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Barcoded Medication Administration Systems (BCMA) to Improve Patient Safety

Barcoded Medication Administration Systems (BCMA) to Improve Patient Safety. IOM Report. To err is human: Building a safer health system (IOM, 1999) 44,000 – 98,000 die yearly due to medical errors 7,000 due to medication administration errors

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Barcoded Medication Administration Systems (BCMA) to Improve Patient Safety

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  1. Barcoded Medication Administration Systems (BCMA) to Improve Patient Safety

  2. IOM Report • To err is human: Building a safer health system (IOM, 1999) • 44,000 – 98,000 die yearly due to medical errors • 7,000 due to medication administration errors • 1 of every 854 hospital deaths due to a medication error

  3. How to Improve Patient Safety? • Congressional hearings – technologies may help with patient safety. Things like • Bar coding • Computerized physician order entry (CPOE)

  4. How BCMA Works • Manufacturers, repackagers, relabelers, and label distributors required to put NDC code on drugs (no expiration date, lot #) by 2006 • Hospitals not required to use the bar codes

  5. How BCMA Works • Patient’s treatments and MAR entered into hospital database • Same encoded into patient wristband • Both accessible to RN via handheld device • Scan wristband to display MAR for patient • At time of med administration • RN scans drug bar code, pt. wristband, RN ID badge • Computer updates MAR accordingly

  6. Successes with BCMA – Veteran’s Adminstration • Began using system in 1993 • 1998 – medication documentation software • 1993-2001 – 86.2% decrease in medication errors • 75.5% - wrong medication • 93.5% - wrong dose • 87.4% - wrong patient • 70.3% - missed dose • Bar coding mandated in all VAs (including for IVs)

  7. Successes with BCMA • NICU study reported 47% decrease in adverse drug events (Morriss et al., 2009)

  8. Benefits of BCMA • Helps enforce 5 rights (medication, dose, time, patient, route) • Catches medication errors otherwise undetected • Catches drug allergies • When US fully automated, estimated $2.5 million savings to hospitals annually (preventing adverse drug events)

  9. Benefits to BCMA • Nurse satisfaction • Can save time due to fewer problems, errors (some say increases time for medication administration) • Improve patient satisfaction • Generate community goodwill (hospitals taking steps to improve safety)

  10. Problems with BCMA • No drug expiration dates • Need to increase dosing windows • Costs associated with developing, supporting, implementing systems

  11. Problems with BCMA • Requires significant training (nurses, pharmacy staff, IT personnel) • Scanning technology may not be compatible with other systems • Scanners difficulty reading curved surfaces • 2003 – 2% US hospitals used bar coding

  12. Problems with BCMA • Not consistently nurse friendly • Medication refusals – ‘unscanning’ a problem • Medication deletions from MAR when not administered • Less MD/RN consultation

  13. Problems with BCMA • RNs by-passing system features when perceived cumbersome (unsafe workarounds), e. g., • Placing patient ID band on object rather than patient • Scanning multiple patients’ meds at a time • Scanning label after removing it from actual medication • Removing scanner from cart away from computer information • Disabling alarms

  14. Problems with BCMA • RNs ‘controlled’ by technology • Interfered with other responsibilities, judgment, flexibility • Titration problematic • Time consuming

  15. Problems with BCMA • Short lifespan of hardware • Batteries have short lifespan • Long-term care problems • Armbands become illegible • Durable armbands uncomfortable • Demented patients remove armbands • RN discomfort with technology

  16. References • Koppell, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes and threats to patient safety. Journal of the American Medical Informatics Association, 15, 408-423. • Meadows, M. (2003). Strategies to reduce medication errors. FDA Consumer, May-June, 21-27. • Morriss, F. H., et al. (2009). Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: A prospective cohort study. Journal of Pediatrics, 154 (3), 363-368. • Roark, D. C. (2004). Bar codes and drug administration: Can new technology reduce the number of medication errors? AJN, 104 (1), 63-66. • Work, M. (2005). Improving medication safety with a wireless, mobile barcode system in a community hospital. Patient Safety & Quality Healthcare. Retrieved October 31, 2005 from http://www.psqh.com/mayjun05/casestudy.html

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