Bar-Coded Medication Administration Systems
Medication errors may have tragic consequences for patients. While that is bad enough, they also damage the reputations of healthcare organizations, the nursing profession and the cost is quite expensive. A good portion of adverse drug events (ADEs) are preventable. They can occur during the ordering, administration, transcription or dispensing stages, but a good share of ADEs are committed at the point of administration. With bar-coded medication administration (BCMA) systems, the likelihood of committing a medication administration error is decreased because the system checks all of the aspects of the medication and verifies that each of them are correct. Unfortunately, even though BCMA systems have been around for over 3 decades now, they are still not implemented as often as one would think they would be, and there are many reasons for that. However, those reasons for not implementing a BCMA system seem less important when one realizes how effective they are.
Bar-coded medication administration (BCMA) systems were created to electronically reduce the number of medication errors. These systems verify what Shah, Lo, Babich, Tsao, and Bansback (2016) of the Canadian Journal of Hospital Pharmacy call the “5 rights of medication administration—right patient, right dose, right drug, right time, right route” (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 394). BCMA systems make it possible for the verification to take place at the patient’s bedside before administering the medication. The way it works is that a nurse planning to administer medication scans the bar code on his or her identification badge, the bar code on the patient’s wristband, and the bar code on the medication. The bar code scans are sent to a computer software program where algorithms check through databases and generate warnings or approval (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 394). Most of the time, the BCMA system works quickly so nurses are not waiting around for the approval, and patients are not suffering in pain or discomfort waiting for their medication while the BCMA system functions. The following diagram from Cummings, Ratko, and Matuszewski (2005) of Patient Safety and Quality Healthcare (PSQH) illustrates how a BCMA system works.
Impression of BCMA
The idea of having multiple checkpoints for medication administration seems like a good way to improve patient safety, protect the organization’s reputation, decrease litigation costs, and preserve the image of the nursing profession. Cummings, Ratko, and Matuszewski (2005) were writing about this type of system 14 years ago, and it seems that some healthcare organizations have adopted them, but with mixed results. Cummings, Ratko and Matuszewski (2005) explain, “The adoption of barcode technology by hospitals has been slow. The first prototype systems were developed in the early to mid-1990s and began to be disseminated in the late 1990s. . . .The rate of implementation is climbing, though it is still probably in the range of 5% to 10% of hospitals” (Cummings, Ratko, & Matuszewski, 2005). One would think that 14 years later more BCMA systems would have already been implemented in hospitals.
BCMA systems have been implemented, but slowly and with measured success. Siwicki (2017) of Healthcare IT News says, “Only 30 percent of 1,859 measured hospitals fully meet the . . . patient safety standard for use of bar code medication administration technology, but a significant 74 percent fully meet the group’s patient safety standard for use of computerized physician order entry systems to minimize medication errors” (Siwicki, 2017). The BCMA system involves nurses, who are the healthcare providers who most frequently administer medications. The system used should be the one that fully meets the safety standards of those who most often administer medications. Physicians may make medication errors also, but they do not administer medication at the same rate of frequency as nurses do.
The reasons for the slow adoption of BCMA systems are many. Some fear that the electronic gadgetry will not work correctly. Others fear that those who would be using the systems will be unfamiliar and afraid of the new technology. Shah, Lo, Babich, Tsao, and Bansback (2016) say, “Other than cost, one of the barriers to widespread adoption of BCMA technology is the lack of definitive evidence that BCMA actually reduces preventable medication errors, especially in hospitals that are already using other safety systems, such as computerized prescriber order entry (CPOE) and automated dispensing devices (ADDs)” (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 394). On the other hand, Sakowski and Ketchel (2013) report, “Hospitals have reported experiencing more than a 50% reduction in medication administration errors and a relative risk reduction of 11% in the rate of ADEs after implementing a BCMA system. However, these systems are expensive and little is known about the cost-effectiveness of this technology” (Sakowski & Ketchel, 2013). So, for many different reasons, BCMA systems have not been implemented, or if they have, they have not performed as expected, do not perform to the standard expected by the cost, or the systems are just too expensive and are not even considered.
Benefits and Improvements Made
The cost of implementing a BCMA system is expensive. Sakowski and Ketchel (2013) say, “Implementing and operating a commercial BCMA system, medication dose repackaging, and electronic pharmacy management system in a community hospital setting for 5 years costs $40,000 (range: $35,600 to $54,600) per BCMA-enabled bed” (Sakowski & Ketchel, 2013). However, a better way to analyze the cost is by looking at what it costs for each ADE that is averted. “The cost of implementing and operating a hospital inpatient BCMA system over 5 years is $2000 (range: $1800 to $2600) per moderate or severe event averted when both costs and errors are discounted at 3% per year” (Sakowski & Ketchel, 2013). Two thousand dollars to perhaps save a life and avoid litigation, damaged reputation, and the other negative aspects of medication errors seems like a small price to pay. Perhaps that is the way healthcare facilities should view BCMA systems rather than as expensive software that may or may not be necessary.
Conclusion and Implications
The cost of BCMA systems have probably decreased since Cummings, Ratko, and Matuszewski (2005) wrote about them. The costs have probably even decreased since Sakowski and Ketchel (2013) wrote about them because the cost of new technology always decreases as more users adopt it. While BCMA systems are quite expensive, the cost of saving a life, avoiding expensive court costs, maintaining a healthcare organization’s reputation, and preserving the status of the nursing profession, the price is worth it. The method of checking the nurse administering the medication, the patient receiving the medication and the medication itself via a barcode system is efficient and largely foolproof. While there may be concerns of user compatability, effectiveness, and, of course, costs, implementing a BCMA system still seems like a good idea. The “bugs” would be worked out just as those associated with electronic health records (EHRs) have been. That too was an expensive system to implement. Many people were reluctant to use it due to fears about their ability to use it, the effectiveness of the system, and many other reasons. However, because it was mandated by the Affordable Care Act, electronic health records were implemented, and have now become part of most healthcare practices. BCMA systems could and should be implemented with the same results.
References
Cummings, J., Ratko, T., & Matuszewski, K. (2005). Barcoding to Enhance Patient Safety. Retrieved from Patient Safety and Quality Healthcare: https://www.psqh.com/sepoct05/...
Sakowski, J. A., & Ketchel, A. (2013). The Cost of Implementing Inpatient Bar Code Medication Administration. American Journal of Managed Care, 19(2). Retrieved from https://www.ajmc.com/journals/...
Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar Code Medication Administration Technology: A Systematic Review of Impact on Patient Safety When Used with Computerized Prescriber Order Entry and Automated Dispensing Devices. Canadian Journal of Hospital Pharmacy, 69(5), 394-402. Retrieved from https://www.ncbi.nlm.nih.gov/p...
Siwicki, B. (2017, April 28). Medication errors: Hospitals slow to meet barcode standard, big on CPOE. Retrieved from Healthcare IT News: https://www.healthcareitnews.c...
