Practical strategies for ensuring safety of medication overrides from automated dispensing cabinets

Abstract

BackgroundThe Institute of Safe Medication Practices (ISMP) and American Society of Health-System Pharmacists (ASHP) have made recommendations on the judicious use of the override feature on automated dispensing machines including guidelines for the creation of safety protocols, security, and decision support, yet it remains unclear how health care organizations (HCOs) have been able to implement these recommendations and what metrics are used to monitor safety and compliance. ObjectivesThis study aimed to assess and compile medication override practices and metrics used by HCOs to ensure medication safety and regulatory compliance. MethodsUsing the ISMP and ASHP’s guidelines on medication overrides, a survey was developed and distributed to organizations to understand their approach and processes surrounding medication overrides. ResultsThirty organizations responded, with 93.3% (28/30) reporting having a medication override policy. A standard override rate was not evident, but 46.7% (14/30) shared a rate of 5% or less. Two-thirds of respondents identified the medication safety committee or its members as being responsible for reviewing the list of overridable medications, with over half stating that this review occurs annually. Furthermore, 80% (24/30) of organizations described a retrospective process used to review individual medication overrides daily, monthly, or at a lower frequency using reports from the automated dispensing cabinet, the electronic health records, pharmacist review of associated orders, or a combination of the three. Although every participant has implemented at least one of the recommended practices in the ISMP and ASHP guidelines, standard practices and benchmark data surrounding acceptable override rates remain unclear. ConclusionThis survey provided insight into current processes used in various organizations to safely manage medication overrides. Its results can be used by institutions to optimize their processes. Information from a larger number of organizations is needed to establish standard best practices and benchmark metrics.