Medication Errors and Delays: How IT Outages Disrupt Pharmacy Operations

Shane M
Apr 17
4 min read

Pharmacies are the backbone of medication safety and patient care in hospitals, ensuring the right medications are dispensed, verified, and tracked efficiently. However, when an IT outage occurs, pharmacy operations can grind to a halt, creating dangerous vulnerabilities in medication administration. Automated dispensing cabinets, barcode verification systems, electronic prescribing, and inventory tracking—all of which ensure accuracy and prevent errors—become inaccessible, leaving healthcare teams to rely on manual processes that are slower, more error-prone, and less secure.

In an industry where seconds matter, the inability to properly verify and dispense medications due to an IT failure can lead to delayed treatments, incorrect dosages, and compromised patient safety. To prevent critical failures, healthcare organizations must have a robust pharmacy downtime plan that ensures continuity in medication management and minimizes risks.

How IT Outages Disrupt Medication Management

An IT outage can impact nearly every aspect of pharmacy operations. Among the most severe disruptions:

Automated Dispensing Cabinets (ADCs) Go Offline: Systems like Pyxis and Omnicell, which store and dispense medications in real time, may no longer function, requiring manual tracking of withdrawals.
Electronic Prescriptions and Order Entry Fail: Physicians cannot send prescriptions electronically, and pharmacists must rely on paper orders, increasing transcription errors.
Barcode Scanning for Medication Verification is Disabled: Nurses lose the ability to scan medications at the bedside, heightening the risk of incorrect medication administration.
Inventory Tracking is Disrupted: Without real-time inventory visibility, hospitals may run out of critical medications or struggle to locate essential supplies.

These disruptions don’t just slow down operations—they jeopardize patient safety by increasing the likelihood of medication errors, duplicate orders, and drug interactions that might otherwise have been flagged by digital systems.

Key Strategies for Managing Pharmacy Operations During IT Downtime

1. Implement a Paper-Based Prescription and Verification Process

With electronic prescribing unavailable, hospitals must revert to manual prescription processing to ensure timely medication delivery. This includes:

Pre-printed downtime prescription forms to streamline handwritten orders.
Double verification for high-risk medications such as anticoagulants, insulin, and opioids.
Physician-to-pharmacist communication protocols to confirm accuracy, especially for critical and STAT orders.

By training staff on clear, legible documentation, hospitals can reduce transcription errors and ensure prescriptions are still processed efficiently.

2. Establish Manual Dispensing Protocols for Automated Cabinets

When automated dispensing cabinets (ADCs) are offline, accessing medications requires careful oversight to prevent miscounts and unauthorized withdrawals.

Pre-printed emergency override lists for essential medications should be kept readily available.
Controlled substance tracking forms should be used to manually log narcotics and other high-risk drugs.
Designated pharmacy runners should be assigned to manually retrieve and deliver medications to nursing units to prevent bottlenecks.

By having predefined manual workflows in place, hospitals can ensure that essential medications remain accessible even without digital tracking.

3. Enhance Communication Between Pharmacy, Nursing, and Physicians

A pharmacy IT outage affects multiple departments, making clear communication vital to ensuring safe medication administration. Hospitals should implement:

Dedicated phone lines or secure messaging apps for medication queries and verification.
Scheduled huddles between pharmacy, nursing, and physician teams to discuss high-priority medications and patient needs.
Visual indicators on patient charts (e.g., color-coded stickers) to signal patients requiring urgent or complex medication management.

Without structured communication, medication errors can easily escalate. Keeping all teams aligned helps minimize risks and ensures patients receive their prescriptions on time.

4. Implement a Manual Medication Administration Record (MAR)

When EMRs and barcode scanning systems are offline, nurses must manually track medication administration using paper-based MARs. To reduce errors:

Nurses should cross-check medication orders with downtime prescription logs before administration.
A second nurse should verify high-risk medications before dispensing to the patient.
All manual MAR entries must be carefully reconciled with electronic records once IT systems are restored.

Without electronic safety checks in place, reinforcing manual verification processes is critical in preventing dangerous errors.

5. Prioritize Emergency and High-Risk Medications

Some medications cannot be delayed—such as thrombolytics for stroke patients, antibiotics for sepsis, or emergency pain relief. During an IT outage, hospitals should:

Create an emergency medication priority list for rapid dispensing.
Assign a pharmacist or clinical leader to oversee critical medication workflows.
Pre-position key medications in high-risk areas like the ICU and ER to reduce wait times.

By triaging medication requests, hospitals can prevent treatment delays that could lead to worsened patient outcomes.

Restoring Operations After an Outage

When IT systems come back online, the transition must be carefully managed to prevent data discrepancies and missed entries. Hospitals should:

Reconcile all manually recorded medication administrations with EMR data.
Audit all controlled substance logs to ensure proper tracking of narcotics and high-alert drugs.
Review system integrity before resuming full automated dispensing, ensuring that medication stock levels reflect actual use.
Conduct a post-incident debrief to identify process gaps and areas for improvement in future IT downtime scenarios.

Final Thoughts: Preparedness is the Key to Patient Safety

Healthcare IT outages are unpredictable, but their impact on pharmacy operations doesn’t have to be. Hospitals that proactively prepare for downtime scenarios, train their staff on manual workflows, and maintain clear communication strategies can greatly reduce the risk of medication errors and delays.

Investing in downtime drills, paper-based workflow training, and enhanced cross-department collaboration will ensure that when IT systems fail, patient safety remains a top priority.

Is Your Hospital’s Pharmacy Ready for an IT Outage?

At Stone Risk Consulting, we help healthcare organizations develop real-world pharmacy downtime response plans that protect patients, maintain operational efficiency, and ensure compliance. Contact us today to assess your hospital’s resilience and preparedness for IT disruptions.