Quality Improvement Research Articles

Physico-chemical characteristics and quality assessment of soil in parts of the Banganga Basin in northeastern Rajasthan, NW India.

Soil is a vital natural resource that has a bearing on any developmental activity. A database comprising primary physicochemical characteristics and soil suitability would assist the planners in devising an appropriate land use policy and any intervention strategy for soil quality improvement. The physicochemical characteristics of soils in parts of the Banganga Basin, located in the semi-arid terrain of NW India were evaluated mainly through surface samples and sub-surface ones wherever sections were exposed in stream banks. The soil in the studied terrain is a Quaternary age, pale brown to dark brown and occasionally red, alluvial soil. Sandy loam is the dominant soil type, while sandy soil and loamy sand types also occur. The soil maintains a depth-wise consistency in physicochemical characteristics. The average soil pH value is 8.55, indicating a slightly alkaline and healthy soil. The soil has a high available nitrogen content (0.53 to 2.24%), adequate available phosphorus (23.58 and 62.18mg/kg), and low potassium (22.5 and 200mg/kg) contents. The organic carbon, Mg, and Ca levels are generally on the lower side. A consistency in overall soil characteristics is evident in the narrow range of the Soil Quality Index, varying between 10 and 14, and soil can be categorized into three categories with overlapping soil qualities.

Carbon emission trading scheme and air quality improvement: evidence from quasi-natural experiment in pilot cities in China

Carbon emission trading scheme and air quality improvement: evidence from quasi-natural experiment in pilot cities in China

Utility of Artificial Intelligence–Generative Draft Replies to Patient Messages

This quality improvement study analyzes the usefulness of patient message replies drafted by artificial intelligence for various health care practitioners.

Pre-Operative Gastroesophageal Reflux Does Not Affect 30-Day Outcomes in Patients Undergoing Revisional Bariatric Surgery to Single Anastomosis Duodeno-Ileal Bypass (SADI): An Analysis of 933 Metabolic and Bariatric Accreditation and Quality Improvement Program Patients.

Background: The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Results: Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; p = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; p = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, p = 0.9), reintervention (2.4% vs. 1.2%, p = 0.2), or reoperation (3.6% vs. 2.05%; p = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79-53.23; p = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04-4.56; p = 0.04). Conclusions: Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD.

American emergency room wait times for psychiatric conditions from 2019 to 2021

Use of Emergency Departments (EDs) for psychiatric complaints has increased significantly in past decades. The onset of the COVID-19 pandemic saw large shifts in ED usage, with a relative increase in mental health complaints in EDs. This paper will investigate the difference in ED wait times for psychiatric and non-psychiatric complaints over this period. Utilized National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2019 to 2021, for average wait times for psychiatric versus non-psychiatric complaints. Compared the average wait times for psychiatric complaints by region, triage status, and ICD-10 F code. There was no significant difference in the average wait times overall between these conditions (P = 0.57). People with schizophrenia or psychosis had a significantly higher wait time (P = 0.03) compared to mental health symptoms secondary to physiologic conditions. Northeastern American EDs also had prolonged wait times for psychiatric conditions (P < 0.01) Research into factors of prolonged wait times can advise quality improvements such as the implementation of evidence-based triage and workup tools, and directed psychiatric education.

The mediating role of marital quality in parenting intervention: Effects on preschoolers' conduct problems and effortful control.

This study explores whether marital quality mediates the effects of a parenting intervention on preschoolers' conduct problems and effortful control. Using data from 209 children in a two-wave randomized controlled trial of the Hitkashrut program, participants were assigned to either a 14-session co-parent training group or a minimal intervention control group. Intent-to-treat analysis revealed that improvements in marital quality significantly mediated the intervention's impact on both conduct problems and effortful control. An alternative model, which hypothesized that changes in child behavior would lead to improvements in marital quality, was not supported, reinforcing the importance of targeting marital dynamics to achieve better child outcomes. These findings highlight the potential of marital-focused strategies within parenting interventions to foster healthier family environments and improve long-term developmental trajectories in children.

TERAPAN ETOS KAIZEN DALAM “MENINGKATKAN KELAS” BISNIS KULINER BERKEARIFAN LOKAL

This community service activity aims to provide counseling to the UMKM Association of Komunitas Sukses Berjamaah Indonesia (KSBI) in South Jakarta regarding the application of the Kaizen ethos in improving the quality and success of their culinary business based on local wisdom. This counseling aims to provide an understanding of the concept of Kaizen ethos and encourage KSBI members to apply it in their culinary business. In this activity, an interactive approach method was used through discussions and case studies to understand the potential for improving local wisdom-based culinary businesses. The participants were invited to identify problems, challenges, and opportunities in their culinary business, as well as to utilize local wisdom as an added value in the business. Key Kaizen principles, such as elimination of waste, quality improvement, employee engagement, and continuous improvement cycle, were explained and applied in the context of KSBI's culinary business. Through the delivery of implementation strategies and successful case examples, participants were given practical guidance to apply the Kaizen ethos in their culinary business. In addition, Q&A and discussion sessions provided an opportunity for KSBI members to share their experiences and obtain solutions to the questions and problems they faced. The results of this activity had a positive impact on the members of the UMKM Community Sukses Berjamaah Indonesia (KSBI) in South Jakarta, focusing on continuous improvement and utilization of local potential, the participants managed to improve their operational efficiency and the quality of their culinary products. Awareness of the importance of innovation and adaptation to market changes has also increased, thus opening up opportunities to expand markets and strengthen the competitiveness of local wisdom-based culinary businesses through the application of the Kaizen ethos.

Effect of different levels of micronutrients on vegetative growth, yield and fruit quality of Mango (Mangifera indica L.)

An experiment was carried out to ascertain the impact of foliar application of certain micro-nutrients on fruit yield and quality of Mango (Mangifera indica L.) cultivars "Dashehari" and "Langra" at Agriculture Research Station, Banswara, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan, during the year 2016-17 on seventeen years old mango trees. The experiment was laid out in One way ANOVA (Randomized Block Design) with eight treatments in thrice replications for combinations with different micronutrients Zinc sulphate, Copper sulphate, Borax, boric acid and IIHR-2 mango special were applied on mango cultivars "Dashehari" and "Langra" at different growth stages. All were fertilized with a recommended dose of NPK (1500:500:1000 g as N, P2O5 and K2O). The spraying was done twice; during mid-October, mid-December, and mid-February before the flowering stage and again in mid-March at the marble stage during both years of study. Foliar sprays, in general, improved fruit yield. Yields were exceptionally higher in response to foliar application of Zinc (Zn), Copper (Cu) and boron (B) compared to other treatments. Result proved that foliar application of mango trees with [(RDF + Zinc sulphate (100 g) + Copper sulphate (50 g) + Boric acid (50 g) as soil + Zinc sulphate (0.2%) + Copper sulphate (0.1%) + Boric acid (0.1%) as foliar (Two sprays before flowering and marble stage)] was the promising treatment for improvement of vegetative growth, yield and fruit quality. This treatment was also found best for maximum total carotenoids, average fruit weight as well as fruit yield.

Academic Capacity Building of Lecturers through International Collaboration:

This international community service program aims to enhance the academic capacity of lecturers through collaboration with universities in Malaysia. The program is designed to address the issue of lecturer quality by leveraging the exchange of knowledge and innovative teaching methods. The implementation method includes establishing a baseline, analyzing needs, conducting workshops, evaluating results, developing sustainable solutions, and the role of contributions from related parties. This article highlights the importance of international collaboration in higher education and its contribution to the development of lecturer capacity and the improvement of educational quality. Through this program, an increase in lecturer competence is expected, which in turn can strengthen the bilateral relations between Indonesia and Malaysia in the higher education sector learning.

Comparing the effectiveness of a blended video plus face-to-face educational program with a face-to-face educational program on quality of life among adolescents undergoing hemodialysis in Palestine.

Hemodialysis is frequently used as a primary treatment for individuals with end-stage kidney disease (ESKD), and it significantly impacts the quality of life in adolescents undergoing this procedure. Providing a hemodialysis education to these patients is a valuable strategy for enhancing their well-being. The aim of the study is to assess the effect of the video-assisted educational program on the quality of life among adolescents undergoing hemodialysis in Palestine. This study employed a quasi-experimental design, a pre-test-post-test interventional study, involving a sample of 68 adolescent patients between the ages of 13 and 18 diagnosed with ESKD. The quality of life level was assessed in both groups using an Arabic version of the Pediatric Quality of Life Inventory™ version 3.0 ESKD Module survey. The study was conducted at the dialysis units in four hospitals associated with Augusta Victoria Hospital, An-Najah University Hospital, Palestine Medical Complex/Ramallah, and Beit Jala (Al Housain) Hospital. The study involved providing tailored face-to-face educational sessions with video assistance to the experimental group, while the control group received regular face-to-face education. The Generalized Estimating Equation analysis revealed no significant differences in quality of life between the experimental and control groups over time, across pre-test, post-test, and follow-up periods (p ≥ 0.05). However, within the experimental group, there was a significant improvement in total quality of life scores between the pre-test, post-test, and post-test follow-up (p ≤ 0.001), although the difference between the pre-test and follow-up approached significance but was not statistically significant (p = 0.056). In contrast, the control group showed significant differences in quality of life across the pre-test, post-test, and follow-up time points (p ≤ 0.05). Implementing suitable interventions can potentially enhance the quality of life for individuals undergoing hemodialysis. Consequently, we suggest using video-based education as a cost-effective, uncomplicated, and engaging approach for educating hemodialysis patients.

Identifying Potentially Modifiable Factors To Reduce Hospital Readmissions In A Tertiary Care Hospital In Sri Lanka

Identifying potentially modifiable factors associated with hospital readmissions would lead to reduction of the burden on healthcare expenditure and improvement of quality of life of patients. A cross sectional descriptive study was carried out on medical inpatients of University Medical Unit, National Hospital of Sri Lanka. Among the 425 participants, 178 (41.9%) had at least one prior admission over the preceding year. Participants with readmissions were significantly older than those with single admissions. The onset of illness/time since diagnosis, number of chronic illnesses, number of long-term medications, compliance with medications, compliance with follow-up, availability of family support, depression, anxiety, stress and alcohol use were associated with readmissions, whereas the location of follow-up, living arrangement and level of activity was not. A significant proportion of the study population had readmissions. Interventions aiming to reduce pill burden and to improve compliance with medications and follow-up are suggested, and further studies are recommended to assess their impact. Where appropriate, patients should be directed to local hospitals/clinics for follow-up. Early identification of depression, anxiety and stress among patients and assessing each patient’s alcohol intake, and making recommendations for them to obtain necessary help would be beneficial.

Risk factors for major complications following pelvic exenteration: A NSQIP study

ObjectivesDue to the rarity of pelvic exenteration surgery, it is challenging to predict which patients are at an increased risk for postoperative complications. We aimed to study the predictors for postoperative complications among women undergoing pelvic exenteration for gynecologic malignancy. MethodWe used the National Surgical Quality Improvement Program registry to evaluate postoperative course and complications of those patients undergoing pelvic exenteration in the period 2012–2022. The primary objective of the analysis was to estimate the major postoperative complications following pelvic exenteration. ResultsOverall, 794 pelvic exenterations were included. Of those, 56.5 % were anterior exenteration, 43.5 % were posterior exenteration, and 13.9 % were a combined exenteration. The rate of minor complications was 72.5 % (n = 576), and the rate of major complications was 31.5 % (n = 250). The most common minor complications were blood transfusion (n = 538, 67.8 %), followed by superficial surgical site infections (SSI) and urinary tract infections (9.8 % and 9.4 %, respectively). Among the major complications, the most common was organ/space SSI (11.2 %), followed by sepsis (9.2 %), reoperation (8.6 %), and wound dehiscence (5.2 %). Death within 30 days occurred in 1.5 % of patients. In multivariable regression analysis, the following factors were independently associated with major complications: higher BMI [adjusted odds ratio (aOR) 1.03 95 % confidence interval (CI) (1.01–1.05)], diabetes [aOR 1.82 95 % CI (1.13–3.22)], low serum albumin [aOR 0.73 95 % CI (0.54–0.98)], and high serum creatinine [aOR 1.70 95 % CI (1.05–2.77)]. ConclusionsMajor postoperative complications occur in approximately one third of pelvic exenterations for gynecologic malignancies. Our study highlights independent factors associated with major postoperative complications, of which some are potentially modifiable.

Feasibility of trauma video review for the collection of medication-related information for research and quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Trauma video review (TVR) involves reviewing video recordings of team-based trauma response to evaluate team performance, identify improvement opportunities, and assess procedures, but the feasibility of using TVR to gather medication-related information is unknown. We aimed to assess the feasibility of using TVR for data collection of medication-related variables for research and quality improvement by comparing and describing differences between TVR and electronic medical record (EMR) review. This was an observational study of level I/II trauma patients treated between November 2022 and March 2023. Patients with video recording started within 1 minute of arrival, at least 1 medication administered, and with pharmacist participation in care were included. The number of variables able to be collected by TVR or EMR review were compared and reported in the categories of medication administration, indicators of adverse drug events (ADEs), medication errors, and communication. The numbers and types of discrepancies between data collection modalities were quantified and described. Agreement between TVR and EMR review was assessed and reported as an intraclass correlation coefficient (ICC). Twenty-five patients were included; 758 and 1,011 variables collected by TVR and EMR review, respectively. In total, 689 variables were collected by both methods, and data collection modalities matched exactly in 4 of 25 patients (16%); ICC, 0.677 (moderate level of agreement). There were 46 (6.7%) discrepancies; 84% involved communication related variables. TVR missed more variables than EMR review, mostly medication errors and inability to assess ADEs but captured more communication-related variables. TVR and EMR review together offer a greater source of medication-related information for data collection compared to either alone. EMR review collected medication administration, ADE, and medication errors variables more often than TVR and TVR was better able to collect communication-related variables. When designing studies/quality improvement efforts related to medication use during trauma resuscitation (e.g., pharmacist impact on time to administration), combined data collection modalities should be used, when available.

Economic and biological assessment of a new medium-ripened variety of soft winter wheat Priazovye

Relevance. In the Russian Federation, winter common wheat is the main food and strategic crop. Permanent improvement of productivity and quality of wheat grain, reducing its production costs is the main task of agricultural production. To solve this problem, the leading place is given to the continuous and constant creation and introduction into production of new competitive wheat varieties, highly adapted to stress factors, with guaranteed high yields and high grain quality.Methods. The research was carried out in the southern zone of the Rostov region at the experimental sites of the Federal State Budgetary Scientific Institution ANTS “Donskoy” in 2021–2023 in order to create a new variety of soft winter wheat capable of forming not only high yields, but also having high frost resistance, drought resistance, resistance to leaf diseases, possessing high rheological and technological properties of grain and flour.Results. The winter common wheat variety Priazovie was developed by stepwise hybridization using the varieties Voyazh and Tanya. This is a highly productive variety. On average, over three years (2021–2023) of study in the competitive variety testing, the productivity of the variety laid in green manure fallow was 9.88 t/ha, exceeding that of the standard variety by 1.56 t/ha. The variety is capable of producing high yields after various forecrops. The maximum productivity of the variety (12.23 t/ha) was obtained in green manure fallow in 2022. The variety forms a high stem capacity (up to 800 pcs/m²), and is characterized by high resistance to the main leaf diseases, such as powdery mildew, brown and yellow mildew, loose smut, leaf blotch, etc. According to the main indicators of grain and flour quality, it belongs to valuable wheat, in terms of frost resistance (73.3%) it surpasses the standard Ermak variety (69.2%).

Directionality in BiCROS hearing aids: an investigation of objective and subjective outcomes

Objectives To assess the effect of forward and omnidirectional microphone configurations in BiCROS versus monaural hearing aids on objective and subjective outcomes in different noise conditions. Design After fitting and a 4-week acclimatisation period, speech recognition and sound quality were measured using forward directional, omnidirectional, and unaided settings. Two noise configurations were used, surrounding noise and noise presented from the aided (better) ear. Subjective outcomes were assessed using the SSQ-b and BBSS questionnaires and participant interviews. Study sample Eighteen adult participants (mean: 74.6 y; range: 61–94 y; ten males, eight females) with mild to moderately severe SNHL in their better ear (PTA0.5–4khz > 20 dB HL) and limited usable hearing in their poorer ear (average PTA0.5–4khz > 100 dB HL). Results Significant improvement in speech recognition and sound quality for BiCROS and monaural directional settings over omnidirectional and unaided, in both noise configurations. There were no significant differences observed between monoaural and BiCROS directional settings. Conclusion Speech in noise recognition and sound quality scores demonstrated a significant directional benefit for both BiCROS and monaural directional fitting settings over omnidirectional and unaided conditions. Unique BiCROS-specific experiences were identified in a patient-oriented approach. These can inform the development of BiCROS-tailored tools.

Genetic architecture of meat traits in Large White sows

Currently, genome-wide association analysis is a modern and reliable method for analyzing genomic information about animals, as well as determining the “genotype — phenotype” relationship. This study aims to use the GWAS method to identify significant SNPs located within or linked to genes for meat traits in Large White pigs — backfat thickness over the 6–7th and 10–12th vertebrae, and loin muscle depth. The conducted GWA analysis revealed 60 genes, of which 17 are associated with biological functionality, annotated using the DAVID program. Three genes were found to have codification in the Pig QTL database. The genes were divided into 10 groups based on gene ontology (GO). Of all the genes, the AUTS2 gene, located on chromosome 3 and predicting the number of corpora lutea in sows, is of greatest interest. The results of this scientific work will contribute to the development of a genetic evaluation system and improvement of meat qualities in pigs.

Extragenital self-collection testing for gonorrhea and chlamydia: A feasibility study for expanding STI screening in the Veterans Health Administration.

Rectal and pharyngeal infections with gonorrhea and chlamydia are of concern because they are associated with higher risk of HIV acquisition. Extragenital screening in asymptomatic persons at high risk may have the potential to reduce the incidence of these sexually transmitted infections (STIs). Several testing platforms are available for the testing of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using nucleic acid amplification tests (NAATs). Self-collected extragenital samples are currently not approved by the US Food and Drug Administration in any NAAT platform. This study compares the analytical performance of self-collected extragenital specimens to that of clinician-collected specimens. We performed a multicenter/multiplatform validation study as a National Veterans Health Administration Pathology and Laboratory Medicine quality improvement project, with 9 different participating sites. Self-collected specimens were obtained at the same time as clinician-collected specimens. Clinician-collected specimens were used as the gold standard to evaluate the sensitivity and specificity of self-collection. A total of 2324 individual tests were analyzed (501 rectal and 661 oropharyngeal). The sensitivity was 94.44% for CT and 100% for NG for rectal specimens, whereas it was 100% for CT and 97.22% for NG for oral specimens. Specificity for oral specimens was 99.85% for CT and 99.36% for NG, whereas for rectal specimens, it was 99% for CT and NG. Self-collected specimens for extragenital CT/NG testing are highly sensitive and specific, with negative predictive values of 100%. Self-collection has the potential to overcome a major barrier for STI screening by providing an accessible, convenient, and patient-centered alternative.

Development, implementation, and acceptability of a bedside mindfulness intervention for adults with sickle cell disease

ABSTRACT Acute and chronic pain are the most frequent complications of sickle cell disease (SCD), often severely reducing quality of life and requiring management with long-term pharmacological interventions. A biopsychosocial approach conceptualizing pain in SCD as the result of complex biological, psychological, and social factors could facilitate targeted behavioral interventions. Mindfulness is one procedure for management of pain in individuals with chronic pain/illness. The goal of the current project was to design and implement a bedside mindfulness intervention to help patients with SCD enhance self-efficacy of pain management and reduce distress. As part of a quality improvement project in SCD clinics in a large health system, we developed a bedside mindfulness intervention to be provided during infusion sessions for patients presenting for acute vaso-occlusive episodes (VOE). The approach to development and implementation involved engagement of professionals working directly with patients. Concept planning meetings with these professionals along with qualitative patient and provider feedback informed feasibility, design, and intervention application. During a quantitative phase, patients completed validated surveys items on acceptability. Interview data (N = 11) supported patient interest in mindfulness skills and highlighted a need for tailored, person-centered interventions and non-pharmacological treatment strategies. On quantitative items, participants (N = 14) liked the intervention and agreed mindfulness skills would help manage disease-related distress. Following the interventions, participants reported increased mindfulness (p = .005). While preliminary, these results provide support for the continued development of evidence-based, mindfulness-oriented services to help individuals with SCD manage pain and other psychological difficulties.

Evaluating Racial Disparities in 30-day Outcomes for African Americans Following Colectomy for Volvulus.

Surgery is the definitive treatment for colonic volvulus despite initial decompression therapy. In general surgery, African Americans were found to have higher risks of mortality and morbidities. However, racial disparity in colectomy outcomes for volvulus among African Americans had not been explored. This study examined the 30-day outcomes for African Americans following colectomy for volvulus. The National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was used. Only patients with volvulus as the primary indication for colectomy were selected. A 1:1 propensity score matching was applied to African Americans and Caucasians to match sex, age, baseline characteristics, preoperative preparation, indication for surgery (if emergent), and operative approaches. Thirty-day postoperative outcomes were examined. There were 1027 and 7451 African Americans and Caucasians who underwent colectomy for volvulus, respectively. All African Americans were 1:1 propensity-score matched to their Caucasian counterparts. African Americans and Caucasians had a comparable mortality rate (7.21% vs 7.89%, P = 0.62). While African Americans had a higher risk of pulmonary complications (16.85% vs 13.53%, P = 0.04), other surgical complications were all comparable between African Americans and Caucasians. However, African Americans had a longer time from admission to operation (2.70 ± 3.99 vs 2.17 ± 3.36days, P < 0.01) and a longer length of stay (LOS; 12.81 ± 10.28 vs 10.50 ± 7.72days, P < 0.01). African Americans were found to have higher risks of pulmonary complications, delayed operation, and extended LOS. These disparities raise concerns and warrant further investigation into their underlying causes. Effective targeted interventions may be necessary to address these issues.

Development and implementation of autoverification standardization in the adult and pediatric emergency department.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This project utilized the guidance of the American Society of Health-System Pharmacists (ASHP) autoverification toolkit to refine our health system's approach to autoverification and contribute to the literature regarding appropriate use of autoverification technology in a pediatric and adult emergency department (ED). This single-center quality improvement study was conducted in an academic medical center ED that has 33 pediatric beds and 77 adult beds. A team consisting of clinical pharmacy specialists in emergency medicine, medication safety and informatics personnel, operational managers, and pharmacy leadership was identified to develop and implement autoverification best practices in the ED utilizing practices outlined within the ASHP autoverification toolkit. Before implementation of best practices, defined as the "preoptimization" state, autoverification took place for most medications available in the automated dispensing cabinets (ADCs). By anchoring the autoverification rule on ADC inventory, it was challenging to optimize both inventory practices and autoverification best practices. This project focused on redesigning the autoverification rules in the electronic health record, defined as the "postoptimization" state. In the postoptimization state, autoverification in the ED was updated to better align with regulatory standards. Autoverification metrics and the percentage of orders that autoverified vs required pharmacist verification were analyzed in the preoptimization and postoptimization states. This project utilized the guidance from ASHP's autoverification toolkit to refine our health system's approach to autoverification. High-alert medications (eg, insulin, extended-release opioids, digoxin) were taken off autoverification following implementation. Optimization of autoverification rules allows more orders for high-alert medications to be reviewed by a pharmacist.