Using bcma software to

Participants are encouraged to attend the training for a discipline other than their own to illustrate the collaborative effort involved to implement and effectively use the BCMA v3. The "Go-Live" portion of this activity provides immediate on-site support of individual users as they begin to use the hardware and software and immediate response to questions.

Target audience includes:. Improving safety with information technology. N Engl J Med. ASHP statement on bar-code-enabled medication administration technology. Am J Health Syst Pharm. Bar code technology and medication administration error. J Patient Saf. Effect of bar-code technology on the safety of medication administration. Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

Qual Saf Health Care. Medication safety improves after implementation of positive patient identification. Appl Clin Inform. Implementing a safe and reliable process for medication administration. Clin Nurse Spec. Edlavitch SA. Adverse drug event reporting: improving the low US reporting rates.

Arch Intern Med. Nurse staffing and patient care quality and safety. In: Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses.

Fundamentals of medication error research. Am J Hosp Pharm. Cochrane handbook for systematic reviews of interventions. Version 5. The Cochrane Collaboration; Mar, [cited Jul 28]. Support Center Support Center.

External link. Please review our privacy policy. Poon et al. Inpatients from 35 adult medical, surgical, and intensive care units in a bed tertiary academic medical centre United States. Oncology units because of complex protocols, dosing regimens, and specialized workflow for administering medications. Implementation of BCMA with eMARs versus Traditional, paper-based process of administering drugs whereby medication orders were manually transcribed to paper MAR by physician, with nurse manually verifying dose and patient identity before giving the dose CPOE and ADD systems were in place before and after the intervention.

Franklin et al. Patients and staff of a bed surgical ward of a London teaching hospital United Kingdom. IV doses for MAE rate calculation, as implementation of eMAR changed workflow one nurse could now prepare IV medications while another prepared oral medications ; this situation introduced potential for bias in results IV infusions and oral anticoagulation remained in paper charts.

Helmons et al. Patients in 2 medical-surgical units and 2 ICUs of a bed academic teaching hospital United States. BCMA technology medication administration checked with software system interfaced with CPOE and pharmacy information system versus MAR printed once daily serving as a paper reference for medications to be delivered to patients and completed that day; hospital CPOE system that was already implemented had to be regularly checked for new or modified medication orders, and any changes had to be transcribed onto the MAR.

Richardson et al. Medication error rates recorded on the basis of a before- and-after approach Study focused on key steps guiding clinical nurse specialists to improve safety of medication administration by implementing BCMA, with phased-in approach over 3 years; scanning rates were recorded in 3 phases months 6—13, months 14—24, and months 25— Higgins et al.

Before-and-after study in a large teaching hospital with retrospective analysis; pre-implementation data collected from to April ; post-implementation data collected from April to BCMA helps users to be in compliance with the "Five Rights" of medication administration: right patient, right dose, right route, right time, and right medication [2]. Although adoption of BCMA is proceeding slowly in the United States, the Agency for Healthcare Research and Quality AHRQ has provided leadership by funding eleven organizations in a variety of care settings in implementing bar-coded medication administration projects and exploring the effects of BCMA on health care quality, safety, cost, and other outcomes.

Information regarding AHRQ-funded bar-coded medication administration projects can be found at the links provided at the end of this document. While the projects described are not yet complete, some key "lessons learned" have emerged from the grantees' experiences in implementing BCMA.

These findings focus on implementation considerations for BCMA:. Lesson 1: Implementing BCMA requiresworkflow modifications for nursing, pharmacy, and other stakeholders, with changes in culture, attitudes, and practice, to achieve the benefits of this technology. Lesson 2: The placement, accessibility, compatibility, and durability of equipment are essential to effective implementation of BCMA.

Lesson 3: Training staff and modifying policies to address issues relevant to BCMA administration are key steps in preparing to go live with a new system.

Institute of Medicine. Committee on Quality of Health Care in America. Patient Safety and Healthcare Quality. This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. The VHA leadership recognized the need for additional emphasis with respect to business procedures, standardization, and usability issues identified by BCMA end-users.

The team established an overall goal of using BCMA to safely administer and document all medications within the first 24 hours following coronary artery bypass graft CABG surgery, since delays in medicating patients in this complex population can produce life-threatening results. Using a series of Plan-Do-Study-Act cycles a technique originally developed and described by Langley et al.

If a drug manufacturer's barcode label can't be scanned successfully, or if bulk-packaged products are transferred to unit dose packaging by the pharmacy staff, these items then must receive a pharmacy-generated barcode label that is affixed to or printed directly onto the outer wrap of the dose packaging Figure 3 , Panel A. Examples of valid and invalid BCMA barcode samples. Panel A: Typical pharmacy-generated unit dose barcoded label. Panel B: Example of a patient-specific multi-dose medication barcoded label.

Moreover, patient-specific multi-dose medications e. If a medication can't be scanned on a clinical care ward, it is likely the nurse will employ a work-around technique and enter the Internal Entry Number IEN for the medication manually, thereby bypassing BCMA and placing the patient at significant potential risk for a medication error. An example of a work-around is shown in Figure 3 , Panel C. It is the responsibility of the pharmacist to be responsive to such problems and to investigate scan failures and the return of properly labeled items in a reasonable amount of time.

This process has led to significant reductions in the number of phone calls from nurses to the pharmacy, thereby increasing overall efficiency.

Conversely, the initial BCMA software version was not configured to accommodate urgent or one-time i. As much as 30 minutes could elapse between the provider's order entry and the appearance of either type of medication in the BCMA nursing interface. Without this convenient feature, the BCMA system would not have been deemed acceptable for use in an acute care setting such as the ICU.

Although the initial version of the BCMA software was considered very useful for administering unit dose medications and reporting doses missing from the medication cart, the application's intravenous IV medication functionality was limited.

These documentation issues are especially challenging with respect to critically ill CABG patients, who have a propensity for multiple titratable IV fluids administered simultaneously and whose IV administration rates and status change frequently. ICU end-users have expressed their collective desire to have automated infusion pump programming and verification incorporated into the BCMA system, and some of these features are being designed and developed by manufacturers. When the collaborative team first sought to remove the paper MAR system from the ICU, the impact of various differences in the way the pharmacists completed orders for intravenous medications quickly became apparent.

These differing styles were most likely due to inconsistencies in IV dosage form terminology taught at health care institutions and pharmacy schools throughout the United States. The BCMA collaborative team therefore held joint departmental meetings whereby nursing and pharmacy staff members established grass roots definitions for each respective parenteral medication category. Using triage questions developed by VHA's National Center for Patient Safety, the collaborative team decided in October of that the next crucial step in the IV schedule standardization process was the development of a straightforward color-coded cognitive tool for pharmacists that could be referenced quickly during order editing for CABG patients.

This tool has been implemented and judged acceptable by the Truman Memorial pharmacy staff. In fact, the hospital patient safety manager in February noted the tool had been used several times in the span of 20 minutes, for cardiothoracic and acute non-ICU patient medications, following observation of an inpatient pharmacist.

Since the VHA is actively improving upon the current pharmacy software package, the process should become much more intuitive to the needs of the hospital pharmacist in the future, to the possible extent that upon finishing an order, a pop-up box would suggest the proper documentation tab for a particular drug or drug combination, thereby eliminating the need for a supplemental information table.

Thus, a color-coded cognitive tool was developed to standardize IV medication order processing by pharmacists. The tool has been truncated here so as to provide one example from each of the IV medication schedule types. Inpatient pharmacists were then instructed on proper entry of IV medications based on the printed table.

Pharmacy and nursing staff members must collaborate closely with information management staff, if the medication administration arm of a hospital care system is to work optimally, just as rapid computer response time is crucial to the success of a computerized medication administration system.

As a result, computer response time and reliability were improved greatly, thereby helping to ease the eroding staff confidence in the network system. Further improvement included making the computer support staff more available and on-call around the clock to resolve hardware and software issues as they arose.

Perhaps the most crucial network system modification centered on the hospital staff's development of a BCMA Contingency Plan. Briefly, the medication administration history for each floor was periodically written to an electronic file sent to six personal computers throughout the hospital. Each of the designated PCs was provided with the capability to print each floor's medication administration history in case a technical difficulty on a particular floor prevented the report from being generated.

Staff members were briefed on how long to wait before activating the contingency plan, and tabletop drills were done for demonstration purposes. In addition to the consideration given to software issues, the success of the BCMA implementation required functional and adequate point-of-care equipment, as supported by Patterson et al. The scanner cords were long, but in some cases they would not reach the patient's wristband for scanning.

This shortcoming encouraged the caregiver to bypass the BCMA system. Cordless scanners were purchased prior to the BCMA re-implementation in , and nurses now can access the wristband barcodes without needing to move equipment.

Additionally, a wireless laptop on a roll-around stand was deployed on the ICU unit to increase nursing staff access to the BCMA system during those instances when the bedside computer was being used by another provider. Dual medication systems i. Since that time, the documented percentage of these same medications in the BCMA system has risen to more than 95 percent, and several nurses have expressed the opinion that their overall workload has decreased as well.

The collaborative learned that safe, successful barcode medication administration is not a passive or mutually exclusive process, and that pharmacy-nursing staff communication is key to BCMA success. One of the collaborative team's initial core objectives involved inter-staff communications.

This was done for all open-heart CABG surgeries. Nursing staff members documented the calls on the ICU flow sheet, and pharmacy staff members were directed to keep a written log of the calls. The collaborative discovered that a simple policy change requiring an uncomplicated phone call to the pharmacy helped to ensure the timely administration of medications. We learned a similar communication lesson during the BCMA reimplementation while attempting to solve a problem related to the handling of pre- and post-surgical IV medication barcodes for CABG patients.