title: Assessing and monitoring override medications in automated dispensing devices.
abstract: BACKGROUND
  Medication override is not without risk because the absence of pharmacist review may increase the potential for a medication error. The University of Pittsburgh Medical Center's Department of Pharmacy and Therapeutics assessed the safety of the automated dispensing device (ADD) override process to reduce the number of override medications stored in the ADD.
  
  
  METHODS
  A representative expert panel developed criteria for override access and revised the override medication list; an override monitoring tool was used to perform random audits and determine nursing compliance; and changes in override practices for use of opioids, a high-alert medication class, were measured.
  
  
  RESULTS
  The expert panel reduced the number of medications and dosage forms on the override list by 42%, from 119 different medications (in 244 different dosage forms) in 2001 to 92 different medications (in 163 different dosage forms) by December 2003. By May 2004 the opioid override rates were significantly decreased; although slight increases in rates occurred by December 2004, possibly reflecting the lack of formal override monitoring by nursing and pharmacy, the rates were still significantly lower than the baseline in October 2003.
  
  
  CONCLUSIONS
  Pharmacists, in collaboration with the medical and nursing staffs, developed a sustainable process for preventing unauthorized and inappropriate override medication dispensing from ADDs.
authors.affiliation: Medication Safety, University of Pittsburgh Medical Center, USA. KowiatekJG@upmc.edu
authors.forename: Joanne G
authors.initials: JG
authors.lastname: Kowiatek
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weber
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Skledar
authors.forename: Susan
authors.initials: S
authors.lastname: Frank
authors.forename: Michael
authors.initials: M
authors.lastname: DeVita
mesh_terms: D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration; D008508:Medication Errors / Q000517:prevention & control; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*
chemical_list: D004364:Pharmaceutical Preparations