Department of Pharmacy, University of Chicago Medicine, Chicago, IL,USA.
Department of Pharmacy, University of Chicago Comer Children's Hospital, Chicago, IL,USA.
Am J Health Syst Pharm. 2022 Feb 8;79(4):306-313. doi: 10.1093/ajhp/zxab406.
To describe a pharmacist-led reconciliation process for automated dispensing cabinet (ADC) medication override setting maintenance at an academic medical center.
ADC override management requires alignment of people, processes, and technology. This evaluation describes system-wide improvements to enhance institutional medication override policy compliance by establishing a formalized evaluation and defined roles to streamline ADC dispense setting management. A pharmacist-led quality improvement initiative revised the institutional medication override list to improve medication dispensing practices across an academic medical center campus with a pediatric hospital and 2 adult hospitals. This initiative included removal of patient care unit designations from the medication override list, revision of institutional override policy, creation of an online submission form, and selection of ADC override metrics for surveillance. A conceptual framework guided decisions for unique dosage forms and interdisciplinary engagement. Employing this framework revised workflows for stakeholders in the medication-use process through clinical pharmacist evaluation, existing shared governance structure communication, and pharmacy automation support.The revised policy increased the number of medications available for override from 80 to 106 (33% increase) and unique dosage forms from 166 to 191 (15% increase). The total number of medication dispense settings was reduced from 5,600 to 541 (90% decrease). The proportion of override dispenses compliant with policy increased from 59% to 98% (P < 0.001). Median monthly ADC overrides remained unchanged following policy revision (P = 0.995). ADC override rate reduction was observed across the institution, with the rate decreasing from 1.4% to 1.2% (P < 0.001). Similar ADC override rate reductions were observed for adult, pediatric, and emergency department ADCs.
This initiative highlights pharmacists' role in leading institutional policy changes that influence the medication-use process through ADC dispensing practices. A pharmacist-led reconciliation process that removed practice area designations from our medication override policy streamlined ADC setting maintenance, increased the compliance rate of ADC override transactions, and provided a formalized process for future evaluation of medication overrides.
描述在学术医疗中心中，药剂师主导的自动化配药柜（ADC）用药调整设置维护的核对流程。
ADC 用药调整管理需要人员、流程和技术的协同。本评估描述了系统范围的改进，通过建立正式的评估和明确的角色，简化 ADC 配药设置管理，以提高机构用药调整政策的合规性。一项由药剂师主导的质量改进计划修订了机构用药调整清单，以改善整个学术医疗中心校园（含儿童医院和 2 家成人医院）的用药配给实践。该计划包括从用药调整清单中删除患者护理单元的指定，修订机构调整政策，创建在线提交表格，并选择 ADC 调整监测指标。一个概念框架指导了针对独特剂型和跨学科参与的决策。通过临床药剂师评估、现有共享治理结构沟通以及药剂科自动化支持，该框架为用药流程中的利益相关者修改了工作流程。修订后的政策将可调整用药的数量从 80 种增加到 106 种（增加 33%），独特剂型从 166 种增加到 191 种（增加 15%）。用药设置总数从 5600 减少到 541（减少 90%）。符合政策的调整用药配给比例从 59%增加到 98%（P<0.001）。政策修订后，每月 ADC 调整的中位数保持不变（P=0.995）。整个机构的 ADC 调整率都有所下降，从 1.4%降至 1.2%（P<0.001）。成人、儿科和急诊部门的 ADC 也观察到类似的 ADC 调整率下降。
这项计划突显了药剂师在通过 ADC 配药实践引领机构政策变革，从而影响用药流程方面的作用。药剂师主导的核对流程将我们的用药调整政策中实践区域的指定去除，简化了 ADC 设置维护，提高了 ADC 调整交易的合规率，并为未来用药调整的评估提供了正式的流程。
