BCMA
Bar-Coded Medication Administration
MiPI Monthly Podcast (July 2010) hosted by John Poikonen and Jerry Fahrni
Summary of MIPI for July 2010
-Free flowing review of Pharmacy informatics issues
-Mention MU for another podcast from a PI perspective
-Review of ASHP meeting from a Informatics/Twitter POV
-NEJM Study by Eric Poon.
-Eric Poon Interview
BPOC/BCMA
-A recent trifecta for bar-coding
-Scanning difficulties with certain barcodes
-Cool Technology for Pharmacy – NDC Translator
-More BCMA Junk Science, this time from ASHP
--Web 2.0 / Social Media--
-personal-vesus-professional-social-media-wheres-line
-Using the big boys to search for consumer health information
--Definition confusion with Health 2.0 and Medicine 2.0
--Duty to warn in the age of social media by Kevin Clauson
CPOE
-CPOE - Giving it some thought
-Twenty-one criteria for a successful CPOE adoption
-Report Urges Hospitals To Test Error Detection in CPOE Tools - iHealthBeat
Misc
-TEDMED2010
-Lexi-CALC now available for Android | Jerry Fahrni
-RxCalc 1.1 now available for the iPhone and iPod Touch
-Pharmacy Schools and Informatic Leadership
41:42 minutes (80.22 MB)
-
- Download audio file
- 381 downloads
- 23 plays
- 2 comments
Is the 30-minute rule for medication administration good or bad?
The June 17, 2010 issue of ISMP Medication Safety Alert I received has an interesting article on the unintended negative consequences of the Centers for Medicare & Medicaid Services (CMS) regulation requiring medications to be administered within 30 minutes of their scheduled dosing time. I’m sure that the CMS 30-minute rule was created with good intentions in mind, but in reality it creates a lot of anxiety and bad habits. According to the ISMP article, the CMS 30-minute rule “may be causing unintended consequences that adversely affect medication safety. While following the 30-minute rule may be important to hospitals, many nurses find it difficult to administer medications to all their assigned patients within the 30-minute timeframe. This sometimes causes nurses to drift into … unsafe work habits.” Those unsafe work habits include removing meds from automated dispensing cabinets (ADC) for multiple patients at once, removing meds ahead of time, falsifying documentation to meet the 30-minute rule and preparing doses ahead of time; all dangerous practices.
The problem is more widespread than most realize and often flies under the radar. I knew about the issues, but wasn’t prepared to deal with them until we went live with our bar-code medication administration (BCMA) system. A side effect of the BCMA system is that it tends to catch things like late and/or early medication administration. That means no more mythical med passes with all medications administered at exactly the same time.
Cool Technology for Pharmacy – RxVerify
While reading through a pharmacy listserv I came across a seemingly simple piece of software that fills an important gap in the pharmacy distribution process. RxVerify, by Pharmacy Ideas, is a bar-code verification system used during the medication restocking phase for code boxes, anesthesia trays, transport boxes, etc.
The concept is simple and goes something like this:
1) Place labels containing the drug name and associated bar-code on the pockets of your code boxes, anesthesia trays, transport boxes, etc.
2) Pull items that need to be placed in these trays/boxes from pharmacy stock.
3) Scan the bar-code on the pocket followed by the bar-code on the medication. If the bar-codes match you get a stamp of approval and proceed to enter the lot number and expiration information found on the medication for tracking. If the bar-codes don’t match the software gives you a rude warning in the form of a visual queue that says “No Match!” in big red letters. In addition to the “No Match!” warning, a pop-up window appears that prevents the user from continuing.
Pretty simple, but effective if used properly.
In addition to the safety features offered by RxVerify, the system offers various reports for tracking and record keeping purposes. The ability to track lot number and expiration dates is a big plus. One of the reports that is of particular interest to me is the “Med Error Prevention Report”. This report identifies what I like to call “bad scans”. Basically it tracks potential errors caught by the system. Of course not all the bad scans would result in a drug error, but the information can be useful nonetheless.
OTC drug interaction analyzer for smartphones
Medilyzer is a smartphone application designed to provide mobile information and drug interaction checking for various over-the-counter (OTC) medications. The application is available for both the iPhone and Android smartphones, and according to the Medilyzer website a BlackBerry edition is on its way.
iPhone version
Created with consumers in mind, the iPhone application delivers information about OTC products using the barcode located on the medication package. Users simply type in the numbers on the barcode and receive a picture of the medication along with important drug facts. By simply touching the picture of the medication, a screen will appear where users can view the medicine’s active ingredients, warning, dosage information, and comparable generic products. To compare multiple medications users can touch “Check Interaction” located on the main screen. A green check means the OTC medications are ok to take at the same time; a red stop sign means you should not take the medications together and consult with a pharmacist.
A recent trifecta for bar-coding
Bar-code medication administration has been around for a while, but hasn’t gained the same notoriety as other forms of healthcare technology like computerized provider order entry (CPOE) and clinical decision support (CDS). However, it looks like the tide is starting to change as we’re currently in a unique position to see bar-coding from several different angles.
Part 1 - the beginning, i.e. the pharmacy:
Earlier this week I briefly touched on the ASHP Statement on Bar-code Verification During Inventory, Preparation, and Dispensing of Medications. As clearly stated in the title of the paper, ASHP’s position is aimed squarely at what happens from the time a medication arrives in the pharmacy until it is dispensed, i.e. sent to the patient or placed in an automated dispensing cabinet. The document concludes that “Prudent use of bar-code scanning in inventory management, dose preparation and packaging, and dispensing of medications can enhance patient safety and the quality of care.” I can agree with that, especial the part that states “prudent use of bar-code scanning”. Technology won’t do much for you if it is implemented poorly or used recklessly.
Carousel technology article in AJHP
AJHP: “Implementation and evaluation of carousel dispensing technology in a university medical center pharmacy (Am J Health Syst Pharm 2010 67: 821-829)
Results. The estimated labor savings comparing the preimplementation and postimplementation time studies for automated dispensing cabinet (ADC) refills, first-dose requests, supplemental cart fill, and medication procurement totaled 2.6 full-time equivalents (FTEs). After departmental reorganization, a net reduction of 2.0 technician FTEs was achieved. The average turnaround time for stat medication requests using CDT was 7.19 minutes, and the percentage of doses filled in less than 20 minutes was 95.1%. After implementing CDT, the average accuracy rate for all dispense requests increased from 99.02% to 99.48%. The inventory carrying cost was reduced by $25,059.
Conclusion. CDT improved the overall efficiency and accuracy of medication dispensing in a university medical center pharmacy. Workflow efficiencies achieved in ADC refill, first-dose dispensing, supplemental cart fill, and the medication procurement process allowed the department to reduce the amount of technician labor required to support the medication distribution process, as well as reallocate technician labor to other areas in need. ”
More BCMA Junk Science, this time from ASHP
I happen to see this link on the ASHP web site, on an ROI of bar code scanning for administration. The ROI is a real piece of junk science.
Seems to me that evidence based practice should be a goal of ASHP. [Of course supporting hospital pharmacists from not going to jail for doing their job should be one of their goals, but that is ignored as well.]
Some examples of the bogus nature of this ROI:
- 87% administration error avoidance? What reference has this? Complete fantasy.
- 1995 data? (although I have used this study at times).
- Applying the Poon data to this might be better. Although fully half of the Potential Adverse Drug Events in the Poon study are 'documentation errors', which baffles me how that harms patients, outside of a few stretch cases.
CPOE - Giving it some thought
Computerized Provider - or Physician if you like - Order Entry (CPOE) is an older technology that has been in the spotlight for the better part of the past year thanks to the American Recovery and Reinvestment Act (ARRA) and key components of meaningful use. Because of the “stimulus” offered by ARRA many hospitals across the United States will be gearing up to implement CPOE, ready or not. Currently less than 20% of the hospitals in the United States are using CPOE, and only a small fraction of those are using it for all orders throughout their facility (AJHP. 2008; 65:2244-64).
Like many facilities, my hospital is in the process of gearing up for CPOE. We're in the initial stages where committees are being formed, money is being spent, groups are gathering to discuss who is going to do what and IT, pharmacy and nursing are busy trying to figure out how much impact CPOE will have on their departments. Make no mistake, regardless of the impact, we're moving forward.
Eric Poon Interviews on CPOE, CDS, eMAR
Eric Poon, M.D., Associate Physician, Brigham and Women's Hospital
A Podcast Interview with Lead Study Author Eric G. Poon, M.D., M.P.H., Corporate Manager II, BWH Clinical Systems, Partners Healthcare
Chapter 1: Topics Covered — Genesis of the study; is bar-coded eMAR a homerun?; importance of engaging clinicians in process redesign; cost of training clinicians; does the workforce exist to implement eMAR on a national level?
NEJM -- Effect of Bar-Code Technology on the Safety of Medication Administration
ABSTRACT
Background Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).
Methods We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.
Motion C5 tablet gets a ride
Motion Computing makes several Mobile Clinical Assistants (MCA), including the popular Motion C5 tablet. Don't be confused by the MCA moniker, a MCA is simply a rugged tablet PC with some additional features like a barcode or RFID scanner and a digital camera. You can get more information on MCAs at the Intel website.
I've been fairly critical of this class of device in the past for several reasons. After using the Motion C5 for several weeks last year I found the 10.4 inch screen much too small for everyday use. In addition the design of the placement for the barcode scanner in the handle made the MCA too cumbersome to be really effective in patient care areas; it required too much manipulation to scan patient wrist bands. The nurses I've worked with tend to agree.
With that said, I can see using the Motion C5 as a secondary device when a mobile solution is necessary. It's not really a bad tablet computer. It runs a full blown operating system like Windows XP and can be docked for use with keyboard and mouse after all. So when I saw that Motion Computing created the MCW-200 (Mobile Clinical Workstation) for the C5, I decided to give it a second look.
BCMA Implementation Checklist and Lessons Learned
And now, on to my list of recommendations for BCMA implementation:
Pick a strong person to lead your implementation team. They’ll have to shoulder quite a bit and they need to be able to make decisions, stick to them, and hold others accountable.
Create an empowered multi-disciplinary team to work on the project.
Create an empowered multi-disciplinary team to work through issues following implementation.
Only meet when you have to. I hate meeting to decide when you’re going to meet.
Involve nursing early and often.
Make sure you have enough resources assigned to the project. I believe this is one of the most common mistakes that leads to project failure. If you don’t assign the proper resources to a project people will get spread too thin and things will get missed.
Remember: you’ve added something to your healthcare system and it will require maintenance and optimization. You need to have resources assigned and available to handle these two things. Don’t short change the BCMA system.
Identify key people to take ownership of the system once things start flying. In other words figure out who can help troubleshoot something once you go live.
Assign someone to analyze data coming from the BCMA system. If you chose not to have the data analyzed don’t even bother collecting it.
Only speak positively about the system in public. If you have to complain about something do it behind closed doors. People believe what they hear and a positive attitude goes a long way.
Be aggressive with your implementation timeline. Don’t sit on a project too long; it costs money and people get board.
BCMA Implementation checklist and lessons learned
First off let me start by saying that I think BCMA is a worthwhile endeavor. It can have a positive impact on a healthcare system, not only in terms of safety, but with inventory management and billing . The other nice benefit is the ability to see the medication administration in "real-time". Pharmacists can look at vancomycin and aminoglycoside administration times online now instead of going to the paper chart, for example. And isn't that the whole idea behind electronic documentation? I think so. Our facility went live with out first BCMA unit last week. It's still early, but my initial take is that things went fairly well. We had a few minor issues, but nothing that couldn't be handled easily and quickly. No matter how well you plan for something there will always be some bumps in the road, and that is important to note. Below are some things that I picked up along the road to implementation. Some of these things we did well and some we didn't do at all. This list is my opinion and not the gospel on BCMA implementation by any stretch of the imagination. Please remember that as you read through it.
And now, on to my list of recommendations for BCMA implementation:
Let's stick to science, please - BCMA and grocery store rebuttal
I really like reading the PointOfCareForum.com, Mark Neuenschwander’s musing. I enjoy reading John Grisham as well, but would not base the practice of pharmacy on either. Mr. Neuenshwander’s latest in a long line of non-disclosure of conflict musings on BCMA is entertaining. While admitting it is trite to compare grocery stores to medication administration he writes an entire article about it. When it comes to advocating practice, I think it is time to stick to science and leave the emotion, conjecture, and trite analogies to the Pulpit.
Here are some ‘science based’ comments on the points made in the muse.
“Lesson One: Everything does not have to be bar coded to get value from implementing BPOC for medication administrations.”
- This is an excellent point. It would be extremely interesting to see outcome studies of limited BCMA on IV medications. I have always wondered the ROI and real outcome, or lack there of, to bar code everything to insure that a patient's lisinopril is given on time.
Cool Technology for Pharmacy - DoseEdge
The DoseEdge Pharmacy Workflow Manager, formerly IntelliFlowRx Workload Management Software by Baxa, is a system designed to track and manage intravenous (IV) medication dosages prepared by pharmacy personnel in a clean room environment. The system is touted as “The world’s first and only fully integrated workflow manager for the IV room.”
The system is designed to flow something like this:
- IV medication orders entered by the pharmacist, or other healthcare professional, are sent to the DoseEdge system where they appear on the DoseEdge touchscreen.
- When the technician, or pharmacist in some cases, accesses the order via the touchscreen instructions for preparation of the product are displayed.
- The product label is generated.
- The barcode on each injectable ingredient used for the preparation of the IV product is scanned to ensure the correct medications have been selected. Items identified as incorrect result in an audible message of “product not allowed for this dose.”
- The barcode on the IV product label generated by the pharmacy is scanned to ensure that ingredients are appropriately matched.
- Each ingredient is drawn into a syringe.
- An image of the syringe with appropriately drawn medication is taken for review by the pharmacist, or technician, whichever the case may be. This is a nice feature as it allows one to see the actual amount of drug drawn into the syringe prior to shooting it into the fluid bag.
- Ingredients are injected into the fluid bag and an image of the final product is taken.
- A final scan of the product barcode is done to complete the fill.
Quick hit - Barcode scanner consistency
Part of the process of implementing barcode medication administration (BCMA) is evaluating hardware; mostly scanners. There are several makers of barcode scanners including Honeywell, Symbol, Metrologic, Datalogic and Code Corp. Having so many choices always makes the selection process interesting.
One suggestion from several hospitals I spoke with that were already live with BCMA, was to use the same barcode scanner on the nursing floors that were used in the pharmacy. That sounds logical, right? Sure, if the barcode scans correctly in the pharmacy, then nursing should be able to scan the same barcode using the same scanner.
The scanner of choice in our pharmacy department is the the Code Reader 3500 from Code Corp. So of course this is the scanner I recommended in my report to the BCMA hardware sub-committee. For whatever reason, the committee decided to go with a different brand of scanner. Unfortunately the scanners we purchased won’t scan some of the more complex barcodes coming out of pharmacy, making them virtually useless. The scanners purchased by the hospital are on their way back to the wholesaler as I patiently await for round two.
Take away lesson: use the same barcode scanner for the nursing units that the pharmacy department uses to meet their barcoding needs.
Cool Technology for Pharmacy - OnDemand 400
This week's Cool Technology for Pharmacy is the OnDemand 400 for RxMap from MTS, a company that specializes in adherence packaging systems.
According to the MTS website:
OnDemand ® 400 for RxMap ® is the first pharmacy automation equipment system designed specifically for multi-med adherence packaging.
This efficient system uses OnDemand technology to dispense multiple medications for a single patient quickly and accurately and in a fraction of the time it would take to do it manually. This pharmacy automation equipment system utilizes a custom interface to work with your existing information systems, enabling automated workflow management in the pharmacy. This single data input process reduces input time and the possibility of data entry errors. OnDemand ® 400 for RxMap ® uses bar-code technology to accurately dispense multiple medications into one compartment - as many or as few as needed. RxMap ® Adherence Packs vary in size and shape to meet the needs of the customers you serve. The finished product is a patient - specific adherence package filled “just-in-time” for your customer.
Wired for Quality: The Intersection of Health IT and Healthcare Quality
The issue brief explores how health information technology (HIT) can improve the quality of healthcare, the benefits of electronic health records to clinical practitioners (e.g., clinical decision support), and the importance of ensuring that quality improvement and HIT adoption go hand-in-hand.
via qualityforum.org
Nice document (#7 pages) from the National Quality Forum (NQF). NQF has previously recognized pharmacist leadership as essential in assuring the safety/quality of the medication-use process. (http://www.ashp.org/import/news/NewsCapsules/article.aspx?id=276)
Denis Quaid Redux of Speech to ASHP
Actor Dennis Quaid gave the key note at the recent ASHP Midyear Clinical Meeting. Initially I found it to be fantastic presentation. Shortly after I felt cheated and conflicted. Soon after the speech I ran into some folks that knew a lot of about the specific incident that brought Mr. Quaid to speak to the pharmacists organizations. It turns out that he either took artistic license to embellish his presentation or out right lied about the details of the tragic medical error. Either way, my respect for him was crushed.
Mr. Quaid could have taken the large settlement from the hospital and rode into the sunset. Instead he works to help bring attention to the issue of medication errors. For that he is to be commended. So why he would make up aspects of the incident is perplexing and disturbing. I trust my sources of the details of the incident completely, therefore, believe them and not the details that Mr. Quaid recounted. So here are some positive and negative specifics and selected commentary of the speech.
The complete speech can be downloaded here.
http://www.ashp.org/DocLibrary/MCM09/MCM2009-Dennis-Quaid.aspx
“You may have a nagging question – why is he here? He is not a pharmacist…he is an actor.”
Contributor Blogs
Recent Podcasts
Recent blog posts
- Cool Technology for Pharmacy – Baxa Repeater Pump
- Laser etched bar-code may help curb counterfeit drugs, among other uses
- Don’t dismiss the value of an operationally sound pharmacist
- Imprivata OneSign Secure Walk-Away Technology
- The iPad vs. The Tablet PCs in Healthcare - Power of Data Visualization
- Unforeseen barrier to tech-check-tech endeavor
- An iPad should be mandatory in medical school?
- Cool Technology for Pharmacy – Spiroscout Inhaler
- Roche Social Media Code of Conduct: Pharma 2.0 Just Begins! « ScienceRoll
- The Science Behind Engaging Students in Class
Recent comments
-
Definitely not a source graduate students should be citing
-
Good recs
-
Nice Catch on the law
-
Thanks for the BERCI on Twitter
-
Health
-
Engaging Students in Class
-
Wikipedia a reliable source?
