Case study reveals how to improve rate of bedside medication bar coding

Officials at Cook Children's Medical Center in Fort Worth, Texas, say a bedside medication verification (BMV) system has resulted in 97 percent compliance with electronic scanning of medications and patients before the medication is administered.

Although hospitals commonly use electronic barcode scanning for medication administration, the rate of bedside scanning achieved at most hospitals is 70 percent or less, according to a case study by the College of Health Information Management  Executives (CHIME).

The bedside medication verification system was implemented in November 2010. The integrated technology checks before medication is administered that "the right medication is being given in the right dose to the right patient at the right time and in the correct manner," the "Five Rights" of medication administration, CHIME notes in announcing the case study.

That kind of precision is particularly critical for pediatric patients, CHIME says. Dosages vary widely by the patient weight, and mistakes can easily cause an overdose.

An implementation team comprising nursing, pharmacy and IT personnel developed a plan to phase in use of the $2 million bar-coding system and a strategy to encourage its use in treating every patient at the 428-bed hospital, CHIME says. The system employs a single electronic medication administration record (eMAR.)

"There was a lot of education that [BMV] was coming and how it would impact" staff, JoAnn Sanders, M.D., hospital patient safety officer and BMV project sponsor, says in the case study. "It was never billed as a time-saver to staff. Our mantra was that we would try to make it neutral at best. We tried very hard to not make it into nirvana, and we were careful not to sell it as nirvana."

The hospital achieved staff buy-in by emphasizing the project would improve patient safety, according to the case study.

Implementation required changing core habits, such as nurses documenting medication administration in the electronic health record after patients received their doses, or co-signing for narcotics administration away from the patient, the study notes.

Five lessons learned, according to the document, are:

  • Achieve buy-in from the C-suite on down.
  • Know the organization's technology strengths and weaknesses.
  • Take the IT staff to the caregivers.
  • Be patient.
  • Recognize and reward achievement.

Although this year's "Most Wired" hospital survey by Hospitals & Health Networks did not measure use of bar-coded medication administration, last year, 66 percent of Most Wired facilities and 54 percent of all respondents used bedside bar coding or RFID to match medications with patients.

Meanwhile, the European Association of Hospital Pharmacists and European Federation of Pharmaceutical and Industry Associations (EFPIA) announced this week they are working toward a joint vision on single-unit medication bar coding in hospitals.

So far they have exchanged information on country-by-country practices of bedside scanning, regulatory and nonregulatory options to increase scanning, and the possibility of establishing a Europe-wide system of medication identification, according to the announcement.

To learn more:
- see the case study
- read the CHIME announcement
- check out the European announcement

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