Reducing Automated Dispensing Cabinet Overrides in the Perianesthesia Care Unit: A Quality Improvement Project

Area of Science:

• Healthcare quality improvement
• Patient safety in medication management
• Clinical pharmacy practice

Background:

• Automated dispensing cabinets (ADCs) are crucial for point-of-care medication management.
• Override functionality in ADCs, used before pharmacist verification, can lead to medication errors.
• High override rates in perianesthesia care units (PACUs) necessitate targeted quality improvement.

Purpose of the Study:

• To reduce the rate of ADC overrides in a PACU setting.
• To decrease the specific overrides of oral midazolam.
• To achieve a 10% reduction in overrides by December 31, 2021.

Main Methods:

• A multidisciplinary quality improvement project focused on key drivers: timely order entry, nursing verification adherence, and pharmacist verification.
• Interventions included nursing education, individual interviews, and a revised nurse-to-pharmacy communication workflow.
• Three Plan-Do-Study-Act cycles were implemented, with outcomes tracked using statistical process control charts.

Main Results:

• The average monthly percentage of total ADC overrides decreased from 17% to 4% by February 2022.
• Overrides for oral midazolam specifically dropped from 22% to 3% within the same period.
• Interventions demonstrated a significant reduction in medication access prior to pharmacist verification.

Conclusions:

• Modifying nursing and pharmacy workflows effectively reduced both total and specific medication overrides.
• Addressing ADC overrides requires balancing operational efficiency with patient safety.
• Quality improvement initiatives can successfully mitigate risks associated with bypassing medication verification processes.