Development of a Medication Override Process for Obstetrics and Newborn Care at a Large Academic Medical Center



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Background: Automated dispensing cabinets (ADCs) are decentralized dispensing machines used to make medication distribution safer and more efficient and allow for the timely administration of medications in urgent scenarios. ADCs pose a significant medication safety risk when a medication is overridden, bypassing a pharmacist's review before administration. The objective of this study was to evaluate the impact of existing interventions as well as proposed interventions targeting labor & delivery/nursery units to reduce inappropriate medication overrides.

Methods: This quasi-experimental study was conducted at Houston Methodist Hospital, a 900+ bed academic medical center. Override rates were also assessed at 6 additional community hospitals within the Houston Methodist system. The study encompassed three interventions as a bundle including pharmacy technician audits, implementation of a hospital-wide override list, and targeted L&D/nursery initiatives. The pre- and post-intervention periods were January 2022 to February 2022 and January 2023 to February 2023, respectively. The primary endpoint of this study was the rate of ADC overrides in L&D/nursery units pre- and post-intervention. The secondary endpoints were hospital-wide overrides, override rates for the most common medications overridden in the L&D/nursery, and utilization of the inventory function in the L&D/nursery units. A chi-squared test was utilized to determine statistical significance between override rates in the pre- and post-intervention periods.

Results: The ADC override rate for the L&D/nursery was 13.1% in the post-intervention group compared to 21.4% in the pre-intervention group (difference 8.3%, P<0.001). The hospital-wide override rate was 1.3% in the post-intervention group versus 2.3% in the pre-intervention group (difference 1%). The phytonadione syringe override rate was 99.3% in the pre-intervention period and 59.3% in the post-intervention period. Rates were 100% for erythromycin eye ointment and 97.3% for the hepatitis B vaccine in the pre-intervention period compared to 62.4% and 54.5% in the post-intervention period, respectively. The inventory function was utilized 209 times in the pre-intervention group and 171 times in the post-intervention group.

Conclusion: This study demonstrated that the implementation of bundled interventions reduced the ADC medication override rate without a significant increase in workarounds using the inventory function.



Medication safety, Quality improvement, Automation, Medication overrides, Nursing, Labor & delivery, Nursery