Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment

IntroductionIn the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration.ObjectiveTo improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%).MethodsImplementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders.ResultsFollowing a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750–239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855–80 928 per year).ConclusionAdopting John Kotter’s model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.

A Retrospective and Commentary on FDA’s Bar Code Rule

Food and Drug Administration (FDA) published a final regulation in 2004 that requires pharmaceutical manufacturers to place linear bar codes on certain human drug and biological products. The intent was that bar codes would be part of a system where healthcare professionals would use bar code scanning equipment and software to electronically verify against a patient’s medication regimen that the correct medication is being given to the patient before it is administered, which could ultimately reduce medication errors. In the 2004 prospective regulatory impact analysis, FDA anticipated that the rule would stimulate widespread adoption of bar code medication administration technology among hospitals and other facilities, thereby generating public health benefits in the form of averted medication errors. FDA estimated that annualized net benefits would be $5.3 billion. In this retrospective analysis, we reassess the costs and benefits of the bar code rule and our original model and assumptions. Employing the most recent data available on actual adoption rates of bar code medication administration technology since 2004 and other key determinants of the costs and benefits, we examine the impacts of the bar code rule since its implementation and identify approaches to improve the accuracy of future analyses. In this retrospective study, we use alternative models of health information technology diffusion to create counterfactual scenarios against which we compare the benefits and costs of the bar code rule. The magnitudes of the costs and benefits of the 2004 rule are sensitive to assumptions about the counterfactual technology adoption rate, with the upper-bound range of calculated annualized net benefits between $2.7 billion and $6.6 billion depending on the baseline scenario considered.Disclaimer: The findings, interpretations, and conclusions expressed in this article are those of the authors in their private capacities, and they do not represent the views of the Food and Drug Administration.

Bar Code Medication Administration Technology: A Systematic Review of Impact on Patient Safety When Used with Computerized Prescriber Order Entry and Automated Dispensing Devices

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