Title: Impact of IV Electrolyte Autoverification Compared to Pharmacist Verification in the Emergency Department Authors: Raven Gadson, Brittany Onyeji, Kirsten DiPiro, Ambra Hannah
Background/Purpose: Autoverification allows medication orders to bypass pharmacist review, which can improve efficiency but also introduces safety concerns. Studies show that removing high‑risk medications from autoverification increases pharmacist involvement and may reduce medication errors. The purpose of this study is to evaluate the safety and efficiency of pharmacist verification to autoverification for intravenous (IV) electrolyte orders in the emergency department setting (ED).
Methods: A retrospective chart review was conducted from August 1, 2024, to March 1, 2025, to compare pharmacist verification with autoverification. Inclusion criteria were age ≥18 years and received an IV Piggyback (IVPB) in the ED of a Wellstar Health System facility that was stocked in the ED Omnicell. The primary end point was a comparison of error rates related to dosing, indication, duplication, drug interaction, and allergies. Secondary end points included the time to final verification and time to administration that occurred in each study group.
Results: A total of 150 IVPB electrolyte orders were analyzed. Baseline demographics and order characteristics were similar between groups. No clinically significant ordering errors were identified in either group (P = 1). Time to final verification was significantly shorter with autoverification versus pharmacist verification (0 minutes vs 3 minutes, P < 0.001). However, time to administration did not differ between groups (40 minutes vs 40 minutes, P = 0.997). Provider order-entry alerts were infrequent and comparable. Among pharmacist‑verified orders, pharmacists received an alert for 18.7% of orders and documented a clinical intervention on 2.7%.
Conclusion: Autoverification of IVPB electrolytes demonstrated no observed increase in ordering errors compared with pharmacist verification and significantly reduced time to final verification, without affecting time to administration. These findings suggest that, within a safeguarded ED workflow, selective autoverification of IVPB electrolyte orders such as those that are pre-mixed, standardized, or placed through an order set may be a safe and efficient strategy. Limitations include retrospective design, modest sample size, reliance on documented interventions, and analysis restricted to medications that were administered. Prospective studies with larger samples are warranted to confirm safety signals and to evaluate operational levers that influence administration time.
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