Dispensing Medications Using Bar Codes

Dispensing Medications Using Bar Codes

The Institute of Medicine (IOM) estimates that, on average a hospitalized patient is subject to one medication administration error per day, and deems medication administration error a priority in for patient safety intervention (Koppel & Wetterneck, 2008, p. 408). Almost 100,000 deaths associated with medication administration errors occur every year in the healthcare industry. A medication error is any preventable event that may cause or lead to inappropriate medication use or harm while the medication is in the control of the health care professional or consumer (Fowler, Sohler, & Zarillo, 2009, p. 103) Since medication administration is a major nursing duty, it is the nurse's responsibility to ensure patient safety. Due to the large amount of medication errors it has prompted the healthcare industry to find a solution to the problem. The introduction of the Bar Code Medication Administration (BCMA) has proved to greatly reduce the number of medication errors, improve patient outcomes, and increase nurse's job satisfaction. Accurate identification is essential to nursing practice especially when administering medications. According to Fowler et al., multiple steps to medication administration include order entry, transcription and verification, dispensing, medication administration and consumption by the patient. Included in these stages are the five rights: right patient, right time, right drug, right route and right dose.

In order to discuss BCMA we must understand steps to how it is used. A BCMA system consists of hardware (scanner and computer), software, and bar-coded unit dose medication packages. When a nurse scans a patient's wristband using a handheld scanner, the BCMA software program opens, allowing the nurse to view the electronic medical administration record (eMAR). After selecting and preparing the medication, the nurse scans the bar code on the dose packages. If it matches, the nurse completes the verification process and administers the medication (Deyoung, Vanderkooi, & Barletta, 2009, p. 1111).

I will first discuss the differences between traditional and BCMA medication administration. Then I will discuss the pros and cons using the BCMA. Traditionally, medication orders placed by physicians would be faxed to the pharmacy and then copied onto the Medication Administration Record (MAR). If the medication needed to be given immediately, the nurse could bring the order to the pharmacy, and the pharmacist would be able to dispense it right away. Also with the traditional method, nurses had to manually verify the medication with the patient before administering. With the BCMA, the medication appears on the patient's eMAR once the pharmacist has approved them (Poon, Keohane, & Yoon, 2010, p. 1699). If the dose being scanned corresponds to a pharmacist-approved medication order and the patient is due for this dose, administration is automatically documented. However, if the dose does not correspond to a valid order, the application issues a warning (Poon et al., 2010, p.1699).

One of the pros of using BCMA is that it provides an additional level of safety requiring the nurse to scan the patient's wristband and on the medication prior to administering. It also prevents medications from being too closely given together. If medications had an adverse reaction to each other it would be indicated on the screen as a warning. BCMA was most effective in reducing wrong administration time errors (Deyoung et al. 2009, p.1114). Before BCMA, wrong time errors were difficult to catch. Errors were primarily prevented in doses being administered earlier than scheduled, administered without record of the medication or patient, and attempted administration when an order was discontinued or expired (Fowler et al. 2009, p. 104).

Some of the cons associated BCMA are "stat" orders not being put in right away, nurses forgetting to document omission reasons e.g. patient off the unit and in doing so creates a missed dose error, and passing medications takes longer because of the extra steps. The increased errors concerning omissions and documentation/transcription can be attributed to the time requirements of pharmacists profiling the medications and subsequently delivering them to the unit, as well as time for nurses to confirm the orders prior to administration (Fowler et al. 2009, p.108). A change in the level of care can also drop the medication from the computer. Some other errors that may occur using BCMA are omission of process steps, steps performed out of sequence, and unauthorized BCMA process steps (Koppel, Wetterneck, Telles, & Karsch, 2008, p. 410). Omission of process steps include user scans medication without using the five checks, user does not check new medications before administering, and user administers medication without reviewing parameters (Koppel et al. 2008, p. 410). Steps performed out of sequence include user documenting medication before it was administered (Koppel et al. 2008, p.411). And unauthorized BCMA process steps include user scans medications for more than one patient at a time, user scans same medication multiple times and user scans patient identification (ID) barcode on another object (not wristband) (Koppel et al. 2008, p. 411). Studies have shown that BCMA have greatly reduced the number of medication errors but it does not completely