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Reducing Nursing Overrides from Automated Dispensing Machines

Medication errors and adverse drug events (ADEs) can harm patients and impact a hospital’s bottom line. In fact, the average cost of a single harmful ADE in 2018 was greater than $9,000.

Smiling pharmacist and customer discussing a product in the pharmacyAutomated dispensing cabinets (ADCs) help reduce labor costs, contribute to efficiency, and nurses are often authorized to override the ADC electronic dispensing function in order to retrieve medications. However, utilizing the override mechanism and administering medications prior to a pharmacist’s review increases the risk of medication errors and costly ADEs.

Higher Risk of Medication Errors

While ADCs improve the efficiency of medication dispensing, ADCs do not prevent medication errors. The override function is often used in clinical settings that do not have a 24-hour pharmacist on-site to review the orders prior to administration.

Susan Paparella, Vice President at the Institute for Safe Medication Practices (ISMP) has stated, “One of the big problems with automated dispensing cabinets is that sometimes staff are overriding without having an order. There’s no verbal order written down, or they’re anticipating an order, so they get the drug from the cabinet.”1

Review of Orders

The challenge with ADCs is to reduce medication overrides in nonurgent situations and to avoid administering medications from orders not reviewed by a pharmacist.

The Joint Commission has established Standard Medication Management practices (The Joint Commission Standard Medication Management 4.10 – MM.4.10) that require pharmacist review of all medication orders before dispensing a medication, removing it from floor stock, or removing it from an automated storage and distribution device. There are exceptions to this rule when a licensed independent practitioner controls the ordering, preparation, and administration of the medication as well as in urgent situations when a delay of administering the medication would harm the patient.

The Joint Commission, Centers for Medicare and Medicaid Services (CMS), individual state boards of pharmacy and other accreditation bodies are more strictly enforcing first dose review of orders. To meet these rules and regulations, healthcare facilities without 24/7 pharmacists on staff should engage high-quality, affordable telepharmacy solutions.

CPS Telepharmacy Provides Pharmacist Review of Orders 24/7

CPS Telepharmacy offers affordable remote pharmacy coverage from licensed pharmacists 24/7. CPS Telepharmacy remote pharmacists provide review of medication orders prior to administration that reduces the incidence of nursing overrides and the risk of medication errors and costly ADEs.

CPS Telepharmacy:

  • Processes 3 million medication orders a year
  • Intervenes on  200 medication orders daily 
  • Catches medication errors 3.6 times a day
  • Averages 45% reduction in pharmacy operating costs

By operating as a seamless extension of the hospital’s own pharmacy, CPS Telepharmacy reduces readmissions, lowers healthcare costs, improves clinical outcomes, and decreases ADEs while preserving a high level of patient care. To learn more about how CPS Telepharmacy can support your pharmacy operations, visit:


1. Joint Commission Eyes Overrides of Dispensing Cabinets. Accessed 1.06.20.

Posted: Friday, April 17, 2020

Tags: Blog