Unit dose drug dispensing systems in hospitals: a systematic review of medication error reduction and cost-effectiveness

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: MAEs reduced from 19.5% to 15.8% (with barcode integration); harmful MAEs reduced from 3.0% to 0.3%; overall medication errors reduced by 45–70%; dispensing time reduced by approximately 50% per patient per day

• Primary Outcome: Reduction in medication administration errors (MAEs) and overall medication errors in inpatient hospital settings following implementation of automated UDDS

• Nnt Or Sensitivity: Cost-effectiveness ratio: €17.69 per avoided MAE; €30.23 per avoided potentially harmful MAE. NNT not calculable from available data. No sensitivity or specificity data applicable.

• Confidence Interval: Not reported for any outcome

Clinical Application

Implementation requires significant upfront capital investment in automated dispensing hardware and software integration. Workflow redesign and staff training are necessary. Gradual phased rollout is recommended by the authors to mitigate disruption. Integration with barcode medication administration (BCMA) systems appears to amplify error-reduction benefits. In the Australian context, automated UDDS aligns with the Australian Commission on Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards, particularly Standard 4 (Medication Safety). The Therapeutic Goods Administration (TGA) regulates automated dispensing devices as medical devices under the Therapeutic Goods Act 1989. PBS-listed medicines dispensed via UDDS must comply with PBS dispensing requirements, which may require pharmacy workflow adaptation. RACGP and SHPA (Society of Hospital Pharmacists of Australia) guidelines support medication reconciliation and closed-loop medication management systems. Australian public hospital pharmacy departments considering UDDS implementation should note that state-based health technology assessment processes (e.g., NSW Agency for Clinical Innovation, Victorian DHHS) may require local cost-effectiveness modelling before procurement approval. The cost-effectiveness figures reported (€17.69 per avoided MAE) require conversion and local calibration to Australian healthcare cost structures. Inpatients in acute hospital settings where medication dispensing is currently performed via conventional (non-automated) systems, particularly high-volume wards with complex polypharmacy patients

Abstract

BACKGROUND: Medical errors pose significant risks to patient safety and public health. Automated unit dose drug dispensing systems (UDDSs) have emerged as valuable tools to reduce medication errors while optimising economic and logistical resources. OBJECTIVES: This systematic review aims to evaluate studies specifically focused on the impact of automated UDDSs in reducing medication errors and streamlining processes. METHODS: A literature search was performed on PubMed, Scopus, and Web of Science, focusing on peer-reviewed articles published between 2019 and 2024. The search, concluded on 24 September 2024, included studies conducted in inpatient hospital settings that assessed automated UDDS effects on medication errors, therapy management and inventory control. Outcomes examined included effects on patient safety, cost-effectiveness and inventory management. Results were synthesised qualitatively. RESULTS: From 3346 references, four studies met the inclusion criteria: a cost-effectiveness analysis, an uncontrolled before-and-after study, and two observational studies. UDDS improved medication processes, reducing drug-related problems, medication handling and dispensing time by 50% per patient per day. Integrated with barcode scanning, UDDS lowered medication administration errors (MAEs) from 19.5% to 15.8% and harmful MAEs from 3.0% to 0.3%. Overall, medication errors dropped by 45-70%, enhancing safety and reducing manual handling risks. UDDS demonstrated cost-effectiveness by significantly reducing MAEs. The study estimated a reduction in MAEs, with a cost-effectiveness ratio of €17.69 per avoided MAE. For potentially harmful MAEs, the cost-effectiveness ratio was estimated at €30.23 per avoided error. These findings suggest substantial long-term savings potential, though the exact magnitude may vary depending on hospital size and implementation specifics CONCLUSIONS: Automated UDDSs improve patient safety by significantly reducing medication errors and delivering cost savings through better inventory management. Challenges such as high initial costs and workflow adjustments can be mitigated through gradual implementation and staff training. Further integration with other healthcare technologies, such as barcoding, real-time tracking, artificial intelligence (AI)-driven error prevention tools and fully automated restocking systems could enhance UDDS benefits and further support hospital processes.

References

1. 1.Gallina, M., Testagrossa, M., & Provenzani, A. (2026). Unit dose drug dispensing systems in hospitals: a systematic review of medication error reduction and cost-effectiveness. European Journal of Hospital Pharmacy: Science and Practice. https://doi.org/10.1136/ejhpharm-2024-004444