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
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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

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Improvements

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

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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)

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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)
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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

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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 Impact20of20emerging20techno
  logieson20medication20 errors20and
  20adverse20drug20events.
• 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.librar
  ies.psu.edu/pqdweb?index0did1366215051 SrchMod
  e2sid2Fmt3VInstPRODVTypePQDRQT309VName
  P QDTS1260766082clientId9874
• 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/w
  cs/stores/servlet/ProductDisplay
  q_catalogIde_-1a_catTreee_100010,1008631,10259
  82,1025978a_langIde_- 1a_productIde_191002a_s
  toreIde_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/downl
  oads/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/documentlibr
  ary/whitepapers/introduce_ barcode_hospitals.Down
  loadFile.File.tmp/WP13966_HCissueBrief_new.pdf?dva
  r1 White Paperdvar2Issues and Opportunities
  for Introducing Bar Code Systems in Hospitals