Change Initiative: Barcoding Medications

Improved patient safety is the most essential advantage of the BCMA system. “On average a hospital patient is subjected to at least one medication error per day (IOM, 2006)”(Foote). BCMA significantly reduces medication errors that cause a compromise in patient safety. The BCMA verifies the five rights of medication administration before a patient receives a medication by the software alerting the nurse if there is a contraindication between the medicine scanned and the patient’s orders. A pilot study conducted at a 300-bed community hospital found that the BCMA system reduced medication errors by 80% (Foote). Fowler et al states that “decrease in errors related to the wrong patient was a direct result of the bar code system (Fowler).”

According to Rosseter (2011), one of the largest segments of the US workforce are comprised of Registered Nurses, with over three million registered nurses worldwide. Due to the fast paced and rising complex demands placed on our healthcare environment, it is no surprise that over twenty-four thousand post graduate students were actively seeking and earning their master’s degree in nursing in 2011 (DHHS, 2013, p.ix). In order to gain an understanding of the interplay among my education, career path and opportunities afforded to me by taking an approach to higher degree learning. I approached a co-worker whose capabilities impressed me and asked her five questions in person, in order to gain her insightful information of what I will be facing during these next few months.

* Reduction of medication errors- Barcode medication administration safeguards against wrong pt/wrong med/wrong dose errors and alerts to potential medication interactions (Goth, 2006).

Historically, a BSR was given verbally at the nursing station with frequent interruptions, taped on the recorder or a written paper report without the patient being involved in their care. As the healthcare industry has become more of a patient-centered, the hospitals are participating in a publicly reported government HCAHPS survey- a composite scale score that measure patient’s hospital experience through a metric satisfaction survey. An effective handoff is critical when transferring any medical information of a patient’s continuity of care from one nurse to another. According to the Health Professions Education: A Bridge to Quality: “all health professionals should be educated to deliver patient-centered care as members of an inter-disciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” (IOM, 2013). This paper analyzes an overview of nurse’s survey, direct observation on the BSR, a literature summary, nursing challenges and recommendations that might improve patient safety and quality of care.

The pharmacy, nursing, and informatics department were required to be involved in implementing the bar-code-assisted medication administration (BCMA) patient safety initiative. The involvement of the informatics department was required for planning and coordination of the electronic medication administration record and the scanning devices. The nurses were administering the medications so they were required to undergo training on BCMA methods and the importance of BCMA implementation. Pharmacists were needed to assist nurses in case if a scanning error occurred. Pharmacy, nursing, and informatics staff members were responsible for evaluation of the BCMA system upon implementation.

Medication errors are among the most significant cause of patient injury in all types of medical errors (Johnson, Carlson, Tucker, & Willette, n.d). In the nursing profession, medication administration errors occur 34% of the time, second only to physician ordering errors (Gooder, 2011). The introduction of information technology, such as the Bar Code Medication Administration (BCMA), offers new opportunities for reducing medication administration errors. BCMA was developed by the Veteran’s Affairs Medical Center in 1998 to help improve the documentation of medication administration, decrease medication errors and provide

The following articles were reviewed for the purpose of addressing bar code scanning in medication administration. Nursing requires the critical skill of accurate medication administration. The use of electronic medication administration has brought about many changes in the healthcare field. The article,” What Determines Successful Implementation of Inpatient Information Technology Systems” (Spetz et al 2012), was reviewed to address the above question. Computerized patients records and bar-code medication systems continue to gain favor in healthcare. This idea spread across the nation in all VA sites (Spetz et al., 2012, p. 157), providing a safer environment for patient care.

Encourage the use of computer-generated or electronic medication administration records. Plan for the implementation of computerized prescriber order entry systems. Consider the use of machine-readable code (i.e., bar coding) in the medication administration process. Use computerized drug profiling in the pharmacy. Be a demanding customer of pharmacy system software; encourage vendors to incorporate and assist in implementing an adequate standardized set of checks into computerized hospital pharmacy systems (e.g., screening for duplicate drug therapies, patient allergies, potential drug interactions, drug/lab interactions, dose ranges, etc.)”. (Association,

Cerner integrates patient information throughout all of the departments within a hospital setting. This program also has the ability to expand into other health care facilities within a community, such as long term care, hospice, and home health (Cerner, 2015). Cerner offers community hospitals solutions in their “Software as a Service” model. Cerner will host the software program, provide upgrades, and monitor performance to ensure stability. This will allow community hospitals to have a predictable cost for the software (Cerner, 2015). Another advantage of this system is the “Smart Room”. Wireless devices such as infusion pumps, and vital sign monitoring devices can access the system. This allows for instant documentation of this information into a patient chart and will alert if abnormalities are noted. Bar code scanners and carts are available as well. These items improve patient safety (Cerner, 2015). Cerner is capable of CPOE, electronic prescription transmitting, and has the ability to capture data and immunization statuses to meet reporting regulations.

One study reported nurses' compliance rates of 90% (Paoletti et al., 2007), but the other study found that 20% of the drugs were administered without scanning the barcode to ensure right medication (Poon et al., 2010). Helmon et al (2009) reported an increased in compliance rate in checking patients' identities by scanning patients' wristbands in medical-surgical wards, but no difference in the ICUs. Possible reasons for non-compliance in ICUs could be due to high nurse-patient ratio, and that the nurses were often assigned to the same patients (Helmons et al., 2009). Non-compliance in barcode scanning and workarounds could possibly affect the medication error rates. Therefore, it is difficult to interpret the effect of BCMA on medication administration errors due to differences in study designs, study settings and outcome measurement. Further research is required to include more patient care units, and to examine the effect of nursing activities on the impact of BCMA and medication

In observation, (Fahnestock, McComb, & Deshmukh, 2013) stated "Information technologies are transforming the way healthcare is delivered. Innovations such as computer-based patient records, hospital information systems, computer-based decision support tools, community health information networks and new ways of distributing health information.” (p.3.2). In the sector of delivering healthcare using technology, has made it easier for healthcare professionals to access medical records, digitization of prescriptions and view test results. With the use of high-performance devices being used in the hospital, helps to make the jobs of healthcare professionals a little easier. As well as relieve anxiety from anxious patients that may be awaiting lab results to come back. Therefore, IT devices and services has been and continues to be a tremendous help and game changer for the healthcare system. However, there is still a lot of work to be done to help shape and reform the healthcare

Nursing in today?s society involves more than technical skills, critical thinking, and compassion. It also is changing to add the ability to not only understand but be able to utilize technology to impact a patient?s health. There are many technological changes employed in healthcare practices, however, I have chosen to address bar-code medication administration or BCMA. According to an article in the Journal of Patient Safety, ?bar-code medication administration has been shown to be effective in reducing patient medical errors, yet is still only utilized in 5% of the country?s health care facilities? (Sands, Slebodnik, & Young, 2010). Medication errors are common in hospitals and often lead not only to patient harm, but also lengthy hospital stays and law suits. ?One study identified 6.5 adverse events related to medication use per 100 inpatient admissions, more than one fourth of these events were due to errors and were therefore preventable? (Bane, et. al., 2010).

The floor I recently worked on met a change in clinical practice when the supplies room was updated to an electronic scanning system. The new system requires staff to charge supplies to each patient by scanning item bar codes, which assigns and charges the item to the patient.

Wristband print quality is now even more important as bar coding has become common in healthcare. The quality and consistency depend heavily on the printing technology and the wristband material used. This study specifically highlights how these variables impact wristband quality, positive patient identification, and patient safety, and provides guidance for wristband solutions that can deliver accuracy, safety, and convenience throughout the patient care track. Wristband quality directly affects accuracy in patient identification. Patient misidentification was the root cause of 72 percent of adverse event according to a U.S. Veterans Administration (VA) Health System study. Numerous patient safety studies, organizations, and government agencies

Patient safety is one of the main concerns in many hospitals. The present case study deals with medication use and the knowledge of Santiago’s health leaders to solve safety and billing problems. Santiago health system comprises of one large hospital campus and two small satellite hospitals which includes 556 bed hospital, cardiac care center, cancer center, and outpatient surgery center.Dr Trubelli is a warm hearted pediatrician and former chief of staff of the SCC and now hold the position of Medical director of Information systems. Throughout his career he has addressed many medical errors and wants to implement the new system of administration i.e. bar code medications. This system helps nurses to verify all the drugs along the bedside using electronic verification and to prevent medical errors. The pharmacy department at SCC wants to adopt bar code system to ensure safety using codes on medications but their main concern is that all the medications don’t come with bar codes. All the drugs should be packed, compounded and delivered with printed bar codes to implement this system. Changes should be made to the pharmacy technician work flow as implementing the bar code system results in billing changes, dose charging at administration and they are not aware of the responsibilities and roles of the IS staff. Changes are also necessary in the nursing department as most of the nurses face the difficulty in using bar codes at the point of care. In SCC the