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