Eficacia del sistema de dispensación electrónica de medicamentos: revisión sistemática y metaanálisis

Márglory Fraga de Carvalho

Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil.

http://orcid.org/0000-0002-8578-446X

Juliana Mendes Marques

Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil.

http://orcid.org/0000-0002-6730-9649

Cristiano Bertolossi Marta

Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil.

http://orcid.org/0000-0002-0635-7970

Antônio Augusto de Freitas Peregrino

Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil.

http://orcid.org/0000-0002-6617-480X

Vivian Schutz

Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil.

http://orcid.org/0000-0002-5516-4489

Roberto Carlos Lyra da Silva

Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil.

http://orcid.org/0000-0001-9416-9525

Corresponding author: Márglory Fraga de Carvalho. E-mail: miurinha80@hotmail.com

EDITOR IN CHIEF: Dulce Aparecida Barbosa

ASSOCIATE EDITOR: Andrea Bernardes

Databases	Search strategies
Medical Literature Analysis and Retrieval System Online via PubMed	((("Drug Dispensed"[Title/Abstract] OR "Drug dispensers"[Title/Abstract] OR "Drug dispenser"[Title/Abstract] OR "Drug dispenses"[Title/Abstract] OR "Drug dispensing"[Title/Abstract]) OR ("medication systems, hospital"[MeSH Terms] OR ("Hospital Medication System"[Title/Abstract] OR "Hospital Medication Systems"[Title/Abstract]))) AND ((((("Automated dispensing cabinet"[Title/Abstract] OR "Automated dispensing machines"[Title/Abstract] OR "Automated dispensing devices"[Title/Abstract] OR "Automated medication dispensing cabinet"[Title/Abstract] OR "Robotic Dispensing System"[Title/Abstract] OR "Automated drug distribution cabinet system"[Title/Abstract] OR "Distribution cabinet system"[Title/Abstract] OR Medstation[Title/Abstract] OR Robot[Title/Abstract] OR Unit-based[Title/Abstract] OR Cabinets[Title/Abstract]) OR (("point of care systems"[MeSH Terms] OR "point of care systems"[Title/Abstract]) OR ("Point of Care Systems"[Title/Abstract] OR "Point-of-Care System"[Title/Abstract] OR "Point-of-Care"[Title/Abstract] OR "Point of Care"[Title/Abstract] OR "Bedside Computing"[Title/Abstract] OR "Point of Care Technology"[Title/Abstract] OR "Bedside Technology"[Title/Abstract] OR "Bedside Technologies"[Title/Abstract]))) OR ("drug storage"[MeSH Terms] OR (("storage drug"[Title/Abstract] OR "storage drugs"[All Fields]) AND Title/Abstract[All Fields]))) OR (("automatic data processing"[MeSH Terms] OR "automatic data processing"[Title/Abstract]) OR ("Electronic Data Processing"[Title/Abstract] OR "Computer Data Processing"[Title/Abstract] OR "Data Processing Computer"[Title/Abstract] OR "Data Processing Automatic"[Title/Abstract] OR "Optical Readers"[Title/Abstract] OR "Optical Reader"[Title/Abstract] OR "Reader Optical"[Title/Abstract] OR "Information Processing"[Title/Abstract] OR "Processing Information"[Title/Abstract] OR "information Processing Automatic"[Title/Abstract] OR "Automatic Information Processing"[Title/Abstract] OR "Bar Codes"[Title/Abstract] OR "Bar Code"[Title/Abstract] OR "Code Bar"[Title/Abstract]))) OR ((((((("medication therapy management"[MeSH Terms] OR "medication therapy management"[Title/Abstract]) OR "medication therapy management"[Title/Abstract]) OR "management medications"[Title/Abstract]) OR "therapy management practice"[Title/Abstract]) OR "drug therapy management"[Title/Abstract]) OR "management drugs"[Title/Abstract]) OR "therapy management group"[Title/Abstract]))) AND ((((("inpatients"[MeSH Terms] OR Inpatients[Title/Abstract]) OR Inpatient[Title/Abstract]) OR ((((((((("adult"[MeSH Terms] OR Adult[Title/Abstract]) OR Young Adult[Title]) OR "young adult"[MeSH Terms]) OR Aged[Title]) OR "aged"[MeSH Terms]) OR Aged[Title/Abstract]) OR (Midlle[All Fields] AND "aged"[MeSH Terms])) OR (Midlle[All Fields] AND Aged[Title/Abstract])) OR "adults"[Title/Abstract])) OR ((("drug utilization"[MeSH Terms] OR "utilization drug"[Title/Abstract]) OR "drug utilization"[Title/Abstract]) OR "drug utilizations"[Title/Abstract])) OR (((("administration, intravenous"[MeSH Terms] OR "administration intravenous"[Title/Abstract]) OR ("intravenous administration"[Title/Abstract] OR "intravenous administration 10"[Title/Abstract])) OR "intravenous administrations"[All Fields]) OR "administration intravenous"[All Fields])) AND ("humans"[MeSH Terms] )
SCOPUS	( ( TITLE-ABS-KEY ( inpatients OR inpatients OR inpatient OR adult OR adults OR "Young Adult" OR aged OR "Midlle Aged" OR "drug utilization" OR "utilization drug" OR "drug utilization" OR "drug utilizations" OR "administration intravenous" OR "administration intravenous" ) OR TITLE-ABS-KEY ( "intravenous administration" OR "intravenous administrations" OR "administration intravenous" ) ) ) AND ( ( ( TITLE-ABS-KEY ( "Automated dispensing cabinet" OR "Automated dispensing machines" OR "Unit dose dispensing robot" OR "Automated dispensing devices" OR "Automated medication dispensing cabinet" OR "Unit-based cabinets" OR "Automated distribution cabines" ) OR TITLE-ABS-KEY ( "Robotic Dispensing System" OR "Automated drug distribution cabinet system" OR "Distribution cabinet system" OR "Dispensing administration" OR medstation OR omnicel OR robot OR unit-based OR cabinets OR "point of care systems" OR "point of care systems" ) OR TITLE-ABS-KEY ( "Technology Bedside" OR "Technologies Bedside" OR "drug storage" OR "Drug Storages" OR "storage drug" OR "storage drugs" OR "automatic data processing" OR "automatic data processing" OR "Electronic Data Processing" ) ) ) OR ( ( TITLE-ABS-KEY ( "Data Processing Electronic" OR "Processing Electronic Data" OR "Computer Data Processing" OR "Data Processing Computer" OR "Processing Computer Data" OR "Data Processing Automatic" OR "Processing Automatic Data" ) OR TITLE-ABS-KEY ( "Optical Readers" OR "Optical Reader" OR "Reader Optical" OR "Readers Optical" OR "Information Processing" OR "Processing Information" OR "information Processing Automatic" OR "Automatic Information Processing" ) OR TITLE-ABS-KEY ( "Processing Automatic Information" OR "Bar Codes" OR "Bar Code" OR "Code Bar" OR "Codes Bar" OR "medication therapy management" OR "medication therapy management" OR "medication therapy management" OR "management medications" ) OR TITLE-ABS-KEY ( "therapy management practice" OR "drug therapy management" OR "management drugs" OR "therapy management group" ) ) ) ) AND ( ( TITLE-ABS-KEY ( "Drug Dispensatories" OR "Drug Dispensed" OR "Drug dispensers" OR "Drug dispenser" OR "Drug dispenses" OR "Drug dispensing" OR "medication systems hospital" OR "Medication Systems Hospital" OR "Drug Distribution Systems Hospital" ) OR TITLE-ABS-KEY ( "Hospital Medication System" OR "System Hospital Medication" OR "Systems Hospital Medication" OR "Systems Medication Hospital" OR "Hospital System Medication" ) OR TITLE-ABS-KEY ( "Hospital Systems Medication" OR "Medication Hospital System" OR "Medication Hospital Systems" OR "System Medication Hospital" OR "Hospital Unit Dose Drug Distribution System" ) OR TITLE-ABS-KEY ( "Hospital Unit Dose Drug Distribution Systems" OR "Medication System Hospital" OR "System Hospital Medication" OR "Hospital Medication System" ) OR TITLE-ABS-KEY ( "Hospital Medications System" OR "Medication System Hospital" OR "Medications System Hospital" OR "System Hospital Medications" OR "Drug Distribution System Hospital" OR "Hospital Medication Systems" )
Web of SCIENCE	((Tópico: (((((((((((((((((inpatients OR Inpatients) OR Inpatient) OR Adult) OR Adults) OR "Young Adult") OR Aged) OR "Midlle Aged") OR "drug utilization") OR "utilization drug") OR "drug utilization") OR "drug utilizations") OR "administration intravenous") OR "administration intravenous") OR "intravenous administration") OR "intravenous administration") OR "intravenous administrations") OR "administration intravenous") AND Tópico: (((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((("Automated dispensing cabinet" OR "Automated dispensing machines") OR "Unit dose dispensing robot") OR "Automated dispensing devices") OR "Automated medication dispensing cabinet") OR "Unit-based cabinets") OR "Automated distribution cabines") OR "Robotic Dispensing System") OR "Automated drug distribution cabinet system") OR "Distribution cabinet system") OR "Dispensing administration") OR meditation) OR omnicup) OR Robot) OR Unit-based) OR cabinet) OR "point of care systems") OR "point of care systems") OR "Point of Care Systems") OR "Point-of-Care System") OR "Systems Point-of-Care") OR "Point-of-Care") OR "Point of Care") OR "Bedside Computing") OR "Computing Bedside") OR "Point of Care Technology") OR "Bedside Technology") OR "Bedside Technologies") OR "Technology Bedside") OR "Technologies Bedside") OR "drug storage") OR "Drug Storages") OR "storage drug") OR "storage drugs") OR "automatic data processing") OR "automatic data processing") OR "Electronic Data Processing") OR "Data Processing Electronic") OR "Processing Electronic Data") OR "Computer Data Processing") OR "Data Processing Computer") OR "Processing Computer Data") OR "Data Processing Automatic") OR "Processing Automatic Data") OR "Optical Readers") OR "Optical Reader") OR "Reader Optical") OR "Readers Optical") OR "Information Processing") OR "Processing Information") OR "information Processing Automatic") OR "Automatic Information Processing") OR "Processing Automatic Information") OR "Bar Codes") OR "Bar Code") OR "Code Bar") OR "Codes Bar") OR "medication therapy management") OR "medication therapy management") OR "medication therapy management") OR "management medications") OR "therapy management practice") OR "drug therapy management") OR "management drugs") OR "therapy management group")) AND Tópico: ((((((((((((((((((((((((((((((("Drug Dispensatories" OR "Drug Dispensed") OR "Drug dispensers") OR "Drug dispenser") OR "Drug dispenses") OR "Drug dispensing") OR "medication systems hospital") OR "Medication Systems Hospital") OR "Drug Distribution Systems Hospital") OR "Hospital Drug Distribution Systems") OR "Hospital Medication System") OR "System Hospital Medication") OR "Systems Hospital Medication") OR "Systems Medication Hospital") OR "Hospital System Medication") OR "Hospital Systems Medication") OR "Medication Hospital System") OR "Medication Hospital Systems") OR "System Medication Hospital") OR "Hospital Unit Dose") OR "Drug Distribution System") OR "Hospital Unit Dose") OR "Drug Distribution Systems") OR "Medication System Hospital") OR "System Hospital Medication") OR "Hospital Medication System") OR "Hospital Medications System") OR "Medication System Hospital") OR "Medications System Hospital") OR "System Hospital Medications") OR "Drug Distribution System Hospital") OR "Hospital Medication Systems"))
Cumulative Index to Nursing and Allied Health Literature	(inpatients OR Inpatients OR Inpatient OR Adult OR Adults OR "Young Adult" OR Aged OR "Midlle Aged" OR "drug utilization" OR "utilization drug" OR "drug utilization" OR "drug utilizations" OR "administration intravenous" OR "administration intravenous" OR "intravenous administration" OR "intravenous administration" OR "intravenous administrations" OR "administration intravenous") AND ("Automated dispensing cabinet" OR "Automated dispensing machines" OR "Unit dose dispensing robot" OR "Automated dispensing devices" OR "Automated medication dispensing cabinet" OR "Unit-based cabinets" OR "Automated distribution cabines" OR "Robotic Dispensing System" OR "Automated drug distribution cabinet system" OR "Distribution cabinet system" OR "Dispensing administration" OR Medstation OR Omnicel OR Robot OR Unit-based OR Cabinets OR "point of care systems" OR "point of care systems" OR "Point of Care Systems" OR "Point-of-Care System" OR "Systems Point-of-Care" OR "Point-of-Care" OR "Point of Care" OR "Bedside Computing" OR "Computing Bedside" OR "Point of Care Technology" OR "Bedside Technology" OR "Bedside Technologies" OR "Technology Bedside" OR "Technologies Bedside" OR "drug storage" OR "Drug Storages" OR "storage drug" OR "storage drugs" OR "automatic data processing" OR "automatic data processing" OR "Electronic Data Processing" OR "Data Processing Electronic" OR "Processing Electronic Data" OR "Computer Data Processing" OR "Data Processing Computer" OR "Processing Computer Data" OR "Data Processing Automatic" OR "Processing Automatic Data" OR "Optical Readers" OR "Optical Reader" OR "Reader Optical" OR "Readers Optical" OR "Information Processing" OR "Processing Information" OR "information Processing Automatic" OR "Automatic Information Processing" OR "Processing Automatic Information" OR "Bar Codes" OR "Bar Code" OR "Code Bar" OR "Codes Bar" OR "medication therapy management" OR "medication therapy management" OR "medication therapy management" OR "management medications" OR "therapy management practice" OR "drug therapy management" OR "management drugs" OR "therapy management group") AND (Distribution OR "Medication Systems" OR "Drug dispensing" OR "Distribution Systems")
Virtual Health Library Regional Portal	tw:((dispensario OR distribuição OR dispensação OR armazenamento OR armazenagem OR estoque) AND (medicamento* OR droga* OR remedio) AND (eletronico OR robotico OR robo OR automati)) AND (instance:"regional") AND ( db:("LILACS" OR "IBECS" OR "BBO" OR "DECS" OR "colecionaSUS") AND la:("es" OR "pt" OR "en"))
Virtual Health Library Regional Portal	#1 "inpatients" or "Inpatients" or "Inpatient" or "Adult" or "Adults" or "Young Adult" or Aged or "Midlle Aged" or "drug utilization" or "utilization drug" or "drug utilization" or "drug utilizations" or "administration intravenous" or "administration intravenous" or "intravenous administration" or "intravenous administration" or "intravenous administrations" or "administration intravenous":ti,ab,kw (Word variations have been searched) #2 "Automated dispensing cabinet" or "Automated dispensing machines" or "Unit dose dispensing robot" or "Automated dispensing devices" or "Automated medication dispensing cabinet" or "Unit-based cabinets" or "Automated distribution cabines" or "Robotic Dispensing System" or "Automated drug distribution cabinet system" or "Distribution cabinet system" or "Dispensing administration" or Medstation or Omnicel or Robot or Unit-based or Cabinets or "point of care systems" or "point of care systems" or "Point of Care Systems" or "Point-of-Care System" or "Systems Point-of-Care" or "Point-of-Care" or "Point of Care" or "Bedside Computing" or "Computing Bedside" or "Point of Care Technology" or "Bedside Technology" or "Bedside Technologies" or "Technology Bedside" or "Technologies Bedside" or "drug storage" or "Drug Storages" or "storage drug" or "storage drugs" or "automatic data processing" or "automatic data processing" or "Electronic Data Processing" or "Data Processing Electronic" or "Processing Electronic Data" or "Computer Data Processing" or "Data Processing Computer" or "Processing Computer Data" or "Data Processing Automatic" or "Processing Automatic Data" or "Optical Readers" or "Optical Reader" or "Reader Optical" or "Readers Optical" or "Information Processing" or "Processing Information" or "information Processing Automatic" or "Automatic Information Processing" or "Processing Automatic Information" or "Bar Codes" or "Bar Code" or "Code Bar" or "Codes Bar" or "medication therapy management" or "medication therapy management" or "medication therapy management" or "management medications" or "therapy management practice" or "drug therapy management" or "management drugs" or "therapy management group":ti,ab,kw (Word variations have been searched) #3 "Drug Dispensatories" or "Drug Dispensed" or "Drug dispensers" or "Drug dispenser" or "Drug dispenses" or "Drug dispensing" or "medication systems hospital" or "Medication Systems Hospital" or "Drug Distribution Systems Hospital" or "Hospital Drug Distribution Systems" or "Hospital Medication System" or "System Hospital Medication" or "Systems Hospital Medication" or "Systems Medication Hospital" or "Hospital System Medication" or "Hospital Systems Medication" or "Medication Hospital System" or "Medication Hospital Systems" or "System Medication Hospital" or "Hospital Unit Dose Drug Distribution System" or "Hospital Unit Dose Drug Distribution Systems" or "Medication System Hospital" or "System Hospital Medication" or "Hospital Medication System" or "Hospital Medications System" or "Medication System Hospital" or "Medications System Hospital" or "System Hospital Medications" or "Drug Distribution System Hospital" or "Hospital Medication Systems":ti,ab,kw (Word variations have been searched) #4 #1 and #2 and #3
EMBASE	(inpatient:ab,ti OR 'hospital patient'/de OR 'hospital patient'/exp OR 'hospital patient':ti,ab AND ('drug utilization':ab,ti OR 'drug use'/exp OR 'drug use':ti,ab OR 'intravenous drug administration'/exp OR 'intravenous drug administration':ti,ab)) AND ('medication therapy management'/exp OR 'medication therapy management':ti,ab OR 'drug therapy management':ab,ti OR 'hospital medication systems':ab,ti OR 'hospital organization'/exp OR 'hospital organization':ti,ab OR (storage:ab,ti AND drug:ab,ti) OR 'drug storage'/exp OR 'drug storage':ti,ab) AND ('automatic data processing':ti OR 'information processing'/exp OR 'information processing':ti OR 'point-of-care systems':ti OR 'bedside computing':ti OR 'distribution cabinet system':ti OR 'automated dispensing cabinet':ti OR 'chest':ti OR cabinet:ti OR 'medicine chest'/exp OR 'medicine chest':ti)
COCHRANE LIBRARY	Utilization, Drug OR Drug Utilizations AND Drug Storages OR Storage, Drug AND Safety, Equipment OR Medical Device Safety OR Device Safety AND Therapy management, drug OR Management, Medication Therapy AND Medication systems, hospital OR System, medication hospital OR Hospital unit dose drug distribution system OR Drug distribution systems, hospital AND error OR Error, medication OR Drug Use Error OR Use Errors, Drug OR Medication errors AND Healthcare Close Call OR Close Calls, Healthcare AND Safety, Patient OR Patient Safeties

Studies	Type of study/ population/setting	Intervention	Outcomes	Results	Limitations	Oxford
RODRIGUEZ-GONZALEZ CG et al.⁽¹⁰10 Rodriguez-Gonzalez CG, Martin-Barbero ML, Herranz-Alonso A, Durango-Limarquez ML, Hernandez-Sampelayo P, Sanjurio-Saez M, et al. Use of failure mode, effect and criticality analysis to improve safety in the medication administration process. J Eval Clin Pract. 2015;21(4):54-9. doi: 10.1111/jep.12314 https://doi.org/10.1111/jep.12314... ⁾ Spain	Root Cause Analysis (FMEA) and Expert Panel. Inpatient units in a general university hospital with 1381 beds.	Drug administration in a unit that uses the Computerized Physician Order Entry connected to the automated dispensing system (ADS).	Errors and adverse events in drug administration based on a critical index (RPN >100).	Administration of medication to the patient is the phase with the highest risk (Total RPN = 2065). The recovery of medication in the ADS is in 5th place in the criticality ranking (Total RPN = 535). Most common types of errors: incorrect dose (RPN = 320); incorrect medication (RPN = 288).	Inevitable subjectivity in the selection of failure modes and calculation of the critical index. Low possibility of extrapolation of the results.	5D
CHAPUIS C et al.⁽¹¹11 Chapuis C, Bedouch P, Detavernier M, Durand M, Francony G, Lavagne P, et al. Automated drug dispensing systems in the intensive care unit: a financial analysis. Crit Care [Internet]. 2015 [cited 2017 Oct 20];19(1):308. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563942/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ France	Cash flow analysis - before and after. Direct observation of 20 nurses and 20 pharmacy technicians for 10 days before and after implementation. 03 surgical ICUs and a total of 2,082 admissions.	Automated drug dispensing system (Omni RX^®).	Global cash flow - value of generated cash to pay back the invested capital and net present value (NPV) of the ADS. *With an annual rate of return of 4% and a residual cost at year 5 of 10% of the initial price.	Reduction of drug storage cost = 44.298 Euros. Reduction of cost of expired drugs = 14.772 Euros. Global cash flow global (at year 5) was 148.229 Euros and the net present value of the project was positive by 510.404 Euros. Average of 14.7 hours saved per day for nurses and average of 3.5 additional hours per day for pharmacy technicians.	Did not calculate fees or costs due to medication errors (Outcome of interest).	4C
COUSEIN E et al.⁽¹²12 Cousein E, Mareville J, Lerooy A, Caillau A, Labreuche J, Dambre D, et al. Effect of automated drug distribution systems on medication error rates in a short-stay geriatric unit. J Eval Clin Pract [Internet]. 2014 [cited 2017 Oct 20];20(5):678-84. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jep.12202 https://onlinelibrary.wiley.com/doi/abs/... ⁾ France	Descriptive, before and after. Direct observation of medication administration to 314 patients admitted to a 40-bed geriatric unit in a 1800-bed General Hospital.	Impact of change of the drug distribution system from a ward stock system to a unit dose dispensing system, integrating an ADS	Overall rate of medication administration errors.	Rate of medication administration errors before intervention = 10.6%; CI 95% 8.1-13.9%. Rate of medication administration errors after intervention = 5.0%, CI 95% 3.5-6.9% (P <0.001), Absolute risk reduction 5.7%, relative risk reduction (RRR) = 53%. Wrong dose error was reduced by 79.1% (2.4% versus 0.5%, P = 0.005) and wrong drug errors were reduced by 93.7% (1.9% versus 0.01%, P = 0.009). OR: 0.68 CI 95% (0.46-1.02)	Did not compare intervention and control.	2B
LO A et al.⁽¹³13 Lo A, Zhu JN, Richman M, Joo J, Chan P. Effect of adding piperacillin-tazobactam to automated dispensing cabinets on promptness of first-dose antibiotics in hospitalized patients. Am J Health Syst Pharm. 2014;71(19):1662-7. doi: 10.2146/ajhp130694 https://doi.org/10.2146/ajhp130694... ⁾ United State of American	Descriptive, before and after. Review of medical records: pre-implementation (n = 65) and post-implementation (n = 56) in a 377-bed emergency service in California.	Addition of intravenous antibiotics to ADS in patient care units.	Reduction of the time of initiation of antibiotics with the use of the ADS in the emergency department.	Reduction in order-to-administration time (from 4.5 ± 4.1 to 2.9 ± 2.5 hours, p = 0.009) for piperacillin-tazobactam first doses. There was a significant 1.7-hour reduction in the mean.	Did not use sample calculation. It cites a statistical power of 57.2%. There was discrepancy between the pre and post intervention measurement times.	2B
OTERO LÓPEZ MJ et al.⁽¹⁴14 Otero López MJ, Bermejo Vicedo T, Moreno Gómez AM, Aparicio Fernández MA, Palomo Cobos L, Grupo de Trabajo TECNO de la SEFH. Análisis de la implantación de prácticas seguras en los sistemas automatizados de dispensación de medicamentos. Farm Hosp. 2013;37(6):469-81. doi: 10.7399/FH.2013.37.6.1053 https://doi.org/10.7399/FH.2013.37.6.105... ⁾ Spain	Survey Conducted in 36 general hospitals. Scale assessment (Likert), in which the maximum possible score was 465 (=all practices were implemented).	Degree of implementation of safe practices for the design and use of the ADS.	Mapping of practices little-used or not yet implemented related to the proper use of the ADS.	83.3% of the hospitals had implemented unit dose and/or automated systems. Only 1/3 used the ADS as a single dispensing system. ADS as the main dispensing system and connected to electronic prescription: 36.1% of hospitals that used ADS. Lowest score was for removal of medications from the ADS using the override function (28,4%).	Does not cite response rate and the number of questionnaires sent or validated. However, this Survey draws attention to the configuration of alternative technology and the high risk of the override function, suggesting potential risks of drug errors.	5D
HELMONS PJ, DALTON AJ, DANIELS CE⁽¹⁵15 Helmons PJ, Dalton AJ, Daniels CE. Effects of a direct refill program for automated dispensing cabinets on medication-refill errors. Am J Health Syst Pharm. 2012;69(19):1659-64. doi: 10.2146/ajhp110503 https://doi.org/10.2146/ajhp110503... ⁾ United State of America	Descriptive, before and after. A total of 6829 pockets in 26 ADS and 3855 pockets in 24 ADS were inventoried 5 months before (pre) and 18 months after (post). US medical center with 386 beds.	A filling program connected to the bar-code system. * Scanning prepackaged drugs still in stock provides safe administration.	Medication-refill errors were defined as a pocket or compartment containing the wrong drug or wrong dosage.	Reduction in ADS refill errors = 77%, from 62 errors per 6829 refilled pockets (0.91%) to 8 errors per 3855 refilled pockets (0.21%) (p <0.0001). Type of error: incorrect medication in the ADS drawer (before: n=30; 48% versus after: n=1; 13%). OR:0,23 CI 95% (0.11-0.47)	Discrepancy in collection time (5 months before and 18 months after intervention). However, it signals the potential risk associated with technology and the benefits of using bar-codes not only at the bedside, but from the storage stage, reinforcing the principle of traceability.	2B
RODRIGUEZ-GONZALEZ CG et al.⁽¹⁶16 Rodriguez-Gonzalez CG, Herranz-Alonso A, Martin-Barbero ML, Duran-Garcia E, Durango-Limarquez MI, Hernández-Sampelayo P, et al. Prevalence of medication administration errors in two medical units with automated prescription and dispensing. J Am Med Inform Assoc. 2012;19(1):72-8. doi: 10.1136/amiajnl-2011-000332 https://doi.org/10.1136/amiajnl-2011-000... ⁾ Espanha	Prevalence study. 2314 medication preparations and administration to 73 patients, using ADS, were observed in a 1537-bed hospital in Madrid.	Computerized Physician Order Entry connected to ADS.	Drug administration errors and their potential risk factors.	ME: 509 errors were recorded (22.0%), 68 (13.4%) in preparation and 441 (86.6%) in administration. Most common type: wrong administration techniques (especially concerning food intake (13.9%). Errors were mostly classified as no damage (95.7%).	Does not mention the number of nurses observed or the profile of patients admitted to the units.	4C
SIKKA R et al.⁽¹⁷17 Sikka R, Sweis R, Kaucky C, Kulstad E. Automated dispensing cabinet alert improves compliance with obtaining blood cultures before antibiotic administration for patients admitted with pneumonia. Jt Comm J Qual Patient Saf. 2012;38(5):224-8. doi: 10.1016/S1553-7250(12)38028-8 https://doi.org/10.1016/S1553-7250(12)38... ⁾ United State of America	Descriptive, before and after. Based on medical records and ADS of 951 adult patients with pneumonia admitted to the emergency department of a 700-bed hospital in Chicago.	Alert/lock in antibiotic ADS, preventing dispensing without prior collection of blood cultures and results.	Measure impact on compliance with rational use of antibiotics.	Compliance with obtaining blood cultures prior to antibiotic administration was 84% (205/245, CI95%: 79% -88%) and 95% (275/291, IC95%: 92-97%) in the pre and postintervention periods, respectively (p <. 0.001).	Did not examine the impact of patient demographics, day of the week, time of year, or overcrowding in the unit on compliance with obtaining blood cultures prior to initiation of antibiotics and did not consider a secondary diagnosis of pneumonia or misdiagnosis.	2B
ZAFRA FERNÁNDEZ JL, ISLA TEJERA B, PADRO LLERGO J⁽¹⁸18 Zafra Fernández JL, Isla Tejera B, Padro Llergo JR. Efecto de un sistema automático de dispensación de medicamentos sobre el gasto farmacéutico y el grado de satisfacción del usuario. Enferm Glob. 2012;11(25):250-61. doi: 10.4321/S1695-61412012000100015 https://doi.org/10.4321/S1695-6141201200... ⁾ Spain	Economic assessment, before and after. From April to August 2009 (pre-implementation period) and from April to August 2010 (post-implementation period). 110 questionnaires were sent, with a 63% response rate.	Replacement of traditional drug stocks by the implementation of ADS in the Intensive Care Unit.	Cost reduction and user satisfaction.	Reduction of total costs: 24%. Reduction of costs with personnel: 11%. Reduction of costs with medication: 24%. Increased workload of Pharmacy assistant (increasing from 144 hours to 792 hours per year). Users are satisfied with the implementation and 84% of nurses would recommend it to other units.	Did not measure medication errors to relate to drug cost reductions.	5C
PEDERSEN CA, SCHNEIDER PJ, SCHECKELHOFF DJ⁽¹⁹19 Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP National survey of pharmacy practice in hospital settings: dispensing and administration - 2011. Am J Health Syst Pharm. 2012;69(9):768-85. doi: 10.2146/ajhp110735 https://doi.org/10.2146/ajhp110735... ⁾ United State of America	Survey. A questionnaire was answered by the pharmacy directors of 1439 hospitals. 562 questionnaires were returned and the overall response rate was 40.1%.	ASHP National Survey on Drug Dispensing and Administration.	Survey of dispensing systems and their characteristics over the years.	Used a central unit dose distribution system: 60%. Used combined ADS in their distribution systems: 89%. About 96.2% of the ADS used specific medication profiles for the patients, which involved a verification by the pharmacist prior to drug release. Among the hospitals with ADS, 65.7% used compartments with individually secured lid.	Low response rate. Does not mention the rate of drug errors in the ADS over the years, but points out that the option for compartments with individual lids and limited authorization for withdrawal are increasing needs in the hospitals evaluated.	5D
ÁLVAREZ DÍAZ AM et al.⁽²⁰20 Álvarez Díaz AM, Delgado Silveira E, Menéndez-Conde CP, Pintor Recuenco R, López de Silanes EGS, Serna Pérez J, et al. Nuevas tecnologías aplicadas al proceso de dispensación de medicamentos: análisis de errores y factores contribuyentes. Farm Hosp [Internet]. 2010 [cited 2017 oct. 26];34(2):59-67. doi: 10.1016/j.farma.2009.12.003 https://doi.org/10.1016/j.farma.2009.12.... ⁾ Spain	Prospective cohort. Direct observation of the steps of the medication system by a pharmacist on weekdays for 6 months, in a 1070-bed general hospital in Spain.	The use of ADS with and without computerized prescription and dispensing with unitary dose with and without computerized prescription.	Prevalence of errors in different drug dispensing systems.	2,181 errors were detected among 54,169 opportunities of error. Error rate: stock = 10.7%; Unit dose without Computerized Physician Order Entry = 3.7%; Unit dose with Computerized Physician Order Entry = 2.2%; ADS without Computerized Physician Order Entry = 20.7%; ADS with Computerized Physician Order Entry = 2.9%. OR: 6.72 CI 95% (5.78-7.81) Error rate in the filling of the ADS: 20.7%. The most common type of error was omission of doses, with a 11% rate, and different amount of drug in the ADS, with a 5.6% rate.	Single observer in the field. July and August were excluded from the study without justification. Urgent prescriptions or administrations on Saturdays, Sundays and holidays were not considered.	4C
SERAFIM SAD et al.⁽²¹21 Serafim SAD, Forster AC, Simões MJS, Penaforte TR. Assessment of informatization for the dispensing of medications at a university hospital. Clinics. 2010;65(4):417-24. doi: 10.1590/S1807-59322010000400011 https://doi.org/10.1590/S1807-5932201000... ⁾ Brazil	Descriptive. Retrospective review of pharmacy medical records and reports and interviews with 83 professionals - nurses, pharmacists and pharmacy assistants - in an 860-bed university hospital integrated into the Brazilian National Health Service.	Implementation of a computerized drug dispensing system (electronic prescription + dose fractionation machines for unit doses + bar-code systems).	To evaluate the effect on nursing and pharmacy services.	The label was considered legible by 82.8% of the nursing staff (48/58). The system was considered safe by 84.5% (49/58) of the nursing staff and 72.0% (18/25) of the pharmacy staff. Advantages: elimination of manual transcription of prescriptions; increased speed in the process; better identification of doses prescribed by physicians; labels containing all necessary identification; and practicality and safety of optical bar code-based verification of the requested and dispensed medications.	Did not measure medication errors, did not report the total of retrospectively evaluated records, and did not measure the nursing workload after implementing the new technology.	4C
KOWIATEK JG et al.⁽²²22 Kowiatek JG, Weber RJ, Skledar SJ, Frank S, DeVita M. Assessing and monitoring override medications in automated dispensing devices. Jt Comm J Qual Patient Saf. 2006;32(6):309-17. doi: 10.1016/S1553-7250(06)32040-5 https://doi.org/10.1016/S1553-7250(06)32... ⁾ Germany	Descriptive, before and after. Expert panel and audit University of Pittsburgh Medical Center, with 647 beds.	Override monitoring tool to perform random audits and determine nursing compliance.	Assessed the safety of the ADS override process.	Monthly nursing management errors related to override decreased from 1.13 errors in the pre period to 1.07 errors in the post period. The severity of the errors showed no significant changes between the pre and post periods. The severity of the errors showed no significant changes between the pre and post periods.	Does not mention the number of ADS evaluated and the percentage of error in relation to the total number of drugs dispensed.	2B
POVEDA ANDRÉS JL et al.⁽²³23 Poveda Andrés JL, García Gómez C, Hernández Sansalvador M, Walsh AV. Análisis coste-beneficio de la implantación de los sistemas automáticos de dispensación de medicamentos en las unidades de críticos y urgencias. Farm Hosp. 2003;27(1):4-11.⁾ Spain	Economic evaluation, (cost benefit and budget impact). 11 ADS in the Intensive Care Unit and emergency of a University Hospital Complex in Madrid were analyzed.	Implementation of ADS in the emergency and ICU sectors.	Technology implementation cost.	The initial value was 330,557 Euros in 2000 and, at the end of 04 years, it reached 61,964 Euros. Positive benefit/cost ratio 1.95. Savings and global cash flow of 300,525 in 5 years.	Did not address indirect costs with drug errors before and after implementation.	4C
ÁLVAREZ RUBIO L et al.⁽²⁴24 Álvarez Rubio L, Martín Conde J, Alberdi Léniz A, Plasencia García I, Cáceres Gonzalez F, Martín Martín A. Evaluación de un sistema automático de dispensación en el Servicio de Urgencias de un hospital de tercer nivel. Farm Hosp. 2003;27(2):72-7.⁾ Spain	Descriptive. Emergency of a university hospital in Spain. Data from pre and post intervention reports.	Implementation of ADS in the emergency sector.	Assess cost per patient, cost per drug, and workload.	Increase of workload in the pharmacy service, from 3 to 8.75 hours per week. As for inventory management, there was a total reduction from 797 to only 97 types of drugs in stock (13%). Inventory value recovered: 922.75 Euros.	Did not specify the number of ADS implemented and did not conduct a pilot study to find pre-intervention baseline values for comparison.	4C

[1] Corresponding author: Márglory Fraga de Carvalho. E-mail: miurinha80@hotmail.com

Brasil

Brasil

Eficacia del sistema de dispensación electrónica de medicamentos: revisión sistemática y metaanálisis

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