Introduction of Unit-Dose Care in the 1,125 Bed Teaching Hospital: Practical Experience and Time Saving on Wards

Figures & data

Table 1 Representation of the Time Spent for Sub-Processes in Minutes

	t0 [min]	t1 [min]	t2 [min]	∆t0-t1 [min]	∆t0-t2 [min]
Ordering drugs	1.41 ± 0.15	0.71 ± 0.08	0.69 ± 0.09	0.69^####	0.71 ****
Sorting in	0.94 ± 0.30	0.74 ± 0.18	0.86 ± 0.06	0.20^#	0.08
Dispensing	4.52 ± 0.35	1,88 ± 0.17	1.67 ± 0.15	2.64^####	2.85 ****
Control	1.53 ± 0.30	1.50 ± 0.16	1.00 ± 0.16	0.03	0.53 **
Total	8.39 ± 0.55	4.83 ± 0.27	4.22 ± 0.23	3.56^####	4.17 ****

Notes: Spent times per medication process on ward with time gaps between t₀/t₁ and t₀/t₂. *= significant change between t₀ and t₂ (****p = 0.0001; **p = 0.005) using Mann–Whitney U-test; # = significant change between t₀ and t₁ (^####p = 0.0001; ^#p = 0.05) using Mann–Whitney U-test.

Figure 1 Satisfaction with UDDS from the perspective of the nursing staff. The results are presented in percentages with the following scale levels: dark red: do not agree at all, light red: agree rather less, light blue: agree rather, dark blue: agree completely; UDDS = Unit-dose dispensing system.

Figure 2 Stock-keeping on ward of the drugs by tablet count. Second quarter 2019 (white) versus second quarter 2022 (green) shows a significant reduction in immediate ward demand for the drugs metoprolol 47.5 mg tablets (A), metformin 1,000 mg tablets (B) and metamizole 500 mg tablets (C) (****p = 0.0001; paired t-test for metoprolol and metformin, Wilcoxon test for metamizole). The results are shown as a box-whisker plot (5–95 percentiles).

Figure 3 Representation of the mean time spent per patient per day on the ward. Before the introduction of the UDDS (t_o white), four weeks after introduction of the UDDS (t₁ light green) and from six months after introduction of the UDDS (t₂ green). Total time spent on medication-related processes (median ± SEM).****Significant change between t₀ and t₂ (****p = 0.0001) using Mann–Whitney U-test ^####=significant change between t₀ and t₁ (^####p = 0.0001) using Mann–Whitney U-test; min = minutes.

Table 2 Presentation of the Key Data Required for the Calculation of Relieved FTE Nurses for HK-EF Taking Gross and Net Working Time into Account

	HK-EF gross working time	HK-EF net working time
Time reduction	4.17 min per patient per day	4.17 min per patient per day
Cases	2019: 50,000 cases per year 2022: 40,000 cases per year	2019: 50,000 cases per year 2022: 40,000 cases per year
Care days per case	5.96	5.96
UDDS-supplied beds	1,125	1,125
Hours/year FTE	2,002 hours (38.5 hours/week)	1,573.11 hours (38.5 hours/week)
Relief FTE	2019: 9.20 FTE 2022: 7.36 FTE	2019: 11.70 FTE 2022: 9.36 FTE

Notes: The number of care days and cases per year excludes psychiatric wards, which are included in the number of beds with UDDS care. Since no care days were recorded in 2019 for accounting reasons, the calculation is based on the care days of 2022. UDDS = unit-dose dispensing system; HK-EF = Helios Klinikum Erfurt; FTE = full-time equivalent.

Abbreviations: UDDS, unit-dose dispensing system; CLMM, closed-loop medication management; CPOE, computerised physician order entry; CP, clinical pharmacist; CDSS, clinical decision support system; FTE, full-time equivalent; HK-EF, Helios Klinikum Erfurt; PTA, pharmaceutical technical assistants.