By: Sally Walton, MSN, MBA, RN, OCN, NEA-BC
Director of Nursing Technology & Innovation
As part of our ongoing journey toward a safer environment for our patients, you may recall that we began implementation of Barcode Medication Administration (BCMA) in June 2014 across the organization.
The main goal of BCMA is to reduce medication errors by providing additional safeguards for staff to better protect patients from transcription, dispensing and administration errors through positive patient and medication identification.
The technology alone does not ensure a safe system. BCMA was designed to augment, not replace, the nurse’s/respiratory therapist’s clinical judgment.
While clinicians alone can determine whether (or not) to administer medication based on clinical assessments, the practice of medication administration still requires application of the nursing process.
One of the important steps taken during the project was performing direct observations of the medication administration process to see if “The 5 Rights (right patient, right drug, right dose, right time & right route) were followed during key medication administration times (9AM, 1PM, 5PM, 9PM).
The goal was to evaluate and identify opportunities for workflow and system enhancements.
The observations were done for two-week periods both before and after BCMA in the 10 North ICU in the Center for Care and Discovery. Two Patient Care Support Nurses, who were also subject matter experts for the BCMA project, completed both the pre-BCMA and post-BCMA observation studies.
We are very happy to report that since going live with BCMA, we have been able to achieve and maintain greater than 95% overall compliance (patient scanning and medication scanning).
We appreciate the diligence and hard work of all our staff who have adopted this important patient safety initiative. After seeing the post-BCMA results, we were also very happy to see the use of two patient identifiers rise to 99.1%.
We also looked at the number and type of discrepancies related to “The 5 Rights” and there was a rise, however, in discrepancies. The overall rate rose to 20.6% from 6.8%. So we did a deeper dive into the data specifically related to ‘Time’ discrepancies (where we saw 40 instances).
We found 33 times when meds were administered more than one hour after the scheduled time. About 64% of the time, this occurred for ‘unknown’ reasons. But there were other reasons, including a Dr. Cart occurring on the unit, a change in patient condition or drug not available, that caused the delay. Seven meds were administered more than one hour before scheduled time, but six of those were for ‘unknown’ reasons.
When we presented this data to nursing groups, their thoughts on why there were more ‘Time’ discrepancies included:
- the look of the eMAR changed in June 2014 with the Epic upgrade
- a smaller sample size and the possibility that there may be a tendency to “over depend” on the technology.
Since implementing an ‘off-schedule medication administration alert, we have noticed that the number of ‘Time’ discrepancies has decreased in the most recent reports.
The BCMA Clinical Champion group is continuing to monitor BCMA compliance and alerts and will determine if future observations are needed. This data has also been presented and discussed in the following forums: BCMA Clinical Champions, BCMA Sponsor Group, Patient Care Services Leadership, Medication Safety Committee and Nursing-Pharmacy Committee.