Post on 12-Jan-2016
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Bar Code Medication Administration(BCMA) Definitions, Impact on Medication Errors, Fundamental Essentials, and Using Data
to Improve PerformanceBill Templeman, Pharm.D.
Inpatient Pharmacy Quality SupervisorKaiser Permanente
Riverside Medical Center
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Disclosure
The speaker had no conflicts of interest to disclose
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Learning Objectives
Understand the definitions of BCMADescribe the effect of BCMA compliance can
have on medication errorsIdentify the essential components of a successful
BCMA programExplain how using reporting data can improve
system and user performance
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Definitions of Barcode Medication Administration
BCMA is an additional layer of safety to ensure the correct patient is identified and medication is administered The nurse, at the time of administration, will scan:
The patient’s armband to assure the correct patient
Scan the medication bar code to assure the correct medication is being administered
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BCMA Override
A BCMA override is when a nurse electronically documents a medication administration, even after the system displays an alert that indicates there is a problem with patient identification, drug strength, dosage form or administration time.
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BCMA Overrides
BCMA overrides are acceptable under certain circumstances:Medication administered in the
operating roomMedications administered during a
code or urgent procedural sedation situation
Computer downtime
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BCMA Medication Override Warnings
This Medication was not scanned prior to administration
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BCMA Medication Override Alerts
# Alert Name Alert Description Alert Example
1 Barcode Not Recognized Alert
Bar code scanned is not recognized in KP Health
Connect
Product bar code not recognized
2Wrong
Medication Alert
Bar code scan is recognized in KP Health
Connect but the medication is not on
the patient’s MAR
No administrable medications were
found in this patient’s record
3 Other AlertsMedication scanned is no longer active on the
patient’s MAR
No active orders were found in this patient’s
record
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BCMA Override Reason Documentation
“ACTION” “PT. NOT SCANNED” “MED NOT SCANNED”
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Medications Errors Originate and are Intercepted
Prescribing• Origination 39%• Interception 48%
Transcribing• Origination 12%• Interception 33%
Dispensing • Origination 11%• Interception 34%
Administration• Origination 38%• Interception 2%
Leape LL, Bates DW, Cullen DJ, et al. Systems Analysis of Adverse Drug Events. JAMA. 1995;274(1):35-43
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ISMP Estimation of Inpatient Medication Errors
In 2001, Institute for Safe Medication Practices (ISMP) estimated, in the United States’ hospitals, daily there were approximately 320,000 medication errors:
100,000 during medication administration
35,000 during drug dispensing
ISMP Acute Care Edition, July 25,2001
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Medication Errors
Each year, an estimated 7,000 deaths are linked to medication errors [1].BCMA assists personnel that administer medication in compliance with the "Five Rights" of medication administration: right patient, right dose, right route, right time, and right medication [2].
1. Institute of Medicine. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health Care System. Committee on Quality of Health Care in America. Washington, DC: National Academy Press; 2000.
2. Perry A, Shah M, Englebright J. Improving Safety with Barcode-Enabled Medication Administration. Patient Safety and Healthcare Quality. May/ June 2007.
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Effectiveness of Error Reduction
From “Words on Design and Life “ by Cassie McDaniel
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The Swiss Cheese model by James Reason
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An Example of Swiss Cheese
Magnesium 2gm on shortagePatients identified, monitored no harmRoot cause conducted
• Pharmacy- Wrong product ordered and placed in floor stock• Look-alike medication• Nurses not scanning medication in real time
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BCMA Effect on Medication Errors
A study of 14,041 medication administrations showed1:
Error rate of 11.5% on an unit not using BCMA and 6.8% on a unit using BCMA; a 41.4% relative reduction in errors
Rate of potential adverse drug events fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction
1 Poon, et al. “Effect of bar-code technology on the safety of medication administration.” N Engl J Med. 2010 May 6;362(18):1698-707.
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Kaiser Permanente Riverside Data: BCMA Compliance Related to Medication
Errors
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
20
30
40
50
60
70
80
90
100
110
1Q09
2Q09
3Q09
4Q09
1Q10
2Q10
3Q10
4Q10
1Q11
2Q11
3Q11
4Q11
1Q12
2Q12
3Q12
4Q12
1Q13
2Q13
3Q13
4Q13
1Q14
2Q14
3Q14
4Q14
1Q15
%
Override
Med
Errors
Doses/Qtr
Kaiser Riverside Medication Errors Compared to Patient and Medication Scanning Override %
Medication Errors- Doses/Quarter
Medication Scanning Override %
Patient Scanning Override %
Decreased Medication Errors and IncreasedCompliance with
Barcoding
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Use of Bar Code Technology to Decrease Dispensing Errors
Scan on automated dispensing cabinet (ADC) medication fill
All medications need to be checked by a pharmacist prior to distribution from the pharmacyThe technician is to scan all medications prior to filling the ADC
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Use of Bar Code Technology to Decrease Dispensing Errors
“Dispense Prep” and “Dispense Check” The technician and pharmacist scan the computer
generated order bar code and then scan the medication If the scanned medication matches the scanned
medication, the screen will turn green If the scanned medication does not match, a warning of
the mismatch will display
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Dispense Check Screen Shot
The product from the Health Connect label matches the product scanned
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Use of Bar Code Technology to Track Items Used in
Intravenous Compounding
Additives for IV compounded products are scanned
Lot number, manufacturer and expiration date is entered into an electronic IV compounding log
Pharmacist checks and initials compounded item label
Scans label bar code and also verifies base solution and additives electronically
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Essential Foundations of a Successful BCMA Program
Teamwork: IT Pharmacy Nursing and Nursing
Managers Data and usable reports Impact on decreasing medication errors
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Essential Foundations of a Successful BCMA Program
Software Reliable EMR software and computer
network The computer medication system is
compatible with the scanners being used The scanners can transmit the data to
the medical record The scanners are correctly linked to the
computer system (either mobile or stationary)
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Essential Foundations of a Successful BCMA Program
Hardware Functional and
reliable barcode scanners
Plenty of workstations Scanners are working properly
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Information Technology’s Essential Role After Implementation
Ensure scanners are working properly
Ensure identified issues are addressed in a timely manner
Ensure system is reliable with minimal downtime
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Pharmacy’s Role in a Successful BCMA Program
Develop a method for adding the correct bar codes for multi-dose products
Inhaler, creams, ointments, insulins, multi-dose containers
Develop a bar coding label hierarchy
Pharmacy placed bar code label- > manufacturer’s bar code-> computer generated order ID bar code
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Pharmacy’s Essential Role in a Successful BCMA Program
All drugs dispensed from the pharmacy have readable barcodes
All dispensed drugs are built in EMR database
One medication record for multiple manufacturers’ product
The correct ordered product is dispensed from the pharmacy
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Pharmacy’s Role in a Successful BCMA Program
The pharmacy computer generated bar code label should only be used as a last resort
Pharmacy compounded products Medications not in the pharmacy database
The pharmacy generated bar code label usually displays the order number, which does not ensure the correct product was dispensed.
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Nursing Management’s Role in a Successful BCMA Program
Education of staffHolding staff accountable for workarounds and non-compliance with correct BCMA work flowUsing data to identify and counsel non- compliant usersStrong relationships with: pharmacy, informatics, nursing staff and the IT department
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Nursing’s Role in a Successful BCMA Program
Buy in with capitalizing on initial successes and increased patient safetyPerforming BCMA compliant with established workflow :
Not using BCMA labels not attached to a medication
Not scanning in real timeReporting medications that do not scan or scanners that do not work
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BCMA Report Content
Contents:Overall Medical Center
compliance Unit specific compliance User specific complianceHour and date Scanning compliance by
medication
DepartmentPatient
Scanning Compliance
Medication Scanning
Compliance
Total Administ
rations
# of Admins
With Patient
Not Scanned
# of Admins
With Medicati
on Not Scanned
# of Admins
With Neither
Medication Nor Patient Scanned
Unit 1 100% 100% 1Unit 2 95.16% 90.32% 62 3 6 2Unit 3 99.11% 98.54% 7199 64 105 38Unit 4 99.47% 98.83% 7699 41 90 34Unit 5 99.39% 98.72% 11970 73 153 43Unit 6 99.29% 98.58% 10775 76 153 65Unit 7 99.26% 98.62% 13167 97 182 64Unit 8 97.14% 97.14% 35 1 1Unit 9 100% 100% 3Unit 10 98.64% 98.01% 3671 50 73 45Unit 11 98.98% 97.53% 1173 12 29 11Unit 12 99.22% 98.65% 12991 101 176 64Unit 13 98.87% 97.25% 2838 32 78 30Unit 14 99.11% 98.51% 4034 36 60 35Unit 15 91.67% 100.00% 12 1Unit 16 98.96% 98.96% 1053 11 11 6Unit 17 100% 100% 1Unit 18 99.06% 97.94% 7855 74 162 66Unit 19 99.94% 97.60% 3288 2 79 2Unit 20 99.23% 98.73% 14095 108 179 61Totals 99.23% 98.49% 101922 782 1537 566
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BCMA Report Content
BCMA compliance by Medical Center and unit type
High Alert medication overrides Top twenty medications overrides and
rationale foroverrides
Raw data on armband and medication overrides
Wrong medication alerts
Total Administrations
Facility
# of
Admins
With
Patient
Not
Scanned
Patient
Scanning
Override %
# of Admins
With Medication
Not Scanned
Medication
Scanning
Override %All Drugs
Hospital 1 1120 1.05% 1812 1.70% 106600
Hospital 2 756 0.79% 1387 1.45% 95804
Hospital 3 2006 1.32% 3056 2.01% 151971
Hospital 4 2828 1.70% 4290 2.59% 165935
Hospital 5 1072 1.32% 1578 1.95% 80934
Hospital 6 3941 1.84% 5525 2.58% 214142
Hospital 7 306 3.02% 185 1.82% 10146
Hospital 8 416 1.21% 794 2.31% 34431
Hospital 9 874 0.99% 1405 1.59% 88237
Hospital 10 610 0.87% 810 1.15% 70463
Hospital 11 769 0.88% 1226 1.40% 87422
Hospital 12 3762 1.92% 4902 2.50% 195990
Hospital 13 1234 1.22% 2289 2.26% 101095
Hospital 14 1463 1.62% 2392 2.65% 90265
Hospital 15 881 0.95% 1443 1.55% 93037
Total 22038 1.38% 33094 1.97% 1,586,472
Armband Medication
SCal Consolidated BCMA Report Prepared by: Michelle Larsen, Project Manager - Pharmacy Operation
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BCMA Report Content
Wrong medication alerts Respiratory BCMA
compliance Many other data sets and
graphs
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Overall User Summary Table
# Users not meeting 98% Armband Scanning Goal
105
# Users not meeting 98% Armband Scanning Goal
and 97% (96% for ED) Medication Scanning Goal
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% Users not meeting 98% Armband Scanning Goal
15%
% Users not meeting 98% Armband Scanning Goal
and 97% (96% for ED) Medication Scanning Goal
11.3%
# Users not meeting 97% (96% for ED) Medication Scanning Goal
139
% Users not meeting 97% (96% for ED) Medication Scanning Goal
19.8%
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Users with No Overrides
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High Outlier Summary
# outliers/# total* % Of all users% of All
adminsitrations% Armband Overrides
% Medication Overrides
% Both Overrides
% 3.97% 7.3% 35.5% 30.1% 39.8%# outliers/# total 29/730 6385/87422 273/769 369/1226 249/625
Also did not meet 98% armband scanning 22/29% Not meeting 98% armband
scanning75.9%
* 135 or more administrations less than 97% med scanning ( ED threshold is 96%)
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High Outlier Report
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Conclusion
The number of medication errors can be decreased by a robust BCMA process.
It takes teamwork with pharmacy, nursing and IT for a successful BCMA program
Bar coding is just not for administration anymore, pharmacy can use this technology to dramatically reduce
the number of dispensing and ADC refilling errors Reporting can be used to increase compliance and identify
system issues
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Acknowledgements
Don Kaplan, Pharm.D., Inpatient Pharmacy Practice Coordinator, Kaiser Southern California Region
Michelle Larsen, Kaiser Southern California Region Inpatient Pharmacy Project Manager
Kal Khoury, Pharm.D, Area Pharmacy Director Kaiser Riverside Dale Timothy, RPh, MBA, Inpatient Pharmacy Director, Kaiser
Riverside Christel Cheng, BSBA, Administrative Assistant Kaiser Riverside
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