Bringing Barcoding to the Bedside

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Bringing Barcoding to the Bedside
Challenges Benefits of Implementing a Barcode
Point of Care Medication Administration System

• James Douglas, RN and Susanne Larrabee, RPh
• Northern Michigan Regional Health System -
  Petoskey, MI

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Session Overview

• Identify implementation challenges and strategies
  employed
• Describe the role of Bar Code Point of Care
  (BPOC) technology in capturing medication error
  data
• Identify factors influencing data interpretation
  and analysis
• Discuss benefits of implementing BPOC

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Northern Michigan Regional Health System

• 243 bed Regional Referral Center located in
  Petoskey, Michigan
• Major Services Lines
• Cardiology
• Oncology
• Neurosciences
• Orthopedics

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Medication Error Facts

• 7,000 Americans die annually1
• 5.6 million per hospital2
• Hospitals urged to use information technology to
  collect data to reduce and prevent medication
  errors, adverse drug events, (never-events,
  sentinel events, near-misses, near-hits,
  hazardous conditions)3

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Scope of the Problem

• For every 100 hospital admissions, 6.5 experience
  an ADE (adverse drug event).
• For every 100 medication errors that occur,
  approximately 1 harm the patient.
• 5 serious medication errors occur for every
  10,000 medications administered.
• Errors in ordering are much more likely to be
  intercepted (48) than those in the
  administration stage (0)

1 Bates D.W. et al. Incidence of Adverse Drug
Events and Potential Adverse Drug Events, JAMA
199527429-34
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Hospital Buy In

• Change Philosophy
• Champions - all levels of staff
• Readiness of staff
• Nursing, Pharmacy and Information Services
  manager accountability for successful
  implementation
• Mandatory nursing, respiratory and pharmacy
  training

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BPOC Bedside Device

• Wireless Laptop computer with a touch screen and
  bar code scanner
• Deployed on 148 beds ICU, CVU and Med-Surg Units
  on 10/31/2001.
• Average daily census of 100 patients on these
  units
• Average monthly medication administrations of
  50,000 doses.

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Training

• Nursing/RT Theory, basic use, and
  troubleshooting
• Pharmacy Theory, order entry, and
  troubleshooting
• Training Methods Class, Computer Based,
  One-on-One
• Dont forget the Physicians!

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Barcode Technology

• Nurse barcode scans name tag
• Nurse barcode scans patient identification
  bracelet
• Patient MAR appears on bedside laptop
• Scheduled and prn meds are scanned
• Warnings/alerts are issued when indicated

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Care Giver Scanning

• Permanent identifier
• Ergonomics
• Who, where and when

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Patient Scanning

• Durability
• Reliability
• Is the wrist band on the wrist?
• Addressing patient concerns

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Medication Scanning

• Manufacturer bar codes
• Repackaging
• Adding barcodes to existing package
• Quality control

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User Issues

• How to communicate and collect issues on a daily
  basis (Nursing/Pharmacy/IT)
• A plan for disseminating issues to proper
  person(s)
• Tracking, discussing and prioritizing issues
• Who can fix issues on a daily basis?

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Capturing Medication Error Data
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How do you prevent medication errors with bar
code technology?
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Give the Med to the Computer before
you give it to the Patient!!!!!!!!!!!!!!!!!
Scanning takes longer, but it is the best way to
prevent a med error!
Pay attention to the warning messages!!
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Warning Message Algorithm
Nurse Response
Warning Message
Administer
Continue
Potential Error
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Warning Message Definitions
Dose Omitted A prior dose has not been given.
Maximum Daily Dose Exceeded The 24-hour
maximum safe dose will be exceeded.
Route Not Ordered The order does not specify
the route of administration.
Dose Too Soon A medication is about to be
given
Not on Profile The selected medication has not
been ordered for the patient.
Wrong Dose Range The medication entered does
NOT match the prescribed dose.
Dose Late A medication is being given greater
than one hour after it was due.
Orders Discontinued The selected medication has
been stopped by the physician.
Wrong Single Dose Value The medication that
was bar-coded is NOT the actual prescribed dose.
Duplicate Medication This medication has
already been selected to be given.
Order Expired The order for this medication is
no longer valid.
Future Order The selected medication is not
currently scheduled.
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Since going live with BPOC Oct 31st 2001

• Total Medications Administered
• 931,780
• Total Errors Messages
• 285,849
• Total Confirmed Errors Prevented
• 2,493 (0.87)

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Top 10 Medications Involved with Errors Prevented

• Aspirin
• Colace
• Lortab
• Ketorolac
• Metoprolol

• Pepcid
• Percocet
• Prevacid
• Tylenol
• Zofran
• potential for harm if given incorrectly

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Hospital Risk Management

• Have they reported and measured your hospitals
  medication errors ?
• (Most likely they have been doing it for years
  and years.)
• Can you use them to show med error reduction
  after implementing bar code technology?

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Up 29
Up 50
Down 31
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Impact on med errors reported since going live
Oct 31st 2001
live
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So now that you have all this data what are you
going to do with it?

• Root Cause Analysis
• Errors ReportedErrors Prevented
• You now know Total Number of Medications
  Administered by day, week, month, user, unit,
  etc.

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• Benefits and Value of a B.P.O.C. System

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NCC-MERP - National Coordinating Council
Medication Error Reporting Prevention
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Igt
Death
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Cost of Adverse Drug Events (ADEs)

• JCAHO 1998
• 1 ADE costs 2,000 (excluding malpractice)

• Jury Verdict Research
• Average malpractice award for a medication error
  is 636,000

• CA HealthCare Foundation
• Preventable ADE costs 5,000
• 6.5 of all hospital admissions result in ADE

• Leapfrog 2001
• 1 med error costs 10
• 1 ADE costs 2,000

• Schneider 1995
• Med error requiring extra lab or treatment costs
  95 to 227
• Med error prolonging length of stay costs 2,596
• Med error resulting in near-death experience
  costs 2,640

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1Birkmeyer et al. 2001
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Igt
Death
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Potential Severity of Medication Errors Prevented

• Enteric coated Aspirin given instead of
  chewableC
• Zofran q6hrs given 1 hour earlyC
• Lovenox 130mg q12hrs given 6 hours earlyD
• Apresoline 100mg given 30 minutes after previous
  dose was givenE

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2003 378 med errors prevented 311- were Cs 65-
were Ds 2- were Es (17.5) of errors prevented
were potentially serious)
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Benefits of BPOC

• Classify Quantify Med Errors Prevented
• Helps Meet Regulatory Standards
• Patient Safety Mission
• Root-Cause Analysis to drive Process Improvement

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Questions?