When something goes wrong with a patient or a med

Pulling a med on override and charting it so it holds up

The cabinet logs the pull and nothing else. What your override note needs so the chart still makes sense when someone reviews it.

7 min read built on 0 cases updated 2026-10-07

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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Pharmacy hasn't verified the order yet, and the patient needs the drug now. So you pull it on override. The cabinet logs who pulled what and when, and nothing else. It doesn't log who ordered it, why it couldn't wait, who checked the vial or whether the order ever showed up. Your note has to cover those four things.

Key points

  • Order first, then the drawer. Write down who ordered it, the exact drug, dose and route, and the time. If it was a verbal order, read it back and chart that you did.
  • Chart the reason as findings you saw. Vitals, behavior, pain score, rhythm. Emergent on its own doesn't tell anyone why the drug couldn't wait for pharmacy.
  • Name the second check. Write who looked at the vial against the order, their role, and the time.
  • Close the loop. Chart when the provider's order showed up in the EMR and when pharmacy verified it. Also chart that you linked your dose to that order on the MAR.
  • Write up any mismatch. If the order never shows up, or it doesn't match what you gave, chart it. Then tell the provider and follow your facility's reporting process.

What to write

What people write What holds up
Haldol given per MD for agitation.1402 verbal order from Dr. [NAME], ED attending: haloperidol 5 mg IM x1. Order read back and confirmed by Dr. [NAME]. Pulled on override at 1404, pharmacy verification pending.
Pt agitated, med given emergently.Pt striking bed rails, pulled out PIV x1, not redirectable verbally, threatening staff. HR 118. Dr. [NAME] at bedside. Delay for pharmacy review judged unsafe by ordering provider.
Override pull.Vial checked against verbal order by [NAME], RN, at bedside before administration: haloperidol 5 mg/mL, 1 mL, exp [DATE]. Pt ID confirmed x2, allergies reviewed: NKDA.
Morphine given, will f/u.1430 Dr. [NAME] entered order for morphine 2 mg IV x1. Pharmacy verified 1447. Override dose from 1406 linked to verified order on MAR at 1450. Dose and route match.
Order not in yet.1530 no order in EMR for lorazepam 1 mg IV given 1406 on override. Paged Dr. [NAME] at 1532, order entered 1540, pharmacy verified 1552.
Pt tolerated well.1436 (30 min post-dose): pt calm, sitting in bed, RR 16, SpO2 97% RA, responds to voice. Restraints remain off.

Every good entry covers the same ground. Who ordered it, what exactly was ordered, why it couldn't wait, who checked the vial, and when the order and pharmacy caught up.

Template

Chart note at the time of the pull

[DATE] [TIME] Verbal order received from [PROVIDER NAME], [ROLE]:
[DRUG] [DOSE] [ROUTE] x[NUMBER OF DOSES]. Order read back and confirmed
by [PROVIDER NAME] at [TIME].

Indication: [OBSERVED FINDINGS, e.g. HR, BP, SpO2, pain score,
behavior, rhythm]. Provider [AT BEDSIDE / BY PHONE]. Delay for
pharmacy review judged unsafe by ordering provider.

[TIME] [DRUG] [STRENGTH/CONCENTRATION] removed from ADC [CABINET ID]
on override; pharmacy verification pending.

Independent check: [NAME], [ROLE], verified product against verbal
order at bedside at [TIME]. Drug [DRUG], strength [STRENGTH], volume
[VOLUME], exp [EXP DATE]. Patient ID confirmed with [TWO IDENTIFIERS].
Allergies reviewed: [ALLERGIES OR NKDA].

[TIME] [DRUG] [DOSE] [ROUTE] administered [SITE IF APPLICABLE] by
[YOUR NAME], [ROLE]. Waste: [AMOUNT] wasted with [WITNESS NAME] at
[TIME] / no waste.

[TIME] Post-dose: [VITALS AND OBSERVED RESPONSE].

Follow-up note when the order and verification come through

[DATE] [TIME] Order for [DRUG] [DOSE] [ROUTE] entered in EMR by
[PROVIDER NAME] at [TIME]. Pharmacy verified at [TIME]. Override dose
administered at [TIME] linked to verified order on MAR at [TIME].
Ordered drug, dose and route match dose administered.

Message to the provider when the order has not appeared

[PROVIDER NAME], this is [YOUR NAME], RN, [UNIT], re: [PATIENT NAME],
[MRN], room [ROOM]. At [TIME] you gave a verbal order for [DRUG]
[DOSE] [ROUTE] x[NUMBER]. It was pulled on override and administered
at [TIME]. As of [CURRENT TIME] there is no matching order in the EMR,
so pharmacy cannot verify it and the dose is not linked on the MAR.
Please enter the order. Callback: [EXTENSION].

Event report when what was given does not match the order

Date/time of event: [DATE] [TIME]
Patient: [NAME], [MRN], [UNIT/ROOM]
Medication pulled on override from ADC [CABINET ID] at [TIME].

Order as received: [DRUG] [DOSE] [ROUTE], verbal order from
[PROVIDER NAME] at [TIME], read back at [TIME].
Medication administered: [DRUG] [DOSE] [ROUTE] at [TIME].
Order as later entered in EMR: [DRUG] [DOSE] [ROUTE] at [TIME] /
not entered as of [TIME].

Discrepancy: [DESCRIBE THE DIFFERENCE IN ONE OR TWO SENTENCES].
Discovered by [NAME] at [TIME].
Patient assessment after discovery: [VITALS AND FINDINGS].
Notified: [PROVIDER NAME] at [TIME], [CHARGE RN NAME] at [TIME],
pharmacy ([NAME]) at [TIME].
Interventions: [WHAT WAS DONE, WITH TIMES].
Patient status at time of report: [FINDINGS].

Words to avoid

Word or phrase Why it hurts Use instead
per MDWhich MD? When? How was the order given?Dr. [NAME], verbal order at [TIME], read back
emergent / STAT needThat's a label. A reviewer has nothing to judge it by.The vitals, behavior or symptoms you actually saw
anticipated orderMeans you pulled before anyone ordered it.Wait for the order, or chart the actual verbal order
pharmacy will verifyFuture tense. It doesn't say it happened.Pharmacy verified at [TIME], or follow-up note if not
checked (alone)Checked by whom? Against what?Checked against order by [NAME], [ROLE], at [TIME]
tolerated wellYou can't measure it, and there's nothing to compare against later.Post-dose vitals and observed response, with time
will f/uA promise. Reviewers want the result.A separate timed note when the order or verification lands

Figuring the cabinet record covers it

The usual mistake is to pull, give, scan and move on, figuring the cabinet record covers it. It doesn't.

After an override you have three separate records of the same dose:

  1. The cabinet log. Your name, the drug, a pull time.
  2. The provider's order. It often goes in anywhere from 20 minutes to 2 hours later, with its own timestamp. Sometimes the dose or route is slightly different.
  3. The MAR. Your administration time. It might be linked to the order, or it might be sitting there as an unlinked override dose.

Later someone reviews the chart. It could be pharmacy running the override report, your manager or a quality reviewer. They see a drug that left the cabinet before any order existed. Unless your note gives the sequence (order received verbally at 1402, pulled 1404, given 1406, order entered 1431), the record reads like a med given without an order. Your note is the only place those three timestamps get explained.

The second problem is the safety check that never happened. On override, no pharmacist has looked at the order. Nobody checked the dose, allergies or interactions before the drug got to the patient. AHRQ's PSNet published a case study on exactly this. An ED physician gave a verbal order for IM haloperidol, the nurse pulled on override, and the vial was midazolam. The patient fell into a deep sleep. The nurse caught the error, and then flumazenil was given. Two error-prone steps happened at once: a verbal order and an override. If your note names an independent check, it shows someone covered the step pharmacy normally covers.

Bottom line

The cabinet records the pull. Your note has to record the order, the reason, who checked the vial and when pharmacy verified it.

Official guidance

  • Override is for when waiting on pharmacist review would harm the patient. Convenience doesn't count. (PSNet, NCBI Bookshelf)
  • You still need an order before the drug leaves the cabinet. A verbal order counts. Pulling because you expect an order is the problem. (PSNet, CPS Perspectives)
  • Afterward, override pulls get reconciled against the prescriber's order and reviewed. That review reads your note. (PSNet, NCBI Bookshelf)

What this rests on

No published decision turned up for this question. We looked, and the searches are in the record. So this article stands on published guidance and on how the question is asked on the floor, not on a court opinion. That is a weaker footing than the rest of the guide, and you should know it before you rely on it. The decisions behind the other articles are all in one place.

From nurses online

Quoted as written. Opinion, not a source.

  • That's not something I, as a nurse, would catch. But you're right, nothing should be overridden, especially in this day and age. ... We do have a remote verification pharmacy that approves all meds before they can be pulled.

    r/nursing on Reddit: Overriding meds in Pyxis with Epic EMR reddit

  • I override meds on the regular in PACU because meemaw is pulling her a-line out and I don’t have time for pharmacy to verify my versed—it’s no big deal, just make sure the order exists and you’re verifying the medication with the order before giving it ... Cool thank you! It was a part of the med or

    r/nursing on Reddit: Override on pxyis reddit

  • In emergencies, verbally ordered medications can be overridden at the pyxis by selecting a patient name, typing in the drug, and removing it. This populates the drug to the computer chart as an override and flags it to remind you to pester the ...

    r/nursing on Reddit: What is a Pyxis Machines? reddit

  • ... Yeah in emergencies these would be verbal orders, we would override them in the Pyxis and the doc would put in orders later. ... There’s 2 different things here. ... Overriding pyxis to pull meds not ordered or verified by Pharmacy.

    r/nursing on Reddit: Critical care nurses, you can over ride meds without doctor orders? reddit

Other guides

Advice, not law.