Part VI.

1. Part VI. 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” (p.125)

2. BCMA and Nursing Practice The implementation of barcoded-medication administration time has been shown to improve nurse satisfaction, improve nurse confidence, and decrease medication administration time, providing nurses more time for other patient care activities. BCMA also helps hospitals comply with Joint Commission standards and patient safety goals.

3. Decreased Medication Administration Time Example A: During PBMA, nurses spent more time on documenting medications and less time conversing with patients. This changed significantly after implementation of BCMA. BCMA resulted in nurses spending less time on documentation and more time conversing with patients during medication administration process. http://thomasland.metapress.com/content/1t7ugh10k8238365/fulltext.pdf

4. Decreased Medication Administration Times, Continued Example B: A 2009 study conduced in a medical center in North Taiwan showed a decrease in oral medication administration times from 36.49 seconds to 18.42 seconds after 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%. http://www.ijmijournal.com/article/S1386-5056(10)00126-7/abstract 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. Over time and with proper training, this changed.

5. 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 55% and 85%.

6. 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) • The Institute of Medicine’s (IOM) seminal study of preventable medical errors estimated as many as 98,000 people die every year at a cost of $29 billion. (1999) • Administration errors account for approximately one-third of all medication errors, and nurses administer most medications. http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm

7. NOTE: Medication errors can occur at any stage of medication administration (ordering, transcribing, dispensing, administering, and monitoring). For the purposes of this assignment we will focus on errors at the point of administration.

8. Consequences of Medication Errors • Increased Morbidity 2. Elongated Hospital Stays • Increased Cost • Adverse Drug Effects • Increased Mortality

9. 1. Increased Morbidity Morbidity- the state of being ‘unhealthful’. Example: Dennis Quaid’s 11-day-old twins, Zoe Grace and Thomas Boone, received 1000 times the ordered dose of heparin during a hospital stay for their staph infections. 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.

10. 2. Elongated Hospital Stays

11. 3. Increased Cost Adverse drug events cost the United States $37.6 billion each year, and approximately $17 billion of these costs are associated with preventable errors. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year. This estimate does not take into account lost wages and productivity or additional healthcare costs. http://www.datarayusa.com/index.php?option=com_content&view=article&id=82&Itemid=106 “The reduction… in medication errors [with BCMA] provide a return on investment (ROI)” (p125).

12. 4. Adverse Drug Effects By definition, an adverse drug effect The mean rate of inpatients in U.S. hospitals who experience an adverse drug effect is 4.3%. Up to 7,000 deaths each year are due to adverse drug effects from preventable medication errors. More than 30% of preventable adverse drug events take place during the administration stage of the medication use process.

13. 5. Increased Mortality • Example: On July 5, 2006, Jasmine Gant, 16, died after a nurse mistakenly administered an epidural anesthetic (bupivicaine) through her IV. The nurse intended to give IV penicillin, a medication ordered by physicians to treat a staph infection. Jasmine Gant suffered immediate cardiac arrest and could not be revived. Her unborn child survived the incident. The acting nurse, Julie Thao, RN, failed to place an identification bracelet on Ms. Gant and failed to utilize the BCMA stystem in place at the hospital.

14. Q: So, how does BCMA serve to reduce medication administration errors? A: Through automated warnings and error messages– these messages arise if there is any disparity with the Five Rights of Medication Administration.

15. Common Warnings and Error Messages

16. Warnings and Error Messages (Continued) http://ojni.org/14_1/Rivish.pdf

17. Supportive Research

18. Example A: A 2005 study of a 175-bed community hospital in Beloit, Wisconsin noted an 82% decrease in medication errors post-implementation of BCMA for the five units studied. http://www.psqh.com/mayjun05/casestudy.html

19. Example B: A 2009 study by Moriss, et. Al examined the frequency of medication errors pre and post implementation of BCMA across multiple hospital systems. The most significant decrease in medication errors was seen with errors of omission. The overall number of errors decreased with the implementation of a BCMA system for all types of errors at the point of administration. http://ojni.org/14_1/Rivish.pdf

20. Example C: A 2005 study observed the incidence of medication administration errors with and without BCMA. Observers noted 776 nontiming administration errors, 776 nontiming errors in medication administration on units that did not use BCMA (an 11.5% error rate) versus 495 such errors on units that did use BCMA (a 6.8% error rate) — a 41.4% relative reduction in errors. The rate of timing errors in medication administration fell by 27.3%. http://www.nejm.org/doi/full/10.1056/nejmsa0907115#t=articleBackground Example D:

21. (2013). About Medication Errors: What Is a Medication Error? National Coordinating Council for Medication Error Reporting and Prevention. Retrieved November 20, 2013 from http://www.nccmerp.org/aboutMedErrors.html. Dwibedi, N. (2012). Bedside Barcode Technology: Impact on Medication Administration Tasks in an Intensive Care Unit. Hospital Pharmacy, 47(5), 360-366. Retrieved from http://thomasland.metapress.com/content/1t7ugh10k8238365/fulltext.pdf. Hebda, T. and Czar, P. (2013). Handbook of Informatics for Nurses & Healthcare Professionals, (5th ed.) Boston: Pearson. Poon, E.G., et. Al. (May 2010). Effect of Bar-Code Technology on the Safety of Medication Administration. The New England Journal of Medicine, 362, 1698-1707. Retrieved November 21, 2013 from http://www.nejm.org/doi/full/10.1056/nejmsa0907115#t=articleBackground. Rivish, V. & Moneda, M. (February 2010). Medication Administration Pre and Post BCMA at the VA Medical Center. Online Journal of Nursing Informatics (OJNI), 14 (1). Retrieved November 23, 2013 from http:ojni.org/14_1/Rivish.pdf. Tsai, S-l, Sun, Y-C, &Taur, F-M. (August 2010). Comparing the working time between Bar-Code Medication Administration system and traditional medication administration system: An observational study. International Journal of Medical Informatics, 79(10), 681-689. Retrieved November 21, 2013 from http://www.ijmijournal.com/article/S1386-5056(10)00126-7/abstract. Work, M. (2005). Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Retrieved November 20, 2013 from http://www.psqh.com/mayjun05/casestudy.html. http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm References