We utilize Pyxis from BD as our automated dispensing cabinet (ADC) vendor, which includes a feature known as a “Too Close to Remove” alert. This alert functions by warning the end user upon removal of a medication for a patient if a dispense of the same medication within a time frame pre-determined by the organization has already occurred. The time setting is applied to the medication record and cannot be turned off or on for various stations in certain patient care areas (e.g. ORs). In addition, since the alert is only linked to the medication record, it does not pull information from the electronic health record with regard to the frequency that the medication is scheduled to be administered.

By default, the “Too Close to Remove”" alert is currently set to 1 minute for all medications at our organization, but we are seeking to optimize this alert setting, and would like some feedback on the following:

1) Have other organizations implemented this alert function?

2) If so, what approach was used to identify which medications or medication classes to apply this alert? (e.g. high alert medications)

3) How did you determine an appropriate time interval to apply this alert for each medication/med class?

I appreciate any insight that can be provided. Thank you!

Mary Pat Bulfin, PharmD
Medication Safety Pharmacist, Adults Enterprise
Cleveland Clinic