2026 Southeastern Residency Conference

Background: 
Automated dispensing cabinet (ADC) overrides are intended for emergent medication access but introduce risk when medications are removed without an associated order. After a medication is pulled on override, a retrospective order should be placed in the electronic health record (EHR) and the override linked to that order.

Overrides unlinked to orders may reflect breakdowns in ordering workflows, verbal order reconciliation, or documentation practices, increasing the risk of inappropriate medication administration or incomplete clinical review. Additionally, medication administration without a documented provider order may carry legal and licensure implications, as it can be interpreted as practice outside established scope and authorization.

Override monitoring is a critical safety and policy component of ADC governance. A company-wide override dashboard was recently updated to pull data from the EHR instead of pulling data from the ADC. This allowed the additional visualization of overrides being linked to orders in the EHR. However, limitations in filtering functionality and data clarity reduced its effectiveness for identifying trends in overrides unlinked to orders.

Objective: 
To evaluate data integrity within a company-wide ADC override dashboard to enhance identification and review of unlinked overrides.

Methods: 
This quality improvement initiative evaluated override data without linked orders from AdventHealth Central Florida Division (CFD), consisting of 10 acute care campuses and 11 off-site emergency departments (OSEDs). An evaluation of dashboard performance was conducted to assess usability and data reliability.

Results: 
Dashboard filters were refined to allow more precise identification of overrides unlinked to medication orders, including improved medication-level and ADC-level stratification. Following implementation of revised filters, medications and ADCs commonly associated with unlinked overrides were more readily identifiable, enabling targeted analysis rather than broad, non-specific review. During detailed data review, a discrepancy was identified between data displayed and data exported. This prompted review of dashboard logic and strengthened confidence in data interpretation.

Medications and ADCs commonly associated with unlinked overrides were systematically identified, and focused analyses were performed to evaluate opportunities to improve override-to-order linking workflows. These finds were brought to the CFD interdisciplinary Medication Safety Committee to facilitate focused discussions on strategies to improve order linking workflows.

Conclusions:
Refinement and validation of a company-wide ADC override dashboard enhanced transparency, usability, and data reliability in monitoring unlinked overrides. Systematic dashboard optimization and multidisciplinary collaboration are essential to strengthening medication safety surveillance across large health systems.
  

---