Scanning Medication Reduces Errors, Hospital Says

In April 2008, Baystate Medical Center (BMC), a 653-bed teaching hospital in Springfield, MA, began implementation of its Bar Code Point of Care technology to positively impact medication administration in reducing errors. 

In the early pilot programs, BMC reported a 50% bedside scanning rate for all medications and a medication error rate of 1.2 errors per 1,000 patient days.

Following the implementation of an organization-wide bar code scanning process in September 2008, BMC improved its medication scanning rates to 87%—90%. The medication error rate also decreased to 0.3 errors per 1,000 patient days, a 75% reduction.

Implementation and pilot programs

Planning and implementing a bar code scanning system at the bedside was a major undertaking for BMC because the patient safety-focused process is designed to significantly reduce medication administration errors.

"What is so impactful about the whole process is that all departments—with the exception of some emergency departments—are fully bar coded," says Gary Kerr, MBA, PharmD, director of pharmacy services at BMC. "The central pharmacy has been re-engineered to support the outputs necessary to drive and sustain medication bar codes."

BMC started small, with a six-month pilot program that involved three nursing units. It was during this six-month pilot program that Kerr and Mark Heelon, PharmD, medical-surgical director at BMC, committed themselves to learning everything about the bar coding process.

It became clear early on that there were numerous obstacles when scanning a patient every time he or she received a medication, from packaging to process. Examples of identified scanning challenges included large-volume IVs, medications without bar codes, medications with reflective packaging (e.g., suppositories), and computerized physician order entry (CPOE) mismatching products or administration times of medications.  

One specific example of a CPOE scanning issue occurred in the pediatric ICU, where continuous Albuterol updrafts needed to be scanned on an hourly basis, resulting in suboptimal scan rates for the unit. To help resolve the issue, interdisciplinary collaboration among nursing, informatics, and pharmacy focused on educating staff about how to correctly enter continuous Albuterol orders. 

This process was accomplished by developing a medication care set to guide the provider in selecting the appropriate products that ultimately influenced scan rates. This intervention also reduced the number of times the respiratory therapist needed to scan the medication.  "There was really no reason to have the respiratory therapist repetitively scanning on the hour for Albuterol," says Heelon. "Or for any nurse, for that matter." 

The process was changed from needing to scan constantly to the staff member or nurse scanning the medication only when the Albuterol updraft was replaced.

"The foundation of the success of this project was the open line of communication between pharmacy and nursing," says WendySue Woods, RN, MSHA, CSHA, senior consultant at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, and senior advisor to BMC.

BMC felt comfortable implementing this process organization-wide after trialing it for six months and receiving feedback from the nurses on the unit.

Current bar coding success

On each unit, BMC nurses have ready access to bar code scanners. With the scanner in hand, the nurse is able to enter the patient's room with the patient's medication and scan the label on the medication.  

This process augments the five rights of medication administration at the patient's bedside to ensure that the correct patient receives the correct medication. 

"In the past, a medication error that might have reached the patient could have been backtracked to a pharmacy technician placing a wrong medication or strength in the automated dispensing cabinet," says Heelon. "With the new processes and scanners at the patient bedside, we have seen a dramatic decrease in medication errors reaching our patients."

In addition to adding the bar code and scanning process, BMC was able to reevaluate the package system it was using for its medications. Prior to the new process, BMC was purchasing some bulk drugs. Internal repackaging was necessary to create unit doses and assign a bar code to the drug.

"We reevaluated and shifted some purchases to companies where we paid a slight premium for the drug but the medication already comes as a unit dose with a bar code," says Kerr.

Even though this had a slight negative impact at the ingredient cost level, it has proven to be cost-effective at the system level. The FDA is moving toward requiring bar codes on all drugs.

Reaching 100%

Despite these challenges, as of April, BMC has been able to maintain an 87%-90% scanning rate of medications at the bedside.

Kerr admits that the leadership team interacts with him frequently regarding BMC reaching the elusive 100% medication scan rate.

"With respect to that last 12%, we are diligently addressing package and process challenges, while acknowledging there are areas that will never make the 87%-90% rates," says Kerr.

For instance, the post-anesthesia care unit struggles with reaching high medication scan rates. In this particular area, patients who are coming out of surgeries often receive titrated drugs every 10-15 minutes for pain. To drive appropriate throughput and patient flow, the nurse is constantly trying to stabilize the patient in order to move him or her through the system and get ready for the next patient.

"Because of the nature of the unit, the nurses would be scanning the drugs much more frequently than a conventional inpatient unit," says Kerr. 

Management buy-in

The role of senior management and the commitment of multidisciplinary nursing-informatics-pharmacy teams have added to the success of the program.

"This organization can enjoy this success as they have remained true to the focus on patient safety," says Woods.

Kerr echoes that sentiment, saying that leadership involvement has been key. "BMC is committed to be the best and lead the way in technology and automation processes in support of patient safety," he says. "Leadership identified the opportunities, supported funding of the project, embraced key process improvement concepts, and drove the change."

________________________________________________________________________
This article was adapted from one that originally appeared in the October 2010 issue of  Briefings on The Joint Commission, an HCPro publication.