Bar coded medication administration can be used to help minimize medication errors
In an interview with Pharmacy hours® at the American Society of Health-System Pharmacists Summer Meetings and Expos, Kayla Cierniak, PharmD, MS, BCPS, FISMP, Oncology Medication Safety Lead at Seidman Cancer Center, discusses medication administration by barcode and some of the challenges the initiative has faced.
Q: What is Barcode Medication Delivery?
Kayla Cierniak: BCMA is a technology used by nurses at the bedside when preparing a medication for administration. This is an important medication safety technology that was actually invented by a nurse. In the 90s, she was living in Topeka, Kansas, she was very innovative, and she was on vacation and rented a car. When she was done with her vacation, she returned the car to the car rental company and noticed that they opened the door and scanned a barcode on the inside of the door to verify that it was the right car, coming to the right place, at the right time.
She thought, wait a minute, this reminds me a lot of administering beds or medication at the bedside, and she thought, why can’t we apply this to improve patient safety? Can you put a barcode on the patient’s wristband, a barcode on the medication, scan both, and have the computer verify that you have the correct product in your hand?
So here we are decades later. We have widely implemented it in many of our hospital facilities in all organizations across the United States.
Q: What was this year-long process like in a multi-site hospital?
Kayla Cierniak: As I mentioned, BCMA is widely implemented in hospital settings for most large organizations, and the same is true for our main campus. Our inpatient compliance rate is well above our target goal of 95%, which means that out of 100 medications administered, you have scanned 95 and verified via the EMR, or electronic medical record, that it is good medicine.
However, as a cancer center we also have a strong presence in the community. We have outpatient infusion centers located throughout northeast Ohio. The objective of this project was to examine compliance in 10 of these outpatient remote sites and where we know they have an operational setup to perform BCMA, but their compliance is low compared to inpatients. 75% was our compliance rate on outpatient sites at the start of this project, and it was a one-year process improvement project.
We didn’t know it at the time, but this project fits really well with the new ISMP 16 best practice, which encourages health systems to expand BCMA beyond inpatient units and into limited-stay areas or short-term patients.
Q: How has this affected the hospital multi-site oncology infusion service?
Kayla Cierniak: In order to have an effect on infusion centres, we needed a certain methodology. The drug safety office has leveraged some low-cost and simple interventions. These had worked for us on the inpatient side and luckily for us we had the support of our leaders. We have a head nurse who is really supportive of medication safety. We created a cheat sheet that explained how to do the bedside scan, how to troubleshoot it, if you are a frontline nurse. We have ensured that nursing managers have access to these unit-specific reports as this is what is most useful to them when coaching their staff.
We also held training courses, even had one-on-one peer-to-peer conversations with nurse managers, and also reported our trends at monthly safety committees involving nursing. We really invited them to participate, which made it a truly interdisciplinary effort. After one year, our average compliance rate increased from 78% to 96%. We landed right on target at the end of our project.
Q: What were the challenges faced by the initiative?
Kayla Cierniak: Of course, we had challenges along the way. Luckily, many of our nurse managers had walked inpatient spaces before, where, as I said, our compliance was really good. They had seen a lot of best practices. We just needed to educate to make it known to the community.
We had challenges where nurse managers were leaving for a new position. What would the transfer between leaving the nurse manager and integrating the nurse manager look like to transfer these reports? In particular for oncology infusion we had 1 site that had very low compliance, they were around 52% at the start, and we went there to observe what was happening and understand why we are only scanning half medication ?
Turns out they thought only the chemo should be scanned, but with the chemo comes the premeds. You need hydration, perhaps normal saline infusions or other supportive care. They didn’t document any of this. We needed to re-educate that BCMA is not only important for medical safety, but helps us with billing. This helps us track medication usage and ultimately improves the safety of our patients.
Q: What should pharmacists know about this initiative and how should they apply it to their pharmacy to reduce medication errors?
Kayla Cierniak: Pharmacists, know that you can use the new good practice ISMP 16 to give you firepower. If you find management support lacking, or if you have struggled in the past, engage management by moving BCMA only inpatient units to all other areas of patient care. Vanderbilt’s tragic mistake and the unjust prosecution of this nurse. This happened in a CT imaging room, which is a limited patient care area in the state that did not have BCMA technology available to the nurse and could have caught this error.
The remaining spots we need to expand BCMA are a bit notoriously difficult and have held up in the past. They include radiology, emergency services, operating rooms, PACU, dialysis. To start nibbling, find perhaps the one area of your organization that might be the low-hanging fruit where you might have the most stakeholder buy-in initially to try and move this practice forward.
We hope that as these regions continue to embrace BCMA and recognize the value of this technology and improve patient safety, perhaps they will all fall in line like a cascade of dominoes. The reality is that it’s going to take a lot more time and effort on the part of those advocating for drug safety.