Barcoded Medication Administration (BCMA)

1. Barcoded Medication Administration(BCMA) Group A Theresa Dallas Rachel Glenn Tiara Dennison Suzanne Clay Chelsea Borders

2. Topic search and using search engines Search engines are answer machines. When a person looks for something online, it requires the search engines to scour their billions of documents and do two things; first, return only those results that are relevant or useful to the searcher’s query, and second, rank those results in order of perceived usefulness. It is both “relevance” and “importance” that the process of search engine is meant to influence.

3. Search Engines used for BCMA • Google - The world's most popular search engine. http://www.google.com/ • Yahoo! Search: The 2nd largest search engine on the web. http://www.yahoo.com/ • Bing Search: Microsoft's entry into the burgeoning search engine market. Better late than never. http://www.bing.com/

4. Three approaches to assessing a search engine • Accessibility: This is quasi basic for everything (not only for search engines but also for people). • Keyword searching: is using a key word to find what you are looking for. It's perhaps the most common form of search engine searching. • The third method is all about content optimization. How to improve the content so that it is not only interesting for the visitors, but, are especially recommended. This aids in content reliability.

5. Search engine strengths and weaknesses

6. bing

7. Bing Start on the Bing homepage and stop for a minute of sightseeing. Each day a stunning photograph from somewhere in the world occupies most of the homepage. Sure, you can go right on typing your query in the prominent search bar, but instead, roll your mouse over the image and you will find four interesting facts about the location and links to learn more. Curiosity can lead you on a fascinating detour. Pretty, but distracting. Initial search for topic information did lead me to many sources with viable information. I had to use related searches to hone in on more relevant information. And, I must say, once that happened, the source information was very optimal and selected for anyone wanting to build on research on this topic. This I found interesting and had learned that Microsoft understood things like removing results 6 through 10 and replacing them with categorized results and adding a hover with additional content from the site could impact search traffic and for providing information about topic in specific. Bing strength lies more in social integrations as every topic you search has a blog link to get feedback. It also is a great search engine for imagery. Most of the imagery in this power-point was obtained through Bing. However, its weakness also lies with Bing’s strategy that is pointedly different, which is focused on building its own social network. Most site page information included blogs. In the methods of accessibility, key word searching and optimization, it was all there and quite adequate.

8. yahoo

9. Yahoo! Yahoo! is one of the best known and most popular Internet portals. Originally a subject directory of sites, it now is a search engine, directory, and portal. To go to the Yahoo! portal and main starting point, use www.yahoo.com. Use the table of contents on the left to navigate direct access to the search engine: use; search.yahoo.com and for the directory use; dir.yahoo.com. Start on the Yahoo! homepage and stop for a minute of the latest news events (local, entertainment and sports). Initial search for topic information did not lead me to many sources with viable information. I had to use “also try” searches to hone in on more relevant information. This sight also offered the same quality of information and availability as Bing. In design, one could say Yahoo! is boring. However, in the methods of accessibility, key word searching and optimization, it was all there eventually and more for the taking once in the relevant information.

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11. Google Ask anyone on the street what they know of Google and chances are you will get either that it is a great search engine or in some cases it is The Internet. The fact is that Google’s strength and popularity rests entirely on its search engine which for the majority of people is oh so technical and geeky. And Google has added to that perception by its drive for simplicity in design and use. Google’s strength lies that it is one of the premier internet brands in the world. The company is ranked among the top brands worldwide. Google has tapped into just about every market available. Its weakness could lie in how big and integrated they are. Following several similar redesigns from competitors, Google has changed the look of their homepage. The new logo features a more “flat” design and the black menu bar at the top of the screen has been removed. Regardless of your routine, getting around Google should be seamless, and once you’re inside an app, you don’t want any distractions. Initial search for topic information led me to a plethora of relevant sites to obtain information pertaining to research. This sight also offered the same quality of information and availability as Bing and Yahoo!. Methods of accessibility, key word searching and optimization, it was all there and immediate for search building.

12. Home Pages: Bing, Google, Yahoo Bing's front page is distinctly flashy, thanks to its stunning photography. Nevertheless, navigation for specialized search is easy to find. Bing’s front door also includes plenty of shortcuts to other Microsoft-owned Web destinations such as MSN, Windows Live, and Bing Travel. It would be nice to see a shortcut to my Microsoft-managed inbox. For Yahoo!, the search bar is now centered, and is part of a darker toolbar that is fixed to the top of the page as the user scrolls down. The word “search” has been replaced with a magnifying glass icon. Local weather has its own module. What’s trending has been deemphasized and instead of just headlines, the news has story summaries. For its part, Google embraces the elegant simplicity of a white background and the Google Search text field. This reflects the company's desire to be not just a search engine, but a starting point for Internet surfing. Its scattershot approach features search, news, communications tools, and such specifics such as a horoscope.

13. Search Results: Bing, Google, Yahoo Search results for Bing have two main components: a left-hand navigation panel of Quick Tabs that allow you to focus your search fast; and a center row of Categorized Search results, which simply group results in logical categories. Search results include instant answers, deep links, and multimedia. Google and Yahoo search results are delivered no-frills-style with blue links descending from most to least relevant. Both of these search engines deliver results that may include instant answers, deep links, and multimedia.

14. Health Search: Bing, Yahoo, Google From what I can tell, Bing provides shortcuts to top-notch health resources such as the Mayo Clinic when you search for diabetes, influenza, or other health-related issues. Using the Explorer Pane, you can drill down into symptoms and prevention categories. Yahoo Health search results pull up details on topics such as influenza, plus additional information on symptoms, causes, and treatments. Yahoo Health also lists informational videos related to your search. Google search results for topics such as influenza fetch Wikipedia entries and information from the Centers for Disease Control and Prevention. Google's big health strategy has less to do with search and more to do with Google Health, a program for storing your medical records online, finding doctors, and connecting with online health services.

15. searchs

16. Conclusion In conclusion, everyone‘s choice of search engine use comes down to personal preference. They all deliver in information gathering without much fuss. Homepage designs differ and this can be appealing to user personalities. For me, I'm sticking with Google until Bing is able to claim a much greater advantage over the web's largest, most preferred search engine.

17. Blogging

18. Why We Need Barcode Medication Administration- JERRY FAHRNI • This blog discusses the importance of barcoded medication administration. According to the blog, “between 45,000-98,000 people die a year due to medical error” (Fahrni, 2011). The reason barcoded administration is so important in today’s society is because it helps decrease the numberof medication errors. The blog reads on and mentions that not all pharmacies andhospitals have transitioned over to barcoded medication administration, but most arein the process. Research being conducted on barcoded medication administration reveals improved patient safety scores.

19. Closing the loop on Medication Safety- Sally Sapega • This blog discusses how the Pennsylvania Health System has implemented different processes to increase the safety of itspatients. The most recent plan implemented in the Pennsylvania Health System to “close the loop” is barcoded medication administration. The blog describes the process of barcoded medication administration. The BCMA system scans ordered medications and documents those medications directly in the patient’s eMAR. This technology ensures that the drug scanned is what has been ordered by the provider. The nurse scans the patient’s medical bracelet to validatethat the medicines administered are being given to the correct patient. If any piece of information is incorrect, an alert will occur. This reduces medical errors because it assists the nurse in completing the Five Rights of Medication Administration. (Sapega, 2013)

20. Optimizing Electronic Medication Administration Records- John Halamka, MD • This article/ blog discusses what is being done to improve the usage of medication. Mounted computers or computers-on-wheels (COWs) provide a means for easy, convenient access to a patient’s eMAR. The eMAR allows gives the provider a means to see what medications have already been given and what medications are due to be given. The use of iPhone’s and Ipad’s also make the electronic medication system readily available to health care professionals. Allowing such easy access to the eMARensures that people will actually use the eMAR during medication administration; this decreases medication errors throughout the health care system. Patient satisfaction scores are increased when the rates of medication errors decrease. This makes people want to come to the hospital when they are sick. (Halamka, 2013)

21. Tag Archives: medication error- Richard Novak, MD • This blog exists for the anesthesia world andwas created and is maintained by Dr. Novak. This blog discusses medication errors found in anesthesia medicine and ways to decrease these errors. This blog also refers to specific medicines found in anesthesia that are particularly deadly and the different processes needed to prevent medical errors (i.e. color coding, using the Five Rights, and barcoded medication administration). Barcoded medication administration is briefly discussed in this blog because it is important when administering anestheticsbefore a procedure. BCMA systems electronically validate that compliance with the Five Rights of Medication Administration. (Novak, 2013)

22. 5 Consumer websites with summarized findings

23. Bloomberg.com • This site discusses the cost of medication errors. • This website has several articles linked to BCMA. One is titled “Barcoding, ‘Hottest Old Trend’, May Cut Errors, Costs in Medical Industry.” • This article talks about how “barcoding may play a significant role in the Obama Administration’s plan to reduce costly medical errors” (Edney, 2010). Medical errors cause “98,000 hospital deaths and $29 billion in unnecessary medical expenses every year, according to the Institute of Medicine” (Edney, 2010).

24. Bloomberg.com cont. • According to a 2009 study, only about 28% of hospitals use BCMA. There is a push to get every hospital to adopt this technology with all of thehealth reform and stimulus activity. “The stimulus included $19 billion in federal incentives to help hospitals and physicians adopt information technology” (Edney, 2010). • Some of the barriers with adopting this system are that it’s not compatible with some hospital systems already in place, it is costly to start the system, and itistime consuming to place each individual barcode. The “FDA estimates a bar-code system costs an average-sized hospital $550,000 per year” (Edney, 2010). • Even Dennis Quaid has joined the campaign in 2007 for bar coding systems after his twins almost died from a medical error with heparin doses. s

25. Amednews.com • This is a website that is a news source for America’s physicians. It focuses on healthcare, medical practice, and the medical profession. BCMA affects everyone in the medical profession from doctors, to nurses, to pharmacists. • This site has a brief news bulletin about BCMA called “Study: Nurses sometimes skirt barcode safety checks.” • This study talks about the fact that bar coding systems are not a 100% safety system. There are ways to work around the barcode systemand override medications. This study, conducted by Journal of the American Medical Informatics Assn., found that “nurses override bar-code medication administration safety alerts for 4.2% of patients and for 10.3% of medications” (“Study: Nurses Sometimes,” 2008). • Changes still need to be made to bar code systems, including observation of patient work flow to ensure the safety of patients.

26. Healthcare-informatics.com • This is a website that focuses on health information and information technology, which is exactly what BCMA is a part of. • The article on the website is called “They’re Making the Case for eMAR.” • The article speaks of astudy that was done at Bringham & Women’s Hospital about “The effects of bar-code technology on the safety of medication administration” (Hagland, 2010). • The study found that medication error rates and adverse drug reaction rates dropped in hospitals using bar-coding systems. • This is just another study that drives home how important the bar coding system is in preventing medication errors.

27. Marketwatch.com • Marketwatch.com is a website that provides business and financial news to consumers. • This website refers to BCMA in the article “Drugs to have bar codes; FDA unveils plan to reduce risk of medication errors.” • Itisimportant for drug companies and their consumers to be aware of the changes needed for labellingdrugs when adopting the bar coding system. The FDA has created a new rule concerning the labeling and barcoding of medications. • Any new drugs must have a barcode within 60 days. • “The bar code rule will help prevent nearly 500,000 complications and transfusion errors over 20 years for an estimated savings of $93 billion in reduced health-care costs, patient pain and suffering, and lost work time” (Gerencher, 2004). • One of the hold-ups with the bar-coding system was that the bar codes weren’t in “unit-of-use bar code packaging" (Gerencher, 2004). That has changed so that each individual dose can be scanned and accounted for.

28. Medscape.com • This website is a branch of WebMD. It is a place where consumers can go to get information about the latest health information, drug information, clinical trials, and journal articles. • One of the articles on this website is entitled“Bar-Code Medication Administration: A Systems Perspective.” • This article talks about how the BCMA system was developed and how it has evolved throughout the years. • “In 1994, inspiration came to a nurse from the Colmery-O'Neil Veterans Affairs Medical Center (VAMC) in Topeka, Kansas” (Schneider, Bagby, & Carlson, 2008). • By 1999, the first system was developed and was being used in the VAMC; by 2003 all VAMC hospitals were using the bar-code system. • “BCMA is an integral part of the electronic health record” (Schneider, Bargby, & Carlson, 2008). Each VAMC can obtain patient information from other VAMC’s so being able to keep track of treatments and medications given is very important. • “In 2004, two bar-code verification laboratories were established by the Bar-Code Resource Office” (Schneider, Bagby, & Carlson, 2008). These labs are where the VAMC’s can send their medications with bar-coding issues. They also developed a bar-code tracking system. • They work with their labs and their engineers to create the best BCMA system to improve patient safety.

29. Social networking sites contribution to information selection

30. Contributions • Social networking sites like MySpace, Facebook, Twitter, inspire.com, patientslikeme.com, MedHelp, and CureTogether can have a big influence on information selection. • There is a growing number of Facebook pages that are devoted to specific medical conditions that consumers may visit for information or support. • “Public, Internet-based social networks can enable communication, collaboration and information collection and sharing in the health care space” (Keckley & Hoffmann, 2010). • About 1/3 of consumers use social networking sites to obtain health information before they make their healthcare decisions. • Consumers use these social networking sites to talk to other people with the same conditions, to get support (or caregiver support), to get advice, to ask questions, and to research diseases and symptoms. They may also find recommendations to other Internet resources. Consumers tend to listen to people who are going through the same health conditions. They also find comfort and empowerment.

31. Contributions cont. • Some of these sites also allow people to “track and compare health data to better understand their bodies, make more informed treatment decisions and contribute data to research” (Keckley & Hoffmann, 2010). • There are several issues to think about when using social networking sites to get information. These issues include “scientific content, anxiety generation, confidentiality issues, and research ethic issues” (Hebda & Czar, 2013). Not all searchable information may be accurate (depending on where and who the information is coming from). • Due to the popularity of social networking sites, many healthcare providers and healthcare facilities are adding their own ‘pages’ to these sites.mayaccurate pending on where the information is coming from that people are sharing on these sites. Because so many consumers are using social networking sites now, many healthcare providers and healthcare facilities are adding their own sites and information to the internet.

32. best practices, processes, and methods of evaluation The use of barcoded medication administration (BCMA) technologies has been recommended by many organizations, including the Institute of Medicine, the National Patient Safety Foundation, the American Society of Health-Systems Pharmacists, and the National Alliance for Health Information Technology. On February 25, 2004, the U.S. Food and Drug Administration finalized a rule for bar-code labeling medications and blood components to prevent adverse events.The Director of the National BCMA Joint Program Office published a report of fifteen best practices for BCMA administration. These recommendations are intended to maximize the effect of BCMA technologies and to reduce the risk of iatrogenic injury to patients. They are as follows:

33. 15 recommendations for implementation of BCMA • 1.) Put in place a standing interdisciplinary committee. This committee should be comprised of nursing, pharmacy and computer support staff. Representatives should implement and proactively conduct continuous improvement on implementation and use. Committee members should routinely ask staff on the front-line for feedback. This committee is needed in order to support and streamline the implementation of BCMA. The integration of BCMA into medication administration can be extremely complex. • 2.) Train all users. All personnel who administer medications need proper training on the use of BCMA technologies (handheld devices, scanners, etc.). Staff will also need proper education and training as the system is updated over time. Medication errors can occur with inadequate training. Ensuring that each unit has super-users for the computer system can help to decrease medication errors. Training is also necessary for physicians because BCMA can affect how physicians enter their orders.

34. Recommendations Continued 3.) Communicate known problems. Develop a way for personnelto be able to view examples of nationally recurring problems; this information should be available 24 hours per day, 7 days per week. This will allow users to see the problems that are occurring nationally, the status of the resolution of the problems, as well as frequently asked questions. This will reduce the amount of calls to the call center and will allow the user to determine whether his or herproblem is local or national. 4.) Display Contact Information for Resources to Resolve Different Types of Problem. Display contact information for resources to deal with common, recurring problems and ensure that this information is updated as necessary. Time spent searching for resources is time not spent with patients.

35. Recommendations Continued 5.) Do not Employ a Double-Documentation System. Do not employ a paper-based medication administration system in parallel with a BCMA for more than an few weeks. A double documentation system reduces nurses productivity and can lead to medication errors. 6.) Scheduled Planned Downtimes to Minimize Disruptions. Planned downtimes should be scheduled to minimize disruptions to the staff and patient care. Unexpected downtimes can result in missed doses of medications or even double doses due to conflicting gaps in documentation. 7.) Replace Malfunctioning equipment During its Servicing. All hospitals should have a minimum of two complete replacement units to ensure that equipment can be replaced efficiently without causing disruption to nurses.

36. Recommendations Continued 8.) Develop a Procedure for Cleaning BCMA Related Equipment. A procedure should be in place, along with the collaboration of infection control, to ensure that equipment is cleaned appropriately to decrease the risk of nosocomial infections. 9.) Scan Wristbands and Medications Prior to Medication administration. Nurses should be required to scan the patient’s barcoded identification bracelet prior to medication administration. Nurses should scan the actual medication immediately prior to medication administration. BCMA is used to reduce medication errors through electronic validation of the Five Rights of Medication Administration. 10.) Caregivers Should Personally Document at the Time of Medication Administration. The person administering the medication should be the one to document medication administration (if the system does not automatically do so). The medication should be documented immediately following its administration.

37. Recommendations Continued 11.) Verify Allergy Information Displayed in BCMA Prior to Administration. The allergy information displayed by the BCMA system should be verified by a nurse prior to medication administration. The prominent display of allergy information in red will not necessarily deter nurses from administering medications that are contraindicated for the patient. 12.) Support Staff Personnel Should Print a Report at the Beginning of a Shift for Nurses to Use as an Overview Worksheet. This should be printed by the nurse at the beginning of her shift and will serve as an overview of the workload of medications to be administered. This should only serve as a supplementary tool because the information can become quickly outdated. It is also important for nurses to periodically refresh the screen to ensure that they are not missing any new orders and have the most current information. Nurses can better plan their days if they have an overview of orders and medications due. This will also help them make fewer errors of omission.

38. Recommendations Continued 13.) Nurses Should Print Missed Medication Reports Once a Shift. BCMA systems have the ability to print a missed medication report; this should be used to verify medications that were not administered. 14.) Alert Nurses to New (Stat) Orders. Methods to alert nurses to new stat orders, such as having an overview display on a dedicated monitor in a central location with information about new orders, should be developed. In addition, physicians writing the new/stat order should verbally notify the nurse of the new stat order. Relying on nurses to manually access the electronic medical record to detect new orders, or to refresh their screen, is inefficient and contributes to delayed or missed medication orders. 15.) Replace Wristbands as Needed and Periodically in long Term Care. Replace worn, missing, or innacurate wristbands as soon as discovered by personnel. If wristbands cannot be applied to wrists, they may be applied to ankles. If absolutely necessary (and only if absolutely necessary!), identification bands may be applied to items unique to the patient or stapled to the patients chart. Scanning wristbands is more likely to happen when the wristband reliably scans on the first attempt.

39. implications for nursing practice Deployment of BCMA technology in the clinical setting requires a thoughtful and comprehensive approach. It is important to continuously improve BCMA technologies over time. It is also important to tailor technologies to particular contexts. This is why it is so important for nurses and other healthcare providers to be a part of the development process.

40. Contribution of BCMA to nursing practice and patient outcomes. Technology that is used to enhance health and delivery systems “should be designed to make it easy to do the right thing and hard to do the wrong thing”

41. BCMA and Nursing Practice The implementation of barcoded-medication administration has radically transformed the process of medication administration, as well as the process of medication documentation. BCMA has also been shown to improve nurse satisfaction, improve nurse confidence, and decrease medication administration time, leaving nurses more time for other patient care activities. BCMA also helps hospitals comply with Joint Commission standards and patient safety goals.

42. Decreased Medication Administration TIME

43. Decreased Medication Administration Time, Continued Example A: Pre-BCMA, nurses spent more time giving and documenting medications and less time conversing with patients. This changed significantly with the implementation of BCMA. Example B: A 2009 study conducted in a medical center in North Taiwan showed a decrease in oral medication administration time from 36.49 seconds to 18.42 seconds with the implementation of BCMA. 66.7% of nurses participating in the study felt that BCMA would consistently cut the time required to administer oral medications by 50%. NOTE: Studies have shown that the implementation of BCMA initially results in an increase in medication administration time due to the learning curve imposed by new technology.

44. BCMA and Patient Outcomes The implementation of barcoded- medication administration has been shown to reduce medication errors, thereby improving patient outcomes. BCMA has been known to reduce errors between 50% and 85%.

45. Medication Errors, Defined • A medication error is “any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care, professional, patient or consumer.” (National Coordinating Council for Medication Reporting and Prevention) • Administration errors account for approximately one-third of all medication errors, and nurses administer most medications.

46. Common Medication Errors by Nurses • Wrong Patient • Administration of a medication to the wrong patient. • Wrong Drug • Administration of the wrong medication to a patient. • Wrong Dose • Improper dose of a medication administered to a patient; administered the right volume of a medication but an improper concentration. • Wrong Time • Medication administered more than one hour (or whatever timeframe policy dictates) before or after the scheduled administration time • Error of Omission • Failure to administer a prescribed medication (without reason). • Wrong Administration Technique • Administration of a medication via the wrong route, OR administration of medication via the right route but at the wrong location. • Wrong Drug Preparation • Incorrect dilution or reconstitution of a medication. • Overlooked drug interactions or allergies • Administration of a medication or medications that are incompatible or contraindicated based on the patient’s PMH and allergies. • Deteriorated Drug Error • Administration of a medication that has expired or that has been improperly stored.

47. Common Medication Errors

48. Consequences of Medication Errors • Increased Morbidity • Elongated Hospital Stays • Increased Cost • Adverse Drug Events • Increased Mortality

49. Increased Morbidity • Morbidity- the state of being ‘unhealthful’. • Example: Dennis Quaid’s twins, Zoe Grace and Thomas Boone, received 1000 times the ordered dose of heparin at 11 days old. Both twins received heparin prepared from 10,000 unit/mL vials instead of from 10 unit/mL vials. It took 41 hours to stabilize the twins and an extra 12 days in the hospital but they ultimately survived.

50. Elongated Hospital Stays • Preventable medication errors cost both time and money. • The degree to which the hospital stay is elongated depends on the severity of the medication error.