VA Outpatient Clinic Case Study

In the UK, there are more than 1 billion scripts prescribed and dispensed every year (HSCIC, 2013). There are over 12,000 pharmacies in the UK, and approximately 1.6 million people visit a pharmacy every day (HSCIC, 2013). It is therefore natural to assume that between these 1 billion prescriptions, an error or mistake will be made. Current studies suggest that of all the dispensed medicines, there are approximately 0.01-3.32% errors made in community pharmacy and 0.02-2.7% in hospital pharmacy (James et all, 2009).

In Australian hospitals medication administration errors make up 9% or 1 in10 of all medication administrations. These errors include wrong doses, wrong intravenous infusion rates and errors made by prescribing doctors. Errors on discharge of patients were increasingly higher with up to 2 errors per patient related to doctors transcribing discharge medications (Roughead, Semple, & Rosenfeld, 2016).

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).”

It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).

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

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.

The VA is the primary hope for veterans and where there help comes when they need it. Linda Schwartz, the head of Connecticut’s VA says the problem is probably a lot bigger than what the numbers say. “A veteran’s death often does not get reported as a suicide” (Radelat) The problem is huge and daunting to the VA. Schwartz’s VA is proud that her facilities seem to have largely missed the scandal of the VA, and the VA is offering different therapies to widen out the options for the veterans when they go to the VA.

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.

This is a journal study to investigate the perceptions and opinions of the professional community pharmacy staff about the causes of dispensing errors and strategies to prevent these errors. A survey was completed by pharmacists and pharmacy technicians in 49 community pharmacies and the response rate was 90.9% (Lopes, Joaquim, Matos & Pires, 2015). Handwritten prescriptions were the most single cause of medication errors 51.5% and drugs with similar packages 45.6% (Lopes et al., 2015). Checking prescriptions and confirmation of drugs through barcodes was 97% which were the most agreed prevention methods (Lopes et al., 2015). This article would not only be useful to pharmacy personnel but to other health practitioners or students performing research. In addition, a study similar to this could serve as an example (initiative) that may benefit management. Such initiative would be implemented to help improve medication

While the use of barcode technology has had many applications in hospitals for quite some time it has only recently been used to address patient safety. Mitch Work (2005) views bar code technology as a particularly promising advance in the effort to reduce medical errors. Barcodes provide a valuable verification of medication administration by assuring that the "five rights" are confirmed: right patient, right medication, right dose, right time, and right route of administration. The use of barcode technology at the patient's bedside has shown notable gains in reducing medication administration errors, which may account for as many as 7,000 deaths per year in U.S. hospitals.

The National Patient Safety Goals were created in response to the IOM article, To Err is Human: Building Safer Health Systems. These goals were written to address patient safety and are tailored depending on the health care setting to which they are written for. They address system wide solutions rather than focusing on whom or how the error was made. Medical errors have been noted as being the 8th leading cause of death in the U.S. with the most frequent of these errors being medication related (Johnson, K., Bryant, C., Jenkins, M., Hiteshew, C., & Sobol, K. 2010). Therefore a great focus on these goals is needed across the health care continuum. The goals are updated and amended on a regular basis using evidence-based research, in response to areas with high errors in patient safety.

This integrative review sought to identify and understand the impact of information technology in on medication errors. The review of 14 papers shows that the implementation of medication management systems, which include CPOE, BCMA and automated dispensing machines has successfully reduced medication errors and adverse medication events significantly, particularly the two most susceptible stages of prescription and administration of drugs (Armada et al., 2014).

In 1636 U.S. veteran administration hospitals were made to help and take care of the war veterans that come in injured or ill. Also, the bills for this should be taken care of so there are no worries for the most part, but none of this is happening the way it should be or how the system was created to be. Veterans are turned away and avoided by the U.S. veterans hospitals, they have a big thirst for money that has not been quenched and because of this, the veterans that come in are not being treated properly and this effect is turning out very negative.

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).