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Bar Code Rx Administration Compliance Rolling Out Slowly

Analysis  |  By Tinker Ready  
   December 01, 2016

The practice of tracking medication administration electronically promises to improve patient safety, but an early look at some of the data shows that hospitals are still working through barriers that hinder compliance.

Starting this year, the Leapfrog Group began collecting data on the use of bar codes in the administration of drugs to hospital patients. Enabled by electronic medical records, the system allows nurses to scan a patient’s wristband to confirm drug delivery for each patient. 

The practice promises to improve patient safety, but an early look at some of the data shows that hospitals are still working through barriers that hinder compliance.

To meet the nonprofit organization's standards, hospitals have to make sure that bar code systems are deployed in all of their medical and surgical units, including intensive care. And they have to ensure that they are being used.

Leapfrog has not yet collected a full year's worth of data, but the state of Massachusetts offers a snapshot based on three months of the group's 2016 data.

Only six of the 47 hospitals monitored were found to have fully implemented bar code checks during medication administration (BCMA). And those facilities are not the big Boston medical centers that usually score high in the rankings.

Two are in largely rural Western, Massachusetts. The other two are south of the city.

The findings are part of a much broader annual quality report from The Center for Health Information and Analysis (CHIA), a quasi-public agency. It uses its own measures, which are designed to meet the National Academy of Medicine's quality standards, said Christi Carman, the group's quality reporting manager.

A third report used a select group of measures to "tell the clearest story in terms of what the measures intended to capture and how important the measures are relative to… the conversation here in the Commonwealth about quality and value," Carman said.

The report, which looks at both providers and hospitals, used 17 measures broken down by safe care, effective and efficient care, and patient-centered care. The BCMA numbers are in the "Safe Care" chapter, which reported four hospitals in full BCMA compliance. For the rest of the 39 reporting hospitals, 18 reported they were making "substantial progress" and 21 basically said they are still working on it.

Compliance Barriers
Leapfrog reports that "BCMA implementation can be remarkably effective in reducing medication administration errors. It cites a study that found a 41.1% relative reduction in errors (from 11.5% to 6.8%) in non-timing errors in medication administration.

At Carilion Roanoke Memorial Hospital, a 763-bed academic medical center in Roanoke, VA, a root cause analysis of a near miss led back to the BCMA system.

Chad Alvarez, the hospital's pharmacy director, said numerous workarounds and other issues were keeping staff from fully using the BCMA system. These included

  • Unreadable bar codes
  • Hardware problems with scanners
  • Workflow challenges when the patient was off the unit or the entire system was down

One other notable factor: A high percentage of overrides, where a nurse does not scan the medication bar code or the patient's armband. The EMR system requires a reason for the override and nurses commonly check off "nursing message." When the pharmacy removed that option, compliance improved.

It took a team effort to address it, he said.

"Looking at all those things in aggregate and increasing the awareness of what medication errors cost the health system and the potential harm it can cause for patients… It was a pretty easy sell to get everybody in the room," Alvarez said.

A Path to Better Compliance
The fix involved education for more than 800 staff, analysis of overrides to identify trends, and upgrades for wireless system and faulty scanners. Carilion also equipped carts and bedside devices used for medication administration with "problem-solving quick reference cards" on medication and bar-code scanner issues.

Then it published its findings: compliance with bar code medication administration rose from 82% to 97%: "Overall our experience highlights the need to continually improve the clinical components of the medication delivery process, by using a multidisciplinary team particularly where providers and technology intersect and focus on different levels of the system. Improvement was achieved when the multidisciplinary team focused on BCMA."

Tinker Ready is a contributing writer at HealthLeaders Media.


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