*1.Organization name:(Required.)

*2.Organization type (select all that apply)(Required.)

Academic institution

Hospital, Community

Free standing pediatric hospital

County/Federal

Multi-hospital health system

Trauma Center

*3.Position:(Required.)

*4.Who is responsible for auditing ADC override data at your organization? (select all that apply)(Required.)

Pharmacy

Pharmacy and Nursing

P&T Committee

Medication Safety Committee

Other (please specify)

*5.How often is your ADC Override compliance audited? (multiple selections apply)(Required.)

Yearly

Quarterly

Monthly

Other (please specify)

*6.How do you define ADC override compliance? (select all that apply)(Required.)

Used only in emergencies

An override indication/reason is required for nurses to choose corresponding to medication

Any medication in the ADC is overridable 

Nurses can pull medication if not readily available

Other (please specify)

*7.If using an override reason, what types of override categories do you use? (multiple selections apply)(Required.)

justification (medical indication such as hypertensive emergency, acute seizure, antidote, intubation)

drug class (antihypertensives, vasopressors, opioids) 

Other (please specify)

*8.When auditing medication overrides, does your organization audit order linkages as well (override order linked to medication order entered by a provider)?(Required.)

9.How does your organization measure compliance? (multiple selections apply)

Percent of overrides (denominator all ADC pulls)

Percent of compliance of justification

Both

Other (please specify)

10.What is your organization's target ADC override compliance?

<1%

between 2-4%

between 4-8%

Other (please specify)

*11.Additional comments(Required.)