Bar Coded Medication Administration

1. Kelly Cronomiz Amanda Partner Christina Edmonson Bar Coded Medication Administration

2. Objectives • Bar Coded Medication Administration • Describe hardware/software • Assess nursing implications • Examine related legal/ethical implications • Advantages/disadvantages from nursing perspective

3. Trend Description-BCMA • BCMA is the technology of placing a unique identifier (bar code) that is machine readable by an optical scanner on each medication. • This bar code encodes the National Drug Code, which includes; • Drug company labeling • Name of drug • Dose • Type of packaging

4. BCMA Continued • An additional bar code is affixed to the patients wristband. • This is used to ensure positive patient identification, safety, and correct dosage. Cochran, et al. 2007

5. BCMA Hardware Hardware: -Handheld scanning device -Wireless mobile connection -Mobile computer/Cart Optional: -Palm PDA

6. Hardware Continued Handheld Scanning Device • Used to scan barcode information on the patient’s wristband ID and the packaging of the medication to be dispensed. (no author, 2008)

7. Hardware Continued Automated Medication Dispensation Cart • Offers secure medication dispensation and tracking at the bedside • Carts have computer terminal with tracking software on the cabinet to audit access to the system and control electronically locked medication drawers (Polisher Research Institute, 2008)

8. Softwarecontinued. Panel A: Key components include: 1)the medication administration route tabs 2) Virtual Due List for medications 3), the Missing Dose function 4), and the Nursing Medication Order function Panel B: Missing Dose Request pop-up window. Panel C: Nursing Medication Order Button pop-up window. (Henriksen et al. 2005)

9. Software Pharmacy order-verifying software program screen displays Panel A: A sample patient profile Panel B: Medication entry finishing profile for an individual drug entry. (Henriksen et al. 2005)

10. Software Provides near miss Medication Error Reports

11. The bar-coded medication delivery process (Paoletti, et al. 2007)

12. Efficacy of BCMA systems • Data from a study at Lancaster General Hospital in Lancaster, PA • 54% reduction in medication administration errors after BCMA implementation. • 90% nursing compliance rate with bar code scanning. (Paoletti, et al. 2007)

13. Satisfaction • Case study at Beloit Memorial Hospital in Beloit ,Wisconsin during BCMA implementation. • Increased job satisfaction was identified as a benefit of the system. • The nursing staff felt that the hospital was truly committed to improve quality of care by investing in state-of-the-art technology to improve patient safety. (Work, 2005)

14. Satisfaction continued • University of Wisconsin Hospital and Clinics implemented BCMA in Dec. 2001. • Study showed 42% improvement in nursing satisfaction with the medication administration and documentation system after BCMA implementation. Photo by Shawn James, HVAMC MediaSection (Rough, Ludwig,& Wilson, 2003).

15. Ease of Use • Data from same University of Wisconsin Hospital study reported: • Initially some nurse resistance results due to the fact that scanning multiple bar codes added some additional time to the administration process. • Resistance was quickly overcome as staff saw errors prevented by the system. (Rough, Ludwig,& Wilson, 2003)

16. BCMA Information System Review • BCMA is an Order Entry System • BCMA is a Clinical Documentation System • BCMA is a Pharmacy Information System

17. Order Entry System • Replaces handwritten medication orders. • Can provide support and automated alerts to providers • Ensures medication orders are legible and complete. (McGonigal&Mastrian, 2009)

18. Clinical Information System • Collects medication administration information in real time. • Can document observations, interventions, and outcomes related to medications. • Ensures 5 rights of medication administration • NOC outcomes are incorporated to evaluate medications Ex: Pain Level (McGonigal&Mastrian, 2009)

19. Pharmacy Information System • Allow pharmacists to order, manage, and dispense medications for a facility. • Incorporates allergies, height and weight information for effective medication administration. (McGonigal&Mastrian, 2009)

20. Advantages of BCMA • Most beneficial is the missing dose request notification • Reduce medication errors • Improved communications between dept. • Reduction of overall cost of care • Ready access to patient medication record information • Reduce “human error” • Primary purpose is the 5 rights: medication, dose, route, time, patient. (Wideman, Whittler, & Anderson, 2008)

21. Disadvantages of BCMA • Current # of proven software applications are limited • Integration and or interfacing with other core medication management systems can be difficult, costly, and complex • Relies heavily on being user-friendly and intuitive to the clinical end-user. • Initial and ongoing training • No universal symbology (Roberts, 2002)

22. Legal Issues • Overriding the system and using workarounds to compensate for difficulties with the bar codes • Examples of reasons to use workarounds include the following listed • Wireless disconnectivity • Emergency situations • Patients in contact isolation • Unreadable patient Id bands • In return all these could lead to very leagal issues (Kaplan, 2008)

23. Ethical Issues • Affixing extra copies of patient id barcodes on desks, scanning machines, clipboards, supply room all are not standard procedures • Carrying several pre-scanned patients medications on one tray (Koppel & Wetterneck, 2008)

24. Informatics Competencies of the Professional Nurse • Knowledge in using computers • Trained in use of portable medication administration • Able to operate bedside components ( handheld scanner)

25. Functions and responsibilities • Accurately train new nurses in safely administering medications via BCMA • Ongoing training and education on BCMA

26. Summary of BCMA • Each drug is labeled with a unique bar-code • Each patient has a bar coded wrist band • Order is scanned to pharmacy and they put it in the computer • The nurse scans the patient using the hand-held device and then scans the medication • This process has shown great potential for reducing medication errors. • This insures that the “five rights of administration” of drugs is being implemented (Sakowski & Leonard, 2006)

27. Reference • Cochran, G.L., Jones, K.J., Brockman, J., Skinner, A., Hicks, R.W. (2007). Errors prevented by and associated with bar-code medication administration systems [Electronic version]. The Joint Commission Journal on Quality and Patient Safety, 33. 293-301.

28. Reference • Henriksen ,K., Battles, J.B., Marks, E.S., Lewin, D.I., (2005). Advances in patient safety: from research to implementation. Vol. 3, Concepts and methodology [Electronic version]. Rockville, MD: Agency for Healthcare Research and Quality.

29. Reference • Kaplan, M. (2008). Barcoded technology used • to reduce medication administration has flaws. Retrieved December 13, 2008 from Medical news today website: http://medicalnewstoday.com/articles/113498.php

30. Reference • Karsh, B.T. & Koppel, R. & Telles, J.L. & • Wetterneck, T. (2008, April). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Retrieved December 13, 2008 from Jamia website: http://www.jamia.org/cgi/reprint/M2616v1.pdf

31. Reference • Paoletti, R.D. ,Suess, T.M., Lesko, M.G., Feroli, A.A., Kennel, J.A., Mahler, J.M., Sauders, T. (2007).Using bar-code technology and medication observation methodology for safer medication administration [Electronic version]. American Journal of Health System Pharmacy 64(5) 536-543.

32. Reference • Polisher Research Institute, (2008, July 28). Automated medication dispensing cart. Retrieved November 17, 2008, from Technology for long term care Web site: http://www.techforltc.org/ltc.cfm?pageid= 156&producttype=2725&careissue=2511

33. Reference • Roberts, M.R. (2002, June). Barcode medication administration. Retrieved December 11, 2008, from Pharmacy Healthcare Soluntions website: http://www.pharmhs.com/Documents/TechKnowledge%20Jun%202002.pdf

34. Reference • Rough, S., Ludwig, B. & Wilson, E. (2003). Retrieved November 14, 2008, from ASHP Best Practice Award: In Health- System Pharmacy Web site: http://www.ashpadvantage.com/best practices/2003_papers/rough.htm

35. Reference • Sakowski, J. & Leonard, T. (2006, Janurary). Using a Bar-coded medication administration system to prevent medication errors. Retrieved December 11, 2008, from MedScape website: http://www.medscape.com/viewarticle/519719

36. Reference • Wideman, M.V. & Whittler, M.E. &Anderson, T. M. Barcode medication administration: lessons learned from an intensive care unit implementation. Retrieved December 10, 2008, from http:// www.ahrq.gov/downloads/pub/advances/vol3/Wideman.pdf

37. Reference • Work, M. (2005, May/June). Improving medication safety with a wireless, mobile barcode system in a community hospital. Patient Safety and Quality Healthcare, Retrieved Nov. 13, 1008, from http://www.psqh.com/mayjun05/casestudy.h tml

38. Reference • (2008,July, 28). Barcode medication administration. Retrieved November 14, 2008, from Technology for long term care Web site: http:// www.techforltc.org/ltc.cfm?pageid=156&producttype=2608&careissue=2511

39. Reference • (2008). Bar coded medication administration brochure. Retrieved December 10, 2008, from Code Corp Website. http://www.codecorp.com/other_files/C004235_02_BMA_Brochure.pdf