Barcode Medication Administration Research Articles

A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload.

The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.

Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology.

The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system. An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring. Baseline and postprocess improvement outcomes over a year period were collected and analyzed for quality improvement opportunities. Before process change, only 60% (33/55) of reviewed enteral nutrition orders were documented and 40% (22/55) were not documented in the intake flowsheet of the electronic health record. In the year after adding enteral nutrition therapies to the MAR and using bar code scanning, a total of 3807 enteral nutrition products were evaluated. One hundred percent of patients were bar code scanned, 3106/3807 (82%) products were documented as given, 447/3807 (12%) were documented as held (with comments), 12/3807 (<1%) were documented as missing/unavailable, and 242/3807 (6%) were documented as refused. Inclusion of enteral nutrition order sets on the MAR and using bar code scanning technology resulted in sustained improvements in safety, administration, and documentation of enteral therapies for hospitalized veterans.

Sustained barcode medication administration rates less than 2 percent in a large healthcare system

Purpose Implementation of bar code medication administration (BCMA) technology is an effective strategy to decrease medication administration errors. Consistent use of BCMA technology within a hospital system should result in improved patient safety through the reduction of medication related administration errors. Based on this premise, a large health system established an annual goal to reduce BCMA override rates to less than 2%. Methods A large health system located in the Intermountain West developed a BCMA override reporting tool to assist with reducing BCMA override rates. An essential component of the reporting tool is the visual management strategy which allows caregivers to easily identify goal progress. The tool also includes information that managers can use to determine how often their direct reports override medications. Pharmacy caregivers can also use the data from the reporting tool to address specific issues related to medications that do not scan properly. Results Implementation of the tool and education on its use, resulted in individual follow up with nursing units and nurses, ultimately producing sustained barcode overrides less than 2%. Conclusion By implementing reporting systems that identifies specific opportunities for improvement, barcode override rates can be decreased to less than 2% in a large healthcare system.

Implementing a Home-Grown Barcoded Medication Administration System in a Quaternary Care Hospital

Implementing a Home-Grown Barcoded Medication Administration System in a Quaternary Care Hospital

Overcoming Bar Code Medication Administration Scanning Challenges in the Emergency Department

Background: Bar Code Medication Administration (BCMA) scanning is a globally accepted technology. However, many clinicians do not understand the requirements as a metric for nursing quality and safety behind the BCMA process. Objective: The aim of this Quality Improvement (Q.I.) project is to improve the BCMA scanning compliance, to identify the percentage of noncompliance, along with the numbers representing the percentage and to raise awareness of the challenges of using BCMA in the Emergency Department setting. Methodology: The Institute of Healthcare Improvement’s Plan-Do-Study-Act (PDSA) cycle was used to plan, test, and observe the results of this Q.I. project. This report followed the Standards for Quality Improvement Reporting Excellence (SQUIRE V.2.0) publication guidelines. Results: Following a series of PDSA cycle implementations over an 18-month period, BCMA scanning rates for patients were increased to 93%, and medication scanning was increased to 94%, with an overall increase of 33% and 34%, respectively. Timely documentation improved by 18%, which accounted for a total of 96% compliance. Conclusion and Recommendations: Leadership involvement, nursing workflow monitoring of BCMA safety, as well as staff accountability and recognition, were crucial factors in improving the overall compliance rate. Suggestions to improve scanning safety include modifying the dashboard and highlighting the noncompliance scanning percentage along with actual numbers to raise awareness among clinicians. Organizations need to implement ongoing monitoring, continued training, and education, along with improvements and modifications.

Development of the Leapfrog Group's Bar Code Medication Administration Standard to Address Hospital Inpatient Medication Safety.

Medication errors are the most common type of error in hospitals and reflect a leading cause of avoidable harm to patients. Bar code medication administration (BCMA) systems are a technology designed to help intercept medication errors at the point of medication administration. This article describes the process of developing, testing, and refining a standard for BCMA adoption and use in U.S. hospitals, as measured through the Leapfrog Hospital Survey. Building on the published literature and an expert panel's collective experience in studying, implementing, and using BCMA systems, the expert panel recommended a standard with 4 key domains. Leapfrog's BCMA standard provides hospitals with a "how-to guide" on what best practice looks like for using BCMA to ensure safe medication administration at the bedside.

Semi-Structured Interviews to Evaluate a BCMA Implementation Trouble Areas.

Errors in medication administration involve risks to patient safety. "Bar-Coding Medication Administration" is implemented to prevent these errors. Adoption by nurses is one of the main determinants of their effectiveness. The Hospital Italiano de Buenos Aires implemented BCMA 6 years ago, but its adoption rate still finds resistance in certain sectors. We conducted semi-structured interviews with nursing staff to explore the barriers to the use in low-usage wards and explore the current perceptions of nurses. While nurses recognised the safety and usefulness of the BCMA system, they reported many difficulties. The feedback obtained through this process was useful for the implementation team to plan future interventions, priorities and improvements on the system. The semi-structured interview methodology proved useful as a continuous monitoring strategy.

Evaluation of a Personal Digital Assistant Device Implementation for Barcode Medication Administration with Nurses Using a Likert Questionnaire.

The majority of preventable medication errors occur at the administration stage. BCMA systems are used to improve safety and prevent errors in this stage. A variety of devices can be used for this purpose. Hospital Italiano de Buenos Aires is a high complexity medical center implementing a BCMA project since 2015. It is currently migrating to PDA devices for nurses. The objective of this work is to evaluate the implementation of these new devices in selected wards at HIBA using a self-reported questionnaire. From 318 contacted nurses, 58 answered the questionnaire (18.2% response rate). Overall, agreement was high among all statements regarding the new devices. Nurses valued especially the increased safety to reduce errors, improvements in previous hospital processes and achieving improvements in the flow and quality of patient care. Nurses recommended the use of the device in their sector, with a mean score of 4.6/5 and 91.3% agreement, highest in total. This proved to be a cost-effective method of evaluation of the newly implemented devices and acceptance by nurses. Measures to incorporate the remaining nurses' feedback should be considered.

Mindful Workarounds in Bar Code Medication Administration.

Bar-Coded Medication Administration systems (BCMA) are often used with workarounds. These workarounds are usually judged against standard operating procedures or the use of the technology as 'designers' intended'. However, some workarounds may be reasonable and justified to prevent safety errors. In this conceptual paper, we clarify BCMA safety mechanisms and provide a framework to identify workarounds with BCMA that nullify the error prevention mechanisms inherent in the technology design and process. We also highlight the importance of understanding the purpose behind a nurse's workaround in BCMA, focusing on the notion of mindful (thoughtful) workarounds that have the potential to improve patient safety.

Trends in blood pressure diagnosis, treatment, and control among VA nursing home residents, 2007-2018.

Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long-term care residents aged ≥65 years from October 2006 through September 2018 (FY2007-2018). Hypertension prevalence at admission was identified by ICD code(s) in the year prior, and antihypertensive medication use was defined as administration ≥50% of days. BP measures were averaged over 2-year epochs. The age-standardized prevalence of hypertension diagnosis at admission increased from 75.2% in FY2007-2008 to 85.1% in FY2017-2018 (p-value for trend <0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (p-values for trend <0.001) but remained high (80.3% treated in FY2017-2018, 80.1% with average BP <140/90 mmHg). The age-adjusted prevalence of chronic low BP (average <90/60 mmHg) also declined from 11.1% in FY2007-2008 to 4.7% in FY2017-2018 (p-value for trend <0.001). Persons identified as Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have an average BP <140/90 mmHg. Hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by a lower prevalence of chronic low BP. Nonetheless, some high-risk populations have average BP levels >140/90 mmHg. Future research is needed to better understand the benefits and harms of BP control in nursing home residents.

Integrating a simulated electronic medical record system and barcode medication administration into a pre-licensure nursing program.

Many healthcare facilities implement technology to reduce medication errors. Nursing schools are exploring implementing similar technology to promote best practice. Our institution developed a quality improvement project to evaluate the integration of similar technology into pre-licensure curriculum. Our quality improvement project examined using a simulated electronic medical record (EMR) and a barcode medication administration (BCMA) system in pre-licensure nursing curriculum. In our initial project, 96second-semester BSN students participated in a skill check off using the system. Student perception was positive, 96% of respondents stated the system increased realism, and 94% indicated improved clinical preparedness. Implementing this system was a positive experience which enriched our pre-licensure curriculum.

Reducing Near Miss Medication Events Using an Evidence-Based Approach.

Near miss medication events are pervasive without patient harm, mostly because of coincidence. Dynamic clinical environments challenge nurse compliance with medication administration rights and proper use of electronic technology. All nurses are educated in appropriate medication management, but our unit's barcoded medication administration scanning and electronic patient identification practices fell below the 97% benchmarks, representing hundreds of near miss medication events each month. Transformative leadership guided frontline staff to identify gaps in care processes and determined root causes for unsanctioned medication administration practices using a FOCUS (Find-Organize-Clarify-Understand-Select)-PDSA (Plan-Do-Study-Act) methodology. An interdisciplinary team committed to zero events of preventable harm overcame challenges to improve care delivery. Medication management scores exceeded organizational benchmarks, with sustainable gains over 2 years. A rapid-cycle, evidence-based approach engaged staff to reduce near miss medication events. Workable solutions driven by transparent communication and interpersonal collaboration influenced positive safety behaviors.

Interdisciplinary and Innovative: A Nursing and Computer Science Collaboration to Create a Barcode Medication Administration System.

Preventing medication errors remains a priority in nursing education. The implementation of Barcode Medication Administration (BCMA) systems is one strategy that has been used to reduce medication errors. Practice using BCMA in simulated settings may enhance the transfer of these skills to the clinical practice setting. However, the purchase of BCMA educational products available for nursing students can be cost prohibitive for many nursing programs. To overcome the barrier of cost, an interdisciplinary and innovative collaborative approach was used to create a fully functional low-cost BCMA system.

Opioid administration trends among long-stay community living centers residents with dementia.

Pain assessment and management of Veterans with Alzheimer's disease and Related Dementia (ADRD) living in Community Living Centers (CLCs) is challenging. Safe and effective use of opioids in the treatment of pain is of great concern to patients and providers promulgating national policies and guidelines. This study examined long-stay CLC Veterans with ADRD identified in three regulatory periods (period 1: 10/2012-6/2013, n= 3347; period 2: 1/2014-11/2015, n= 4426; period 3: 1/2017-9/2018, n= 4444; Total N= 12,217).This population-based observational study used CLC Minimum Data Set (MDS) data in Fiscal Years (FYs) 2013-2018 and VA bar-code medication administration (BCMA) data. Opioid administration measures included: any opioids, long-term opioids, high-dose opioids, and co-administration with benzodiazepine. Measures were modeled using negative binomial regression with length of stay in CLC as offset adjusting for Veteran predisposing, enabling and need measures from the MDS. Compared to period 1, any opioid administration was 26% lower in period 2, and 34% lower in period 3. Among Veterans who received any opioid medications over the three regulatory periods, high-dose and long-term opioid administration were more than 40% lower in periods 2 and 3 compared to period 1. Co-administration of opioid with benzodiazepine versus no opioid was 11% lower in period 2 and 34% lower in period 3 after adjusting for patient level covariates. All patterns of opioid administration decreased over the four opioid regulations periods when guidelines were promulgated across the VA health system. Further research should clarify whether decreasing opioids among patients with ADRD impacted health outcomes.

Defining key pharmacist and technician roles in response to a hospital downtime or cyberattack

The occurrence of ransomware, or “cyberattacks,” on hospital institutions has steadily increased in recent years. Pharmacy departments that rely on automation and software applications are greatly affected when those systems are offline. Pharmacy workflow without automation can be manually intensive and unsafe for patients. More challenges may be present if the hospital pharmacy is not prepared for a cyberattack or does not have standardized downtime procedures for such an event. This article describes a specific event that took place at a 350-bed acute care hospital located in the United States during the summer of 2021. The hospital lost access to the electronic health record, admitting and registration system, financial systems, pharmacy information systems, barcode medication administration systems, server for the automated dispensing cabinets or inventory management applications, diversion software, compliance applications, and all clinical decision support tools. The goal is to describe a standardized downtime procedure for medication management by identifying specific pharmacist and technician roles when automated processes are offline.

Abstract 057: Trends In Blood Pressure Diagnosis, Treatment, And Control Among Nursing Home Residents, 2007-2018

Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. In this study, we describe the prevalence, pharmacologic treatment, and control of hypertension over time among older adults residing in Veterans Affairs (VA) nursing homes from October 2006 through September 2018 (FY2007-2018). Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long-term care residents aged 65 years and older. Hypertension prevalence at admission was identified by one or more ICD code(s) in the year prior, and antihypertensive medication use was considered present if administered ≥50% of days in the nursing home. BP measures were obtained from the electronic health record and averaged over 2 year epochs. The age-standardized prevalence of hypertension diagnosis at admission increased over time from 75.2% in FY2007-2008 to 85.1% in FY2017-2018 (p-value for trend &lt;0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (all p-values for trend &lt;0.001), but remained high (80.3% of residents treated in FY2017-2018 and 80.1% with average BP &lt;140/90 mmHg). (Figure) The age-adjusted prevalence of chronic low BP, defined as average BP &lt;90/60 mmHg, also declined over this period from 11.1% in FY2007-2008 to 4.7% in FY2017-2018 (p-value for trend &lt;0.001). Persons identified in their health records as being of Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have average BP &lt;140/90 mmHg. In summary, hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by lower prevalence of chronic low BP. Nonetheless, some high-risk populations have average BP levels &gt;140/90 mmHg. Future research is needed to better understand the ratio of benefits to harms of BP control in nursing home residents.

Barcode Medication Administration Software Technology Use in the Emergency Department and Medication Error Rates.

High-quality care during and after a medication process requires complete and accurate medication administration documentation. Veterans Affairs Medical Centers use barcode medication administration technology to document medication administered to Veterans throughout the inpatient and long-term care areas of the hospital. Barcode medication administration has demonstrated a reduction in medication administration errors; however, it is not commonly used in Veterans Affairs Medical Center clinical areas or emergency departments. During this study, only 39% of the recorded 165 Veterans Affairs Medical Centers that use barcode medication administration technology in their inpatient areas stated that barcode medication administration was also used in clinical areas of the hospital. Of these facilities, only 14% had implemented barcode medication administration in their emergency department. This study evaluated medication error rates before and after barcode medication administration technology was implemented in the emergency department of a Veterans Affairs Medical Center located in the Southeastern region of the United States. A total of 258 charts, 129 before and 129 after barcode medication administration technology implementation in the emergency department, were reviewed for Veterans who were evaluated and ordered to receive medication in the emergency department before transferring to an inpatient unit at the Veterans Affairs Medical Center where this study was conducted. A quantitative nonexperimental descriptive comparison demonstrated a 10.8% reduction in medication error rates and 21% reduction in the average number of medications given in error per chart after barcode medication administration technology was implemented in the emergency department. In addition to the study outcome, a potentially unsafe workaround was identified. Stakeholders that use barcode medication administration technology in their emergency departments would benefit from assessing the association between barcode medication administration use and medication administration error rates. However, assessing whether barcode medication administration technology remains useful and continues to provide safe medication administration practices for our Veterans is also recommended.

EASYSCAN : étude pilote française pour la sécurisation de l’administration des médicaments par lecture code-barres

Medication errors are common at the time of administration. To prevent them, technologies allowing consistency check by bar code technology at bedside have been developed. Our study focuses on the evaluation of a BarCode Medication Administration (BCMA) called EASYSCAN with Electronic Medication Administration Record (e-MAR) to verify both patient's identity and medication to be administrated. A prospective observational study was conducted during seven weeks in a French medicine ward. The performance of the system was evaluated by the success rate of BCMA and by the average time for administration with and without EASYSCAN. A satisfaction questionnaire about BCMA was proposed to nurses. We observed 182 administrations including 87 (48%) with EASYSCAN. The verification of the patient's identity was successful in 77% of administrations and 65% of the drugs were scanned successfully. The main causes of check failures were the lack of datamatrix on the drug (81%), error messages (14%) and the lack of system functionality (5%). The average time for administration per patient was significantly increased: 4.68min/patient with versus 2.87min/patient without EASYSCAN. The study shows the EASYSCAN's performance in its first version. Material and software evolutions and an increase of nurses'pratices will be necessary to continue the experimentation of this system still unpublished in France.

Deprescribing Blood Pressure Treatment in VA Long-Term Care Residents

There is growing interest in deprescribing of antihypertensive medications in response to adverse effects, or when a patient’s situation evolves such that the benefits are outweighed by the harms. We conducted a retrospective cohort study to evaluate the incidence and predictors of deprescribing of antihypertensive medication among VA long-term care residents ≥ 65 years admitted between 2006 and 2017. Data were extracted from the VA electronic health record, CMS Minimum Data Set, and Bar Code Medication Administration. Deprescribing was defined as a reduction in the number of antihypertensive medications, sustained for 2 weeks. Potentially triggering events for deprescribing included low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and fall in the past 30 days. Among 22,826 VA nursing home residents on antihypertensive medication, 57% had describing event during their stay (median length of stay = 6 months). Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, acute renal impairment was associated with greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: among residents with this event, 32.7% were described compared to 7.3% in those without (risk difference = 25.5%, p<0.001). Falls were associated with the smallest increased risk of deprescribing (risk difference = 2.1%, p<0.001) of the events considered. Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event.

555. Utilization of Remdesivir for COVID-19 in the National Veterans Affairs Healthcare System

BackgroundAs remdesivir (GS-5734) has become a leading treatment for COVID-19, we sought to assess remdesivir utilization patterns, including utilization of concomitant and supportive therapies, and heterogeneity in treatment approaches.MethodsOur retrospective cohort study included hospitalized Veterans with positive COVID-19 PCR tests treated with remdesivir, from 03/2020 through 4/2021. Using exposure mapping of barcode medication administration records and medication dispensings, we assessed other medications received by each patient on each day of remdesivir treatment. Heterogeneity was defined as patterns of treatment (drug & duration) not shared by any other patient.ResultsOur study included 13,665 patients with COVID-19 receiving remdesivir. The median time to remdesivir initiation from either positive test or hospital admission was 1 day (interquartile range [IQR] 0-4 and 0-1, respectively). The median duration of remdesivir treatment was 5 days (IQR 4-5 days). Median length of hospital stay was 7 days (IQR 4-13). Inpatient mortality was 13.9% and an additional 6.2% of patients died within 90 days of discharge. The most common concomitant and supportive therapies were anticoagulants/antiplatelets (94.8%; enoxaparin 72.6%, heparin 18.4%, apixaban 10.8%, clopidogrel 6.3%), corticosteroids (90.8%; dexamethasone 87.3%, prednisone 2.9%, methylprednisolone 5.5%), statins (55.8%; atorvastatin 38.2%, simvastatin 7.1%, rosuvastatin 6.0%), antibiotics (41.9%; azithromycin 25.6%, ceftriaxone 13.2%, doxycycline 6.0%, vancomycin 4.9%), angiotensin receptor blockers (11.9%) and angiotensin-converting enzyme inhibitors (20.4%), melatonin (29.7%), and aspirin (35.6%). Concomitant utilization of Janus kinase inhibitors (0.5%), interleukin-6 inhibitors (2.4%), and hydroxychloroquine (0.5%) was low. Heterogeneity in concomitant and supportive therapies during remdesivir treatment was 84.6% (68.3% when assessed as drug class/category). ConclusionAmong hospitalized patients with COVID-19 in the national VA Healthcare system receiving remdesivir, remdesivir was initiated early in the admission and substantial heterogeneity was observed in concomitant and supportive therapies during remdesivir treatment.Disclosures Aisling Caffrey, PhD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)Shionogi, Inc (Research Grant or Support)