessary identification, and the verification of the requisitioned and distributed medication by optic reading of the bar code. The data collected in this study permitted us to conclude that most of the persons interviewed consider the system of distribution of medications to be of good quality. Analysis of the data reported here, although it may not involve some important dimensions for the search of a more rational medicamentous treatment, provides information that might contribute to the expansion and refining of the system, also providing support for the execution of studies on the use of medications and opening new perspectives of work and productivity.

Este trabalho foi realizado no período de 06 de abril de 2004 a 21 de julho de 2004, com o objetivo de descrever a estrutura e funcionamento do sistema informatizado para controle da dispensação de medicamentos na Divisão de Assistência Farmacêutica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, bem como avaliar os resultados obtidos com a sua implantação em relação aos serviços de enfermagem e farmacêutico. Foi aplicado um formulário padronizado a 58 enfermeiros, 10 farmacêuticos e 15 auxiliares de farmacêutico que participaram da fase de estruturação, para avaliar a sua opinião quanto aos aspectos relativos à requisição de medicamentos, à forma de apresentação dos medicamentos dispensados pela farmácia hospitalar e à operacionalização do sistema. Como resultados observou-se que para estes profissionais, as principais vantagens obtidas foram: a eliminação da transcrição manual para requisição do medicamento prescrito, a rapidez, a melhor identificação das doses prescritas pelo médico, a embalagem dos medicamentos contendo toda a identificação necessária e a conferência do medicamento requisitado e dispensado através da leitura óptica do código de barras. Os resultados deste estudo permitiram-nos concluir que a grande maioria dos entrevistados considerou o sistema informatizado de dispensação de medicamentos de boa qualidade. A análise dos dados aqui descritos, embora possa não englobar algumas dimensões importantes na busca de uma terapia medicamentosa mais racional, forneceu subsídios que podem contribuir para a expansão e o aperfeiçoamento do sistema, visando dar suporte à realização de estudos de utilização de medicamentos e proporcionar novas perspectivas de trabalho e produtividade. / The present study was conducted from April 6 to July 21, 2004 with the objective of describing the structure and functioning of the informatized system for the control of the delivery of medications at the Division of Pharmaceutical Assistance of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, and to assess the results obtained with its implantation regarding the nursing and pharmaceutical services. A standardized form was distributed to 58 nurses, 10 pharmacists and 15 pharmacist assistants who participated in the structuring phase in order to obtain their opinion regarding the requisition of medications, the form of presentation of the medications distributed by the hospital pharmacy, and the operationalization of the system. As a result, we observed that according to these professionals, the major advantages of the system are: the elimination of manual transcription for the requisition of the prescribed medication, the rapidity, the better identification of the doses prescribed by the doctors, the packaging of the medications containing all the necessary identification, and the verification of the requisitioned and distributed medication by optic reading of the bar code. The data collected in this study permitted us to conclude that most of the persons interviewed consider the system of distribution of medications to be of good quality. Analysis of the data reported here, although it may not involve some important dimensions for the search of a more rational medicamentous treatment, provides information that might contribute to the expansion and refining of the system, also providing support for the execution of studies on the use of medications and opening new perspectives of work and productivity.

The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use in preventing medication errors in the hospital. In addition to the surveys that were completed, interviews were conducted with the pharmacist, the pharmacy techs, and the director of nursing 1 year after implementation to ascertain perceptions of the change from paper-based medication administration to use of the automated medication dispensing cabinet. Medication errors before, during, and after the PYXIS implementation were analyzed. The small sample and the small number of medication errors allowed simple counts and qualitative analysis of the data. The staff members were generally satisfied with the change, although they acknowledged workflow disruption and increased medication errors. The increase in medication errors may be due in part to better documentation of errors during the transition and after implementation. Social change in practice was supported through the patient safety mechanisms and ongoing process changes that were put in place to support the new technology. This project provides direction to other critical access hospitals regarding planning considerations and best practices in implementing a PYXIS machine.