The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments

Int J Pharm Pract. 2018 Dec;26(6):526-533. doi: 10.1111/ijpp.12432. Epub 2018 Jan 22.


Closed-loop electronic medication management systems (EMMS) are recognised as an effective intervention to improve medication safety, yet evidence of their effectiveness in hospitals is limited. Few studies have compared medication turnaround time for a closed-loop electronic versus paper-based medication management environment.

Objective: To compare medication turnaround times in a paper-based hospital environment with a digital hospital equipped with a closed-loop EMMS, consisting of computerised physician order entry, profiled automated dispensing cabinets packaged with unit dose medications and barcode medication administration.

Method: Data were collected during 2 weeks at three private hospital sites (one with closed-loop EMMS) within the same organisation network in Queensland, Australia. Time between scheduled and actual administration times was analysed for first dose of time-critical and non-critical medications located on the ward or sourced via pharmacy.

Key findings: Medication turnaround times at the EMMS site were less compared to the paper-based sites (median, IQR: 35 min, 8-57 min versus 120 min, 30-180 min, P < 0.001). For time-critical medications, 77% were administered within 60 min of scheduled time at the EMMS site versus 38% for the paper-based sites. Similar difference was observed for non-critical medications, 80% were administered within 60 min of their scheduled time at the EMMS site versus 41% at the paper-based facilities.

Conclusion: The study indicates medication turnaround times utilising a closed-loop EMMS are less compared to paper-based systems. This improvement may be attributable to increased accessibility of medications using automated dispensing cabinets and electronic medication administration records flagging tasks to nurses in real time.

Keywords: closed-loop; electronic; medication; turnaround time.

Publication types

  • Comparative Study

MeSH terms

  • Drug Prescriptions
  • Electronic Data Processing
  • Electronic Prescribing*
  • Humans
  • Medical Order Entry Systems / organization & administration*
  • Medication Systems, Hospital / organization & administration*
  • Multi-Institutional Systems
  • Pharmacy Service, Hospital / organization & administration*
  • Queensland
  • Time Factors