One-Stop Dispensing: Hospital Costs and Patient Perspectives on Self-Administration of Medication

1) Objective: To assess staff time and hospital medication costs between One-Stop 18 Dispensing (OSD) and the Traditional Medication System (TMS), and to evaluate patient 19 perspectives on OSD. 2) Methods: The study was conducted at Hvidovre Hospital, University of 20 Copenhagen, Denmark in an elective gastric surgery and acute orthopedic surgery department. 21 The study was designed as an intervention study with a historical control group receiving TMS. 22 The intervention group included adult patients able to self-administer medication. Time 23 measurements included time used by nurses and pharmacy staff to dispense and administer 24 medication as well as medication dialogue. Medication costs with two days of discharge 25 medication were compared between OSD and TMS. Patient satisfaction related to OSD was 26 evaluated by a questionnaire based on a five-point Likert scale ( v́ery poor  ́(1) to v́ery good  ́(5)). 27 3) Results: Seventy-eight elective and 70 acute patients were included. Compared with TMS, OSD 28 significantly reduced used staff time by an average of 12 minutes (P< 0.0001) per patient per 29 hospitalization. Overall, there was no significant increase in medication cost per patient for OSD 30 (1.68 € [CI 95 -0.51 ― 3.87]) (P=0.13). Mean scores for the OSD satisfaction questionnaire ranged 31 from 4.3―4.8. OSD was associated with significantly lower used staff time. 4) Conclusion: Staff 32 time in OSD was significantly lower, there were no differences in medication costs and the patients 33 were overall satisfied with OSD. 34

The intervention group included adult patients able to self-administer medication. Time  49 and automated dose dispensing, where medication is machine-packed into patient-specific bags 50 [14]. However, a new approach is to increase patient involvement in the system [15][16][17]. Patients 51 are likely to know about their own medications used prior to hospitalization, and allowing patients 52 to continue administering their own medication when hospitalized is suggested to could prevent 53 disruption of daily practices and may reduce medication errors [15,18,19]. A systematic literature

64
The objectives of this study were: (1) to compare total nurse and pharmacy staff time to     approved it prior to its start. All nursing and pharmacy staff involved in the study were provided 77 with written and verbal information during at least two staff meetings. The staff was informed that 78 participation was voluntary and they could withdraw from the study at any time. All data was 79 anonymized before any analysis, and no personal data about the observed staff was collected.

105
Patient lists for both wards were screened for potential OSD participants by pharmacy staff.

106
Elective patients were asked to bring their own medication in original containers prior to hospital 107 admission, while acute patients were asked to bring their own medication within 24 hours after 108 admission. Upon inclusion, pharmacy staff recorded an updated medication history for all patients 109 and conducted quality control of POM in accordance with the criteria described by Nielsen et al. [22] .

110
In case of discrepancies between the recorded medication history and the patient's electronic during hospitalization, e.g. due to surgery or pain, the patient was excluded.

117
Patients began to self-administer medication from the first day after surgery.  prescribed "as needed" during hospital admission or stored in a refrigerator were still administrated 125 by the staff. The TMS group received standard care as described previously.

126
One-Stop Dispensing from day 2 to discharge 127 Patients included in OSD were attended to by nursing or pharmacy staff on ward rounds. The 128 patients' medications were continually supplied, and prescriptions were updated when necessary.

129
If dosages of any self-administered medication were changed containers were re-labeled.   costs during hospitalization plus ten days after discharge with and without nutritional supplements.

179
Calculations with ten days of discharge medication were performed to explore the cost of this

208
Inability to self-administer medication prior to admission was the primary reason for exclusion

222
Overall, no difference (P=0.13) was found in medication costs between OSD patients with two 223 days of discharge medication without nutritional supply compared to TMS (

226
Patients perspectives related to OSD are given in

251
Our study shows that staff time used in medication processes was significant lower in OSD 252 compared to TMS. We found no significant difference in medication cost for OSD with two days 253 discharge medication without nutritional supply compared to TMS. Patients in OSD rated the 254 system with an overall high average score of satisfaction and safety.

255
We

283
In this study, we found a high average score for patient perspectives on satisfaction, safety and

304
The primary strength of our study is that it was conducted under daily context-specific 305 conditions in both an acute and elective hospital ward. Time measurements from both departments 306 show that medication dispensing and administration in the hospital is a time-consuming process.

307
However, one limitations of our study is that we did not consider medications prescribed "as 308 needed", or medication given at discharge. Several studies have previously shown that OSD reduces 309 staff time at discharge [16,27], but we did not include this analysis in our study. We also did not in the time period. A third limitation is that our study has not been powered to show a difference in 316 medication cost between medication systems on a ward level. Differences in hospital costs between 317 countries due to medication pricing, subsidies and dosing guidelines should also be considered.

318
Finally, we do not know the possible long term effects of OSD and its impact on medication errors, 319 compliance, treatment effect and health. In the future, these outcomes must be measured in 320 randomized controlled trials in different patient groups, particularly in patients receiving 321 polypharmacy.   state the founding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of 336 data; in the writing of the manuscript, and in the decision to publish the results.