Bar-Coded Medication Administration

1. Bar-Coded Medication Administration

2. Authors: Amanda Bumberger Ashley Grace Piper Katie Ford Sharon Tkaczuk Robin Yetter

3. Objectives: • Define and describe Bar-Coded Medication Administration (BCMA) • List and describe BCMA • Identify, describe, and review BCMA information systems • Describe advantages/disadvantages of BCMA • Examine legal and ethical issues related to BCMA • Describe technology-related competencies needed by professional nurses working with BCMA • Describe functions of the informatics nurse working with BCMA

4. What is BCMA? • Electronic software application • Combines barcode technologies with real-time Ethernet local area network (LAN) that connects with a centralized computer • First developed 1995 VA Medical Center Topeka, Kansas • Introduced nationwide in 2000 (Wideman, Whittler, & Anderson, n.d.)

5. BMCA Basic Steps: • Physician order received • Order faxed to Pharmacy • Pharmacists edit and verify electronic orders into patient profile • Pharmacy dispenses ordered medications in Bar-Coded packages • Nurse accesses BMCA software on computer via log on • Nurse scans unique patient bar-coded ID band

6. BCMA Basic steps cont: • Nurse utilizes two unique patient identifiers to verify armband • Nurse verifies patient profile medications as per order • Nurse scans bar-code on medications • Nurse administers medications

7. BCMA Basic Steps Review:

8. BMCA Hardware: • Pharmacy Scanner • Multiple computers • Keyboard • Mouse • Portable scanner

9. BMCA Hardware: A Closer Look… • Portable Scanner • Scans bar-coded patient armbands • Scans bar-coded medication packages/containers • Registers each medication into the software program • Scanned barcodes have to be the correct medication and at the correct time (Wideman, Whittler, & Anderson , n.d.)

10. BMCA Software: • BMCA Software • Again this system “utilizes barcode technologies in combination with real-time Ethernet local area network (LAN) connectivity with a centralized computer” (Wideman, Whittler, & Anderson, n.d., pg 438)

11. BMCA Software: A Closer Look… • Verifies the correct medication was ordered & administered on time • Displays correct dosage • Documents the administration time • Purpose is to ensure “Five Rights” universal standard of medication administration (Wideman, Whittler, & Anderson, n.d.)

12. BMCA Information Systems: (McGonigle & Mastrian, 2009)

13. Siemens Healthservices Corporation • Med Administration Check System • A clinical information system used by nurses and pharmacists • Point of care bar-coding technology to help reduce the human element in med errors • Enables documentation of medication administration in real time at bedside or at other points of care • Utilizes Local Area Network configuration (Med Administration Check., 2009) (Wideman, Whittler, & Anderson , n.d.)

14. BMCA Advantages: Reduction in medication errors The FDA estimated that over a 20 year period the number of medication errors would be reduced by 50% and up to 500,000 adverse events would be avoided by utilizing BCMA (Food and Drug Administration, 2004). Ease of checking the five rights of medication administration Automatic MAR creation Lab results can be displayed at the point of care Alerts for missed medications

15. Improvements: Patient Satisfaction Patients report feeling more secure with medication administration (Conner-Knox, 2009) Physician Satisfaction Employee Satisfaction Safety Quality of Care (Lorkovic, 2007)

16. Improvements cont: • Decreased patient care costs related to medication errors • Average adverse drug event costs $2, 257 • The average jury award for a med error exceeds $600,000 (ZIH, 2006)

17. Improvement Statistics:

18. BMCA Disadvantages: • Estimated to cost $1,799 per bed to implement BCMA, with an additional $1,000 yearly for maintenance • No universally accepted bar codes • Bar codes that are unable to be scanned • Equipment malfunction • Over reliance on BCMA to catch errors • Stat medication turnaround time (ZIH, 2006)

19. BMCA Workarounds • Over 15 types have been identified that could potentially lead to errors • For example: • Nurses override alerts for 4.2 % of patients cared for and for 10.3% of meds charted (Karsh, Koppel, Telles, & Wetterneck, 2008)

20. Legal and Ethical Issues: • Prior to development, approximately 7,000 deaths per year due to medication error • Developed to decrease medication errors and improve patient safety • Enforces use of 5 Patient Rights of Safe medication administration • System automatically holds electronic patient health and medication record • Decreases length of patient stay due to increased medication efficacy over the long term (American Journal of Health-System Pharmacy, 2003)

21. Informatics Competencies of Nurses using BMCA: • Workshops for knowledge and ease of access • Successful completion of the workshop • Ability to use a computer and log on • Knowledge of how the software works • How to fix errors, or get in contact with someone who can fix it

22. Functions & Responsibilities of Informatics Nurses working with BMCA: • Incorporate theories, principles, and concepts from appropriate sciences and evidence based practice • Integrate ergonomics and human-computer interaction principles appropriately and efficiently • Systematically determine the social, legal, and ethical impact and play an active role in system improvement (McGonigle & Mastrian, 2009)

23. Summary: • BMCA… • Electronic software application that utilizes barcode technologies • Created primarily to increase patient safety related to medication administration • Cost effective over the long term • Increases patient satisfaction • Increasing the use of informatics technology in nursing practice

24. References: American Journal of Health-System Pharmacy (July 2003). Impact of emerging technologies on medication errors and adverse drug events.Retrieved November 30, 2009 from Medscape: http://search.medscape.com/medscape search?queryText= Impact%20of%20emerging%20technologieson%20medication%20 errors%20and %20adverse%20drug%20events. Conner-Knox, J. (October 29, 2009). Technology should reduce medicine mishaps. McClatchey-Tribune Business News. Retrieved November 24, 2009 from ABI/Inform Dateline Food and Drug Administration(2004). FDA issues bar code regulation. Retrieved November 24, 2009 from Department of Health and Human Services: www.fda.gov Karsh, B., Koppel, R., Telles, J., & Wetterneck, T. (2008). Workarounds to barcode administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, April 24, 2008. Retrieved November 24, 2009 from http://jamia.org/cgi/ reprint/m2616vi.pdf

25. References cont: • Lorkovic, S. (2007, August). eHealth and the new culture. Canadian Healthcare Manager, 14(4), 34. Retrieved November 24, 2009 from ProQuest: http://proquest.umi.com.ezaccess.libraries.psu.edu/pqdweb?index=0&did=1366215051 &SrchMode=2&sid=2&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=P QD&TS=1260766082&clientId=9874 • McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Boston: Jones & Bartlett Publishers • Med Administration Check. (2009). Siemens USA. Retrieved December 12 from Seimens AG website: http://www.medical.siemens.com/webapp/wcs/stores/servlet/ProductDisplay~ q_catalogId~e_-1~a_catTree~e_100010,1008631,1025982,1025978~a_langId~e_- 1~a_productId~e_191002~a_storeId~e_10001.htm • Wideman, M. V., Whittler, M. E., & Anderson, T. M. (n.d.). Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation. Advances in Patient Safety, 3, 437-451. Retrieved from http://www.ahrq.gov/downloads/pub/advances/vol3/ Wideman.pdf

26. References cont: • ZIH Corporation (2006). Issues and opportunities for introducing barcode systems in hospitals. Retrieved November25, 2009 from Zebra Technologies: http://www.zebra.com/id/zebra/na/en/documentlibrary/whitepapers/introduce_ barcode_hospitals.DownloadFile.File.tmp/WP13966_HCissueBrief_new.pdf?dvar1= White Paper&dvar2=Issues and Opportunities for Introducing Bar Code Systems in Hospitals