IN INPATIENTS, WHAT IS THE EFFECT OF BCMA RELATED WORKAROUNDS ON DRUG ADMINISTRATION COMPARED WITH NON-BCMA RELATED WORKAROUNDS?

 

Introduction

Medication errors usually have serious and sometimes fatal impact on patient outcomes. It is estimated that in a medical environment, errors in medical administration account for 34% of all drug events that may occur. A combination of drug prescription and administration on the other hand account for 80% of all drug administration errors. Administering medications safely and accurately is a complex process and involves patient assessment as well as verification of the medication order, including drug, dose, route, time, and patient. Because administration of the medication to the patient is the last step in the process, there may be a false sense of safety related to multiple checks performed earlier in the process. This is what ends up bringing medical administration malpractice problems. Over the years, there have been attempts to incorporate technology into medical practice to be able to ease the burden on medical practitioners. Most of these attempts have failed when it comes to administration of medicine. However, all this changed with the introduction of Bar-Code Medical Administration (BCMA) technology.

The Bar Code Medication Administration (BCMA) is one means of modifying care delivery systems to reduce medication errors at the point of administration. The five rights of medication safety: right patient, right drug, right dose, right time, and right route, are incorporated into the technological design of BCMA, this in turn helps improve patient safety. The Leapfrog Group and the Veterans Administration’s National Center for Patient Safety have identified BCMA as an initiative that helps hospitals improve patient safety and aid in automation of medication inventory and billing. According to a study conducted at an academic medical center, BCMA was found to reduce medication errors by 41.4%.

            Computerized physician order entry (CPOE) aided the process by allowing pharmacists to verify medication orders in a timely fashion and deliver them to the unit so nursing can administer them with the help of BCMA, closing the loop on medication safety. With this technology, all a nurse needs to be equipped with is a computer and a bar-code reader scans the patient’s bar-coded wristband to confirm patient identification. Once confirmed, the patient’s information and medication profile display on the software’s Virtual Due List. Medications to be administered within a facility-defined period displays on the computer screen. The nurse scans the bar-coded medication at the point-of-care. This technology and its advantages has not only helped reduce the workload of healthcare givers but has also saved many lives. This has spiked up its popularity in medical institution and by the year 2008, slightly less that 25% of healthcare institutions in America had fully adopted these evidence based practices.

 

 

 

Literature search

The research of this paper is based on different literature works that involve either well-designed investigations or quasi-experimental study. The resources also include different kinds of clinical examples and expert opinions.

 

Title: Implementing a Safe and Reliable Process for Medication Administration

Summery: The article outlines a process change in medication administration using technology and led by clinical nurse specialists (CNSs) that has been successful and sustainable over time. The article was based on a study performed by the team over a period of 36 months. The team introduced BCMA into an institution and monitored the quality improvement over that period(Barbara & Avis, 2012).

 

Title: Bar-code-assisted medication administration: A method for predicting repackaging resource needs    

Summery: This paper is a result of a study at two hospitals to validate and test systems for bar-code assisted medication administration (BCMA). The report, included data on bar-code scanning failures and BCMA-related staff resource needs. The study found that during inventory assessment, scanning failures occurred at the two pharmacy sites, mainly due to the absence of a bar code label or the inability to identify NDCs within the package bar code. The research concluded that despite the fact that BCMA is a good discover, it is also flowed (Strykowski, et.al, 2013).

 

Title: Study of Nurse Workarounds in a Hospital Using Bar Code Medication Administration System

Summery: This article is because of a study that analyzed registered nurse workarounds in an academic medical center using bar code medication administration technology. Nurse focus groups and a survey were used to determine the frequency and potential causes of workarounds. More than half of the nurses surveyed indicated that they administered medications without scanning the patient or medications during the last shift worked. Benefits of this study included considerations when implementing bar code medication administration technology that may minimize the development of these workarounds min practice (Laurie et.al, 2012).  

 

Title: Challenges Implementing Bar-Coded Medication Administration in the Emergency Room   in Comparison to Medical Surgical Units

            Summery: this article is because of a study conducted in the emergency room of a specific hospital in 2010. The purpose of this study was to explore the factors that contribute to lower BCMA utilization in the Emergency Department (ED). Data analysis, observations of medication administrations, and interviews with nurses showed that numerous factors impacted BCMA utilization in the ED, including verbal and protocol orders, medications administered by others, unpredictable workflow, increased workload, alert fatigue, and hardware limitations. Some of these factors, such as workflow, more steps to chart medications with BCMA, and alert fatigue, have affected medical-surgical nurses as well as ED nurses (Nancy, 2013).

 

Title: Implementation of a Web-based medication tracking system in a large academic medical center

Summery: this paper is based on a research carried out on Pharmacy workflow efficiencies achieved by an electronic medication-tracking system. The research found that relative to the manual tracking method, electronic medication tracking allowed the capture of far more data points, enabling the pharmacy team to delineate the time required for each step of the medication dispensing process and to identify the steps most likely to involve delays. A comparison of baseline and post implementation data showed substantial reductions in overall medication turnaround times with the use of the Web based tracking system. In addition to more accurate projections and documentation of turnaround times, the Web-based tracking system has facilitated quality-improvement initiatives (Sam & Jonathan, 2012).

 

Title: Errors in Transfusion Medicine: Have We Learned Our Lesson?

Summery: this article focuses on the importance of patient safety at the hospital. The article examines blood transfusion, and how a minor problem such as a mix up, may lead to fatalities in a healthcare institution. This article outlines the importance of having a technological system in place that would reduce this error (Barbara & Harold, 2011).

Title: Scanning for Safety: An Integrated Approach to Improved Bar-Code Medication Administration

Summery: the article is as a result of research carried out on a health institution with seven clinics. The primary project objective was to evaluate, using a systems approach, process improvements in utilization of a BCMA system. The team sought to promote a culture of safety and identify the impact on medication error prevention, morbidity, mortality, and cost savings for hospitalized patients (Cynde et.al, 2011).

 

Title: Quality-Monitoring Program for Bar-Code-Assisted Medication Administration

Summery: this paper resulted from a study on the implementation of a quality-monitoring program that identifies and corrects problems associated with using a bar-code-assisted medication administration (BCMA) system at a health institution. The study found that a quality-monitoring program that identified and provided best-practice recommendations corrected problems associated with using a BCMA system and improved bar-code labeling processes (Elizabeth et.al, 2009).

 

Title: Compliance With Intended Use of Bar Code Medication Administration in Acute and Long-Term Care: An Observational Study.

Summery: the objective of this study was to identify the types and extend of workaround strategies with the use of Bar Code Medication Administration (BCMA) in acute care and long-term care settings. The research found that Workaround strategies were employed with BCMA that increased efficiency but created new potential paths to adverse events. There was a significant difference in the rate of use of workaround strategies between acute and long-term care (Emily et.al, 2006).

 

Title: Integrating technology to improve medication administration

Summery: this is a study conducted in order to observe the development, implementation, and evaluation of an i.v. interoperability program to advance medication safety at the bedside. The study found that by integrating two standalone technologies, i.v. interoperability was implemented to improve medication administration. Medication errors were reduced, nursing workflow was simplified, and pharmacists became involved in checking infusion rates of i.v. medications (Amanda et.al,2011).

 

Implementation process

The IOM report in 2000 incited many healthcare institutions to implement e-prescribing and automated administration and dispensing of medications to prevent adverse drug events. Moreover, in 2004, the FDA call for bar codes on drugs and blood products has laid the groundwork for the widespread use of BCMA and the complementary technologies to reduce medication errors and improve patient safety. This makes it almost a necessity to introduce BCMA into health institutions. Introduction of this program may be hard because not only may it disrupt the normal working routing of the institution, but it will also be costly to the institution.

The FDA recommends a Bar Code Medication Administration (BCMA) system to decrease the errors and risks of medication events. It has been proven that BMCA technology improves patient safety – but only when used properly. If the technology is not correctly integrated into the nursing workflow or the hospital’s EHR system, the clinical staffs often try to find workarounds to save time. Therefore, for BMCA to be successful, the IT department of the hospital has to be perfect so that they ensure that the program is run without glitches. One element of a successful BCMA system is a program within each medical center pharmacy that ensures that machine-readable and correctly decoded bar codes are dispensed to the BCMA point-of-care areas

 

Research has also shown that if the caregivers are not educated as to how they can handle evidence based research and the technology, then errors are still prone to occur even with the introduction of BMCA. It is therefore the duty of the institution to ensure that all persons who will be involved in the program receive adequate training and sensitization. Diligence is required by medical center staff to continuously monitor medication labels, correct identified deficiencies, and report metrics quarterly to the BCRO.

 

Based on the research I have done, it would be wise for the institution to implement this program only after they have had a test program. This means that the institution introduce BMCA phases while observing the outcome. This will ensure that the institution does not pour all its money in the project without monitoring the success rate or failure of the program.

Potential findings

By integrating BMCA, there is immediately a great improvement in medical administration. Medical errors are reduced, nursing workflow is reduced, and unpredicted workflow is eliminated. The system also helps root out potential problems such as medication administered by others and alertness fatigue. It also removes the cumbersomeness of giving verbal orders.

Factors that could affect the implementation of BCMA

Although time has proved the effectiveness of BCMA programs, there are challenges faced by the implementation of these programs. Some of these problems are simple and can easily be corrected or dealt with. However, there are major problems that cannot be over looked.

As previously mentioned, if the program is set up yet the medical administrators are not educated on how to use it, then the program will be marred in errors. Studies have revealed that if nurses are unsure of how to use the BCMA, they will work around it. This may pose as a risk to the patient.

Institutions are also advised to know the cost of implementing BMCA systems. This is because it is a very costly venture. It is therefore advisable to properly research on this and weight its compatibility to the institution before applying it.

The BCMA may itself encounter external problems that are out of the institutions reach. A key example is the fact that not all medication have bar code, therefore they cannot be entered into the system. There may also be mix-ups in the system that may result in errors or delays in the administration of medication.

Issues associated with BCMA

Feasibility

It is estimated that the cost of replacing a manual medication administration process with a BCMA system for 5 years, including routine hardware replacement and system upgrades, is $40,000 per BCMA-enabled bed. This is a bit on the high side. However, over a 5-year operating horizon, utilizing a bar-code medication administration system for inpatient medication administrations cost $2000 per moderate or severe medication error prevented, less than published estimates of the additional costs of hospital care resulting from preventable adverse drug events. BCMA can be an effective and potentially cost-saving tool for preventing the morbidity and mortality associated with preventable medication errors in the community hospital setting.

Ethical

There is some element of carelessness by the employees who attach extra copies of patient ID barcodes on desks, scanning machines, clipboards, and supply rooms, which is not the standard procedure. Reports also indicate that some medical administrators carry several pre-scanned patients medication on the same tray. This may be deadly for it may lead to confusion in the administration of the medication.

Legal

Over the years, medical administrator have been overriding the system and using workarounds to compensate for difficult presented by bar codes. These difficulties include wireless disconnectivity, emergencies, unreadable patient id bands, and unreachable patients in isolation. These difficulties that lead to the overriding of the system could present potential legal problems.

Conclusion

In conclusion, since its introduction, BCMA has demonstrated its ability to not only reduce the workload of a health institution, but to ultimately reduce the errors in medical administration. Technology was created to reduce human error and this is exactly what BCMA does. It not only reduces the overall cost of care, but also makes access of patient information easier. Ultimately, Bar Code Medication Administration is the perfect enforcer of the medication order: drug, dose, route, time, and patient.

 

 

 

 

 

 

 

 

References

Amanda E. P, Tina M. S, Richard D. P, Stephen T. O, and Sta rann D. W. (2011).Integrating technology to improve medication administration. Am J Health-Syst Pharm—(Vol 68) 835-842.

Barbara R. F. & Harold S. K. (2011). Errors in Transfusion Medicine: Have We Learned Our   Lesson? Mount Sinai Journal of Medicine 78:854–864.

Barbara, R. Bridget, B. & Avis, H. (2012). Implementing a Safe and Reliable Process for Medication Administration. Clinical Nurse Specialist. 169-176.

Cynde E, Chris R, Jennifer M, Karen W. L & Ellen M. H. (2011).Scanning for Safety: An Integrated Approach to Improved Bar-Code Medication Administration. Computers, Informatics, Nursing & Vol. 29, Topical Collection to Issue 4, TC45–TC52.

Elizabeth .M, Chris .T, Russ .C, Ron .S, and Jonathan .B. (2009). Quality-Monitoring Program for Bar-Code-Assisted Medication Administration. Am J Health-Syst Pharm Vol 66. 1125- 1131.

Emily S. P, Michelle L. R, Roger J. C, Marta L. R. (2006). With Intended Use of Bar Code Medication Administration in Acute and Long-Term Care: An Observational Study. Human Factors Vol, 48, No, 1, Spring 2006, pp, 15-22

Laurie L. R. Linda A. D. & Gail A. W. (2012). Study of Nurse Workarounds in a Hospital Using Bar Code Medication Administration System. J Nurs Care Qual Vol. 27, No. 3, pp. 232–239.

Nancy, G. (2013) Challenges Implementing Bar-Coded Medication Administration in the Emergency Room in Comparison to Medical Surgical Units. Computers, Informatics, Nursing & Vol. 31, No. 3, 133–141.

Sam V. C. & Jonathan P. W. (2012) Implementation of a Web-based medication tracking system in a large academic medical center. Am J Health-Syst Pharm—Vol 69.1651-1658.

Strykowski, J., Hadsall, R., Sawchyn, B., VanSickle, S., & Niznick, D. (2013). Bar-code-assisted medication administration: A method for predicting repackaging resource needs.   American Journal Of Health-System Pharmacy, 70(2), 154-162. doi:10.2146/ajhp120200