Enhancing anesthesiology medication safety and security through implementation of an automated dispensing system in a multihospital health system

PURPOSE: This quality improvement project describes the implementation of 150 Automated Dispensing Cabinets (ADCs) across a large multihospital health system's surgical and procedural areas to enhance medication safety and security in anesthesiology practice by addressing vulnerabilities in controlled substance handling, medication documentation, and diversion risk. SUMMARY: An internal audit identified significant opportunity for greater adherence to American Society of Health-System Pharmacists recommendations regarding controlled substance dispensing, medication labeling, and barcode scanning. In response, over 150 ADCs were deployed across the enterprise to provide point-of-care dispensing, electronic tracking, and automated label generation. A multidisciplinary team conducted comprehensive planning including physical assessments, medication inventories with particular attention to look-alike/sound-alike medication separation, inventory management protocols, and extensive staff training. Following full implementation which began in 2022, the system processed 737,906 total annual medication vends across the health system with closed loop tracking for controlled substances. Electronic monitoring replaced manual audits, enabling comprehensive insight into transactions, and supporting more efficient identification of workflow variances. CONCLUSION: Implementation of ADCs fundamentally transformed perioperative medication administration by providing real-time surveillance, eliminating large quantities of pre-dispensed controlled substance practices, and enabling comprehensive waste tracking with the ability for 100% testing capability. The transition from paper-based to electronic systems substantially improved accountability, documentation accuracy, and security measures against diversion. This multidisciplinary approach demonstrates that systematic innovation in medication management significantly enhances patient safety while creating more efficient and sustainable clinical workflows.