Automated dispensing cabinets and nurse-related medication errors in inpatient settings: A systematic review

Background: Automated Dispensing Cabinets (ADCs) are computerized medication storage and dispensing systems increasingly used in inpatient hospital settings to support safe medication administration. As nurses represent the final point of medication delivery to patients, understanding the impact of ADCs on nurse-related medication errors is critical. This systematic review aimed to assess the association between ADC implementation and medication errors involving nurses in inpatient hospital settings. Methods: A systematic search of PubMed, MEDLINE, Scopus, and Google Scholar identified 16 eligible studies published between 2008 and 2025 from 184 retrieved records. Included studies employed quantitative, qualitative, and mixed-methods designs. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT), and findings were synthesized narratively due to heterogeneity in study designs and outcome measures. Results: Across quantitative studies, ADC implementation was generally associated with reductions in reported medication errors, particularly omission errors and wrong drug or wrong dose events, although reported reductions varied widely. Some studies reported maintenance of previously low error rates. Qualitative findings described perceived improvements in workflow efficiency, medication access, and nurses' confidence in medication safety, alongside temporary workflow challenges during early implementation. Conclusions: Overall, the evidence suggests that ADCs may support safer medication administration and nursing workflows when appropriately implemented. However, evidence quality is limited by largely observational designs, heterogeneous error definitions, and inconsistent outcome reporting, highlighting the need for more standardized and methodologically robust research.