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

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.

Name thesis:degree_name

Master of Science

Level thesis:degree_level

Masters

Discipline thesis:degree_discipline

Pharmacy Leadership & Administration

Grantor

University of Houston

Year dc:date.issued

2023

Author dc:creator

• Awuah, Alfred

Advisor dc:contributor.advisor

• Wanat, Matthew A.

Committee members dc:contributor.committeemember

• Attia, Engie
• Adeola, Mobolaji
• Hatfield, Catherine L.

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

Statement dc:rights

• The author of this work is the copyright owner. UH Libraries and the Texas Digital Library have their permission to store and provide access to this work. Further transmission, reproduction, or presentation of this work is prohibited except with permission of the author(s).

Language dc:language.iso

eng

Handle dc:identifier.uri

https://hdl.handle.net/10657/14525

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/14525