Are You Prepared for Joint Commission Scrutiny on Cabinet Overrides?

Several situations may prompt overrides, which are medications issued from an automated dispensing cabinet without a profiled order:

  • Issuing a medication for an emergent medical condition before the order can be reviewed and verified by pharmacy
  • A network failure that prevents verified orders from pharmacy reaching the cabinet
  • The OR or procedural area where p hysicians’ orders are not reviewed and verified by pharmacy
  • A non-24-hour pharmacy where pharmacy orders are not reviewed and verified during the overnight shift

Because overrides allow medications to be issued to patients without an order being profiled, the Joint Commission requires a reconciliation policy and procedure to be in place. In January 2018, the override assessment process became an official performance element in the Joint Commission’s medication management (MM) standards.3 Surveyors are particularly scrutinizing overrides in cabinets that are not profiled. Profiling provides the confidence that medication orders have been reviewed by the pharmacist. Using the override function bypasses the pharmacy review, so it should be used sparingly.

Override Flexibility in Omnicell System

The Omnicell® Automated Dispensing Cabinet (including AcuDose-Rx® cabinets) can be set up in different ways to enable access to emergent medications prior to the pharmacist review.

Configuration by Item

Individual medications in each cabinet are designated for override, providing maximum flexibility; items eligible for override can be selected based on the clinical area. It’s best to limit override medications to only those needed for emergent situations.

Configuration by Select Users

Only designated clinicians are permitted to perform overrides in order to limit their use. These users may be given permission to override conditionally or always.

Critical Override

Enables overrides by any user in a critical situation. It can be enabled when the Pharmacy Information System is not available to send medication order information. (Available with OmniCenter 19.0 and above.)

Enable/Disable Automatic Critical Override

Automatically activates Critical Override after the cabinet loses connection with OmniCenter for a predetermined length of time, and can be set to automatically disable after the connection is restored. (Available with OmniCenter 23.0 and above.)

Is Diversion Occurring?

Each time a medication is removed from the cabinet via the override function, it is recorded and the information is available through the Medication Order Override report in the OmniCenter® server as well as through Omnicell Analytics and Pandora™ Analytics—two tools for monitoring potential drug diversion activity. Omnicell Analytics flags override behavior on transaction-level reports.

Reviewing overrides can help identify potential drug diversion activity, and the reports should be looked at daily. Look for:

  • Multiple override orders for a narcotic without a corresponding physician’s order
  • Narcotics removed via override even when that same order is profiled (which can also indicate a nurse needs further training on the cabinet)

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