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

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES
Christine D. Franciscovich MSN, CRNP, NNP-BC (is the Patient Safety and Improvement Advanced Practice Provider, Children's Hospital of Philadelphia.), Anna Bieniek BS, PharmD, MS (is the Pharmacy Regulatory Compliance, Quality Assurance, and Medication Safety Program Manager, Children's Hospital of Philadelphia.), Katie Dunn BSN, RN, CPN (is a Certified Pediatric Nurse, Children's Hospital of Philadelphia.), Ursula Nawab MD (formerly Senior Medical Director of Patient Safety, Children's Hospital of Philadelphia, is Chief Patient Safety and Quality Officer, Johns Hopkins All Children's Hospital. Please address correspondence to Christine D. Franciscovich)
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引用次数: 0

Abstract

Background

Automated dispensing cabinets (ADCs) are used to store and dispense medications at the point of care. Medications accessed from an ADC before pharmacist order verification are removed using override functionality. Bypassing pharmacist verification can lead to medication errors; therefore, The Joint Commission considers overrides acceptable only in limited scenarios. During an 18-month period, the override rate in our perianesthesia care unit (PACU) was 17%, with oral midazolam accounting for roughly 40% of overrides. A multidisciplinary quality improvement (QI) project was initiated with a goal to reduce overrides by 10% (17% to 15%) by December 31, 2021.

Methods

Key drivers for reducing overrides included timely medication order entry, nursing practice to wait for verification, and timely pharmacist medication order verification. Interventions related to the latter two drivers included nursing education, individual interviews, and a workflow change involving nurse-to-pharmacy communication prior to medication overrides. Interventions were implemented in three Plan-Do-Study-Act cycles beginning in July 2021. Outcome metrics were average monthly percentage of total medication overrides and overrides for oral midazolam, which were analyzed using statistical process control charts.

Results

Following interventions, the average monthly percentage of total medication overrides decreased from 17% to 8% in July 2021, and further to 4% in February 2022. Oral midazolam overrides decreased from 22% to 9% in July 2021, and further to 3% in February 2022.

Conclusion

Both total and oral midazolam overrides were reduced by changing nursing and pharmacy workflow. Reducing ADC overrides is a complex process balancing operational flow and safety efforts.
减少围麻醉期护理病房自动配药柜的越位:质量改进项目。
背景:自动配药柜 (ADC) 用于在护理点储存和配药。在药剂师核对订单之前从 ADC 取用的药物会通过覆盖功能移除。绕过药剂师验证可能会导致用药错误;因此,联合委员会认为只有在有限的情况下才可以接受覆盖功能。在 18 个月的时间里,我们围麻醉期护理病房(PACU)的超量使用率为 17%,其中口服咪达唑仑约占超量使用的 40%。我们启动了一个多学科质量改进(QI)项目,目标是在 2021 年 12 月 31 日前将超限率降低 10%(17% 至 15%):方法:减少超量用药的关键因素包括及时输入药单、护理实践中等待验证以及药剂师及时验证药单。针对后两个驱动因素的干预措施包括护理教育、个别访谈以及改变工作流程,其中包括在药物超限之前护士与药剂师之间的沟通。从 2021 年 7 月开始,分三个 "计划-实施-研究-行动 "周期实施干预措施。结果指标为平均每月药物超量使用总数的百分比和口服咪达唑仑的超量使用百分比,并使用统计过程控制图进行分析:干预后,总药物超量的月平均百分比从 17% 降至 2021 年 7 月的 8%,到 2022 年 2 月进一步降至 4%。口服咪达唑仑的超量使用率从 2021 年 7 月的 22% 降至 9%,到 2022 年 2 月进一步降至 3%:通过改变护理和药房工作流程,咪达唑仑的总超量率和口服超量率均有所下降。减少 ADC 过度使用是一个复杂的过程,需要在操作流程和安全性之间取得平衡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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