"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.
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.
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."