Barcoding makes its mark on daily practice

Embrace barcoded medication administration for its contribution to patient safety. Finding ways to minimize or eliminate medication errors continues to be an ongoing process for health care. According to the United States Department of Health and Human Services, preventing adverse events related to medication errors can yield a savings of $3.9 billion annually. 1 By barcoding patient identification bands and medication doses, facilities can reportedly reduce medication errors by 65% to 86%. 2 In March 2003, after several years of research, the Food and Drug Administration (FDA) proposed two rules to improve patient safety: medication barcoding and safety reporting. The initiative requires barcodes on medications and changes in reporting mandates for safety problems related to medication administration. 3 The FDA estimates that its barcode rule will result in a 50% increase in error interception at the dispensing and administration stages, resulting in approximately 413,000 fewer adverse events over the next 20 years. 4 System implementation The Department of Veterans Affairs Bar Code Medication Administration (BCMA) software, implemented in all 163 VA hospitals by June 2000, provides a real-time solution to validating bedside medication administration. Now other institutions are following suit. According to the FDA, if used properly, BCMA allows the health system to administer 5.7 million doses of medications without the occurrence of a single error. 5 As a replacement for traditional keyboard entry, barcoding requires that an identifier be converted to a symbol that can be affixed to an item, read by a scanner, and fed into a computer. 6 For the nurse using BCMA, this process validates the accuracy of the medication or warns of a potential error if the action doesn’t meet the five rights of medication administration (right patient, right medication, right route, right dose, and right time). Nurses, who are in the most vulnerable position for making a medication error, seek a system that will prevent errors from occurring. 7 Although BCMA implementation and usage creates changes and challenges to clinical practice, nurses are committed to incorporating technology into daily practice to decrease medication errors. Deal makers or breakers As the managers of patient care information, nurses enter and retrieve data from diverse electronic systems, using multiple input devices and a variety of software applications. Too often, nursing units lack the computer functionality that’s required to document medication administration. Ongoing support and timely training are critical to BCMA’s success in the clinical arena. Each level of nursing maintains distinct responsibilities regarding the quest for safe patient care through computerization. (See “Supporting roles.”) In addition to participation from all nursing levels, BCMA hinges on the following elements: ♦communication and administrative support. Initial planning for such a complex process calls for an appropriate interdisciplinary team comprised of staff nurses, informatics nurses, pharmacy staff, computer specialists, biomedical engineers, and engineering staff. Choose discipline-specific members who are respected change agents and opinion leaders. Your organization’s administrators will need to plan and allocate long-term substantial financial and human capital to ensure adequate resources during planning, implementation, and rollout. ♦staff buy-in. Plan a vendor fair to display potential BCMA products for staff to evaluate. Develop a requirement analysis instructing staff to provide input via product evaluations. Choose software that can be customized to the clinical practice at your facility, requiring minimal change by nurses, physicians, and pharmacists in their current practice. Ensure that all staff members understand the project’s magnitude and its expected outcomes. View decision-making and implementation as joint efforts; include feedback from the planning team, content experts, and clinical staff. ♦hardware. Validate hardware and input device durability by checking the vendor’s references. Select input devices, for example, mouse or touchscreen, and decide where the laptop will reside on the medication cart—mounted on an adjustable arm or attached to a side tray. Test component compatibility and battery life. Decide if the scanner will be tethered or wireless, and test durability of the wristband barcode print. Plan for equipment replacement every 2 years and allocate funds for additional hardware and equipment to serve as backups for out-of-service components. ♦training and initial support. Provide end-users with a computer-training laboratory, which mirrors the practice environment in terms of equipment and software. Offer training, followed by reinforcement in the practice environment. Maintain 24-hour on-site support from clinical informatics staff during implementation on each clinical unit for at least 1 week. Ask clinical informatics staff to provide one-on-one supervision and support to nurses during the first medication administration pass. ♦ongoing support. Clinical informatics staff members should be available to offer immediate, on-site assistance to nurses via a help desk from 6:30 a.m. to 5:30 p.m. covering all three shifts. In addition, an organization should hold weekly interdisciplinary BCMA rounds, which enable pharmacy, information management staff, and informaticists to talk with each nurse to identify hardware, software, scanning, and pharmacy issues. The informatics team should work with software developers to request changes or enhancements to the BCMA program. Perils and pearls of technology Hardware, input devices, and computer software don’t always integrate well or perform as expected, which potentially creates slow response time, equipment problems, missing armbands, and illegible barcodes. These interferences pose costly and annoying issues for staff. Specifically, experts identify five side effects from BCMA implementation: potential for missed medications resulting from the automatic removal of medications by the software degraded coordination between nurses and physicians development of workarounds resulting from the unreliability of technology conflict between meeting the monitored medication delivery window and prioritizing other patient care activities limited software flexibility for dosing needs. 8 To help avoid these problems, test each component for performance, adequacy, integration, and durability, and keep an open-door policy with staff regarding quality improvement. Strive to highlight the finer points of barcoding technology, including its ability to provide legible documentation and to integrate the entire medication process, thus promoting better patient outcomes. Encourage staff to use features such as pop-up boxes and activity reports as ongoing reminders of the initiative’s main goal—safer patient care. Nurses will embrace BCMA for its contributions to patient safety. Although not a substitute for professional judgment, barcoding technology gives them more confidence when administering medications. Nurses at all levels value the technology’s ability to move health care from a culture of blame to one of optimal safety.