Purchase of unit dose medication carts is one of the major capital expenditures in the development and maintenance of a unit dose distribution system. Critical factors in this selection process are the considerations of product reliability and durability. To develop an assessment of user satisfaction with the various brands of unit dose carts, a national survey of 500 randomly selected hospital pharmacies was developed and mailed. The questionnaire requested information on types of carts used, satisfaction with cart performance, types of repairs needed, frequency of repairs, providers of cart repairs, and frequency of cart maintenance inspections. Two hundred seventy responses (54%) were available for evaluation. Eighty-five percent of cart users have five or more carts. Although 60% of respondents have carts greater than or equal to 4 years old, comparative satisfaction did not decrease as a function of increasing age of carts. There were 11 brands of unit dose carts reported by 214 responders. One hundred and three of these 214 responders (48.1%) used MacBick as compared with 36, 22, 18, and 35 users of Trans Aid, Lionville, Ferno Forge, and seven other brands, respectively. MacBick's users reported less equipment failure rate compared with the other brands, but this difference did not reach statistical significance (p less than 0.2 greater than 0.05). It was also determined that only 29% of hospitals routinely inspect carts to insure proper functioning. Since the most frequent type of equipment failure reported (up to 61% of users) involved cart locking mechanisms, drug security can be compromised without routine inspections.