ISMP Automated Dispensing Cabinet (ADC) Survey

Please take a few minutes to help us identify safety measures currently being used with unit-based automated dispensing cabinets (ADCs). Please submit your responses by November 25, 2007.

Please circle the statement that best describes your current use of ADCs (also know as unit based cabinets, automated dispensing machines).

a. Not used
b. Used for narcotics/controlled substances only
c. Used for narcotics/controlled substances, floor stock/prn medications
d. Used for narcotics/controlled substances, floor stock/prn medications, and first doses
e. Used as a primary means of drug distribution

Please select the best response for the following statements. If the statement is not applicable, please check N/A.

Statements	Always	Frequently	Sometimes	Never	N/A
a. Medications stocked in the ADC are specific to patient care units
b. Multiple concentrations of the same drug are stored in the same cabinet
c. Medications are stocked in ready-to-administer unit doses
d. Medications for restocking the ADC are stored in a separate location in the pharmacy
e. A pharmacist checks restock medications in the pharmacy before the drugs are sent to patient care units for placement in an ADC
f. Another person verifies drug placement in the ADC after restocking
g. Bar-code technology is used when selecting medications in the pharmacy for restocking ADCs
h. Bar-code technology is used for restocking medications in ADCs in patient care areas
i. Only the drug selected can be removed from the cabinet drawers/shelves
j. Pharmacy staff must review/verify orders before drugs can be removed from the ADC
k. The list of drugs that can be obtained by overriding pharmacy order review/verification is specific to each patient care unit
l. First-line medications used for emergencies (codes) are stocked in the ADC
m. Nurses have to wait in line to access medications from the ADC
n. The organization’s ADCs are located in an area free from distractions or interruptions
o. Drugs removed by overriding pharmacy review/verification are double-checked by another practitioner before administration
p. Override reports are routinely analyzed by managers
q. Nurses remove one patient’s medications at a time (for one dosing schedule) from ADCs, and administer the medications before removing the next patient's medications
r. Nurses return medications that have not been administered to a return bin in the ADC
s. Items other than medications and IV solutions are stored in the ADC (excluding ADCs solely used for central supply items)
t. Maintenance IV infusions and piggyback solutions are contained in ADCs
u. Warfarin is stored ADC cabinets

Other Questions

Do all of the ADCs in your facility have the capability for pharmacists to review/verify orders before the medication is removed?

Yes No

Does the organization have specific written policies, procedures, or guidelines for the following?

Statements	Yes	No
1. Criteria for determining the drug products, strengths, and quantities that will be stored in the ADC
2. Criteria for identifying products that are considered inappropriate in ADCs (short expiration dates, high-alert medications, etc.)
3. Periodic review of ADC contents (based on formulary changes, emerging drug safety issues, changes in patient population, etc.)
4. Handling of medications removed from the ADC but not administered
5. Safe methods for transporting medications from the cabinet to the patient bedside
6. Criteria for the use of overrides

Please select one of the following categories that best describes your organization:

Other: