Development of a Medication Override Process for Obstetrics and Newborn Care at a Large Academic Medical Center
type: CreativeWork
description: 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 …
abstract: 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 …
author: Awuah, Alfred
language: eng
keywords: Medication safety, Quality improvement, Automation, Medication overrides, Nursing, Labor & delivery, Nursery
date published: 2023-06-14
date modified: 2026-07-24T02:32:27Z
provider: University of Houston
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Houston

PropertyValue
property ID: Handle
value: https://hdl.handle.net/10657/14525