PubMed · 6405313
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R G Sikora. 1983. Planning and implementing a mobile decentralized unit dose system.. https://pubmed.ncbi.nlm.nih.gov/6405313/
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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. CONCLUSION: Pharmacists, in collaboration with the medical and nursing staffs, developed a sustainable process for preventing unauthorized and inappropriate override medication dispensing from ADDs.
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BACKGROUND: North Mississippi Medical Center (NMMC), the largest rural hospital in the United States, offers a continuum of health care services stretching from high-tech trauma and/or cardiac care through to compassionate home, long-term, or hospice care. OVERALL APPROACH TO QUALITY AND SAFETY: NMMC uses a care-based cost management (CBCM) approach to performance improvement, which is used to look beyond traditional cost drivers (people, equipment, supplies) to the care issues that have a much greater impact on the actual cost of care-practice variation, complications, and social issues. APPROACH TO ADDRESSING THE SIX IOM QUALITY AIMS: The CBCM approach addresses NMMC's quality, safety and financial critical success factors and is applied to address the six Institute of Medicine quality aims. For example, by conceptualizing "patient safety" to include appropriate care for every patient, CBCM leads directly to IOM aims and evidence-based practice. Physician champions and nurse outcomes managers liaison with providers to achieve decreased complications, analyze practice variation from best practice, and address social issues that impair care improvement. CHALLENGES AND LESSONS LEARNED: One of NMMC's greatest challenges is to continuously improve the health of the people in its region. Since 1995, it has partnered in periodic community health assessments to examine its wellness initiatives and plan programs.