How Are You Managing Automated Dispensing Cabinet Overrides?

There are legitimate reasons to issue medications from your automated dispensing cabinet (ADC) via override. For example, a patient may be experiencing severe pain or suddenly have elevated blood pressure—indicating an emergent situation.

However, the need to manage and monitor override use is just as critical—and is a Joint Commission compliance issue. According to Jeannell Mansur, RPh, PharmD, FASHP, the practice leader for medication safety at Joint Commission Resources, surveyors are scrutinizing ADCs that are not profiled and looking at the override process.[1]

The Joint Commission’s medication management (MM) standard 05.01.01 specifically identifies the need for a pharmacist to review the appropriateness of all medication orders to be dispensed in the hospital. This crucial checkpoint ensures that the patient’s allergy information, medication contraindications, duplications, and potentially important lab information are considered when medications are prescribed.

The profiling of medications in the ADC provides the confidence that medication orders have been reviewed by the pharmacist before the items can be dispensed from the ADC. Using the override function essentially bypasses the pharmacy review, or profile requirement, so it should be used sparingly.

Override Options in Omnicell System

The override function in the Omnicell automated dispensing system can be set up different ways to enable emergent medications to be accessed prior to the pharmacist review.

Configuration by item—Provides maximum flexibility for the use of overrides; items eligible for override can be selected based on the clinical area.

Configuration by select users—Only designated clinicians are permitted to perform overrides to limit the use of overrides. These users may be given permission to override conditionally or always.

The Value of Monitoring Overrides

Each time a medication is removed from the cabinet via the override function, it is recorded and the information is available through OmniCenter® and Pandora® analytics reports. The use of reporting allows the pharmacy to review override activity to help identify problem items or areas where the MM standard is not quite being met.

Is Diversion Occurring?

The retrospective review of overrides can also be a great tool for identifying potential diversion activity. The removal of multiple doses of a narcotic for a patient without approved orders is a red flag that should require further review by the pharmacy.

For example, if a user conducts an override of morphine for a patient at 8 a.m., the next dose should be issued via medication order. If the order hasn’t been approved by the timing of the next dose, noon for example, it may indicate possible diversion.

Learn More

Omnicell customers can download the document Best Practices: Managing Med Order Overrides via myOmnicell.com, our customer portal. If you are a current Omnicell customer you can register for the site here.

What is your policy for managing overrides? Feel free to share your best practices below.

[1] Tilyou S. Getting ready for Joint Commission surveys. Pharmacy Practice News. September 2013.

5 Comments on “How Are You Managing Automated Dispensing Cabinet Overrides?

  1. When the nurse removes a medication from the Automated Dispensing Cabinet (ADC) and there is not active medication order, the ADC documents it as an override. At some point, there should be an active order for that medication order. Since there is an interface between all orders and that ADC, is it possible to have the ADC automatically document those overrides for which there is not a future order for the medication? That way, the review of overrides could be focused on just those overrides which do not have a corresponding future medication order.

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    • Reviewing compliance for med override reconciliation can be streamlined today using available electronic tools. Medication dispenses from an ADC and medication orders are captured in the cabinet database, but the existing Med Override Report in Omnicell does not match and filter those linked transactions. However, the same information is available in most current electronic health records (EHR). End users should link the med override pull to the future order in the electronic medication administration record (eMAR) per hospital policy as part of their routine workflow. Pharmacists or nurse managers can use available reports within the EHR as the source of truth for compliance review.

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  2. The purpose of automation is NOT to generate reports for people to look at. Instead, the ADC system should look at Override Transaction Data and Medication Order Data and then only report out to the human those Override Transactions that do NOT have a matching medication order. This would take the human much less time to complete and allow them to focus on higher value clinical activities…

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    • You make a good point. I will forward your suggestion to appropriate Omnicell staff. Thank you for sharing this feedback.

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  3. I too agree with rayatvci. We spend an inordinate amount of time auditing controlled substances for documentation. Best practice would be a configurable report that could be generated/emailed from ADC system when documentation in the EHR record doesn’t match the dose removed from cabinets.

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