Time and Workflow Burden Associated With Manual Monitoring of Automated Dispensing Cabinet Overrides

Automated dispensing cabinet (ADC) overrides facilitate timely medication access but bypass standard medication-use safety checks, necessitating ongoing monitoring to identify potential risks. Many health systems rely on manual, retrospective workflows to review override activity, yet operational burden associated with these processes is not well characterized. Objectives of the evaluation were to describe the workflow, quantify the time burden, and identify limitations associated with a manual ADC override monitoring process within a large health system. This retrospective, descriptive quality improvement evaluation was conducted at a large oncology-focused health system. The existing ADC override review process was assessed over a 6-month period. Workflow steps included generation of external reports, manual alignment and manipulation of data within spreadsheets, and creation of pivot table summaries for analysis across patient care areas. Time required to complete each monthly override audit was tracked, and process limitations were documented. The mean time required to complete a monthly override audit was 1 h and 7 min, with a range of 42 min to 1 h and 55 min. The most time-intensive activities were spreadsheet construction, data manipulation, and report preparation. Additional effort was required to train and validate reviewers. Key process limitations included reliance on retrospective reporting, lack of standardized review methodologies, and challenges aggregating data to identify system-level trends. Manual ADC override monitoring is resource intensive and subject to variability due to retrospective, spreadsheet-based workflows. These findings suggest a need for optimized and standardized approaches to support medication safety surveillance and improve scalability of override review processes.