Improving BCMA Compliance

Introducing an improvement plan related to bar code medication administration 

Improving patients' safety is critical to the USA, and the health department alongside the FDA have encouraged hospitals and health organizations to adopt technological mechanisms that reduce ADE (Patterson et al., 2002). Despite the far-flung preventive measures and education of personnel in hospitals, medication errors that lead to adverse drug experience still pose major threats to patients’ safety (Shah et al., 2016). Adverse drug administration errors resulting in patient harm or inappropriate medication lie in the preventable reach. Given systems such as the Bar Code Medication Administration (BCMA), medication errors find a solution in health information technologies, hovewever it is not being used due socio-technical issues (Nancy Iribarren, Guo, & Weir, 2015). Bar code scanning is currently not being utilized by the nurses in the way it was intended. The industry sets its scan rate at ninety-five percent, yet a review of past scanning data from the EMR revealed significant gaps in the compliance in my organization. With a percentage ranging between fifty-eight and seventy-two, there is dire need to improve the compliance rate. One of the main causes of non-compliance is Nurses' tendency to have a workaround for every reason (Kopel et al., 2008). This study recommends improving BCMA compliance through ongoing education, training, and constant update of organization policies and training materials, and guidelines to mirror BCMA requirements. 

Proposed Quality Standards Including the IOM’s six aims for quality improvement. 

System training is an integral part of ensuring BCMA compliance. An analysis of the experiences by Wideman, Whittler, & Anderson, (n.d) showed that health care providers put emphasis on appropriately training staff as an improvement of health care standards. The study showed that nurses who are not tech savvy require more training time to familiarize them with computerized processes (Hook et al., 2008). The AHRQ study experienced a need to increase training time per nurse from two hours to four hours for improved compliance. 

Other than dedicating more time, training can be extended to other staff in the hospital including physicians, respiratory therapist and pharmacy staff (Patterson et al., 2014). Training on BCMA use should be sufficient time wise and inclusive to encourage more use, and filling in knowledge gaps between other staff working in partnership and nurses (Taliercio et al., 2014; PSNET, 2019; Schmidt, 2012). AHRQ realized that extending training might be costly, but in the end, it was an integral undertaking (PSNET, 2019). For instance, pharmacists giving out medication should be able to record the event using a bar code scanner for a consistent patient record. 

Training experience can be enhanced using superusers. These could be stuff such as nurses, pharmacist or physician, who undertakes extra health system training and has shown the capability to offer colleagues peer-to-peer support (Patterson et al., 2014; Wideman, Whittler, & Anderson, n.d). In one AHRQ project hospital they wore brightly colored uniforms and had memorable names given to them. Other than superusers from within, organizations can benefit from having onsite support from system vendors. 

Integration of a system training should have a pilot that gives the staff an opportunity in an environment they wouldn't accidentally result in ADE (Hook et al., 2008). In the AHRQ project, an organization came up with a playground for training, which nurses received well. It provided a safe space for trying out. Pilot programs for BCMA can be exemplary platforms, which promote user ability, debugging for errors and training on reporting measures (PSNET, 2019). The pilot will also ensure inclusive training as other staff will also have the chance of testing the BCMA system. 

The organization can align its plan to enhance patient safety to the IOM’s six Aims for health quality improvement. The first aim is providing safe care that avoids injuring patients (Hughes, 2008). Complying with BCMA by healthcare providers can help reduce cases of severity caused by total medication errors (Shah et al., 2016). The Second aim is effective care, which encompasses using scientific knowledge in the provision of health care (Hughes, 2008). In the studies by Poon and Richardson which yielded up to ninety percent relative risk reduction using BCMA alongside eMAR systems (Shah et al., 2016). The third aim is having patient-centered care. This means health care providers should be respectful and responsive while allowing clinical decisions to be guided by patients' values (Hughes, 2008). Health systems acknowledge the 5 rights of medication use. Fourth IOM aim is providing timely care by cutting the wait times for patients and health care providers (Hughes, 2008). For instance, the Shah and others (2006) found out that the patient's length of stay increases when there is an occurrence of adverse drug event. The fifth aim is providing efficient care, whereby waste is avoided (Hughes, 2008). Also like time wastage, resources are wasted and translate to monetary values in billions per year (Shah et al., 2016). The final aim is the provision of equitable care, in that quality does not vary due to characteristics of the patient (Hughes, 2008). The BCMA system allows for consistency in service provision while keeping a log of services rendered to patients. Thus historic data can be analyzed for bias trends. 

Implementing health IT systems call for changes in policy regarding the hospital's administration of medication and identification of patients. Organizations featured in the AHRQ project revised their policies to allow for the charting of issues in the presence of the patient, or in their rooms. Other policy changes affected the downtime procedures, adherence to five rights and appropriate use of scanners (Hook et al., 2008). For BMCA compliance to improve, the organization ought to effect policies that enhance its use and reduces conflicts with legacy methods. 

Measures and indicators of performance related to training as a quality improvement issue. 

Dedicated system training is relevant to nurses to enable them to comply with using BCMA technology. Ensuring that all users achieve a threshold time of training will improve their familiarity with the system, thus improved compliance. Trainers can evaluate the milestone achieved by an individual against their compliance records. Training impact can also be determined by the degree of favorable reactions by people undertaking the training (Polchin, 2014). For example, when the facilitator in AHRQ system training realized that extending training time to 4 hours improved the process. . 

Encouraging inclusive training of all organization staff can offer support to BCMA processes undertaken by nurses. Checking the skills, attitudes, and commitment of users helps evaluate the impact of training (Polchin, 2014). The organization can monitor the number of extra staff training and compare it with the general compliance rate. High conversion of normal users to superusers could indicate the improvement of the BCMA compliance rate and expected to create more ripple effects as knowledge dissemination is optimized. 

Methods for gathering historical data and assessing current quantitative and qualitative data, including those currently in use by the organization 

In the implementation of a BCMA system, one of the major benefits is the high chances of doing an evaluation of the organization's medication administration (Patterson et al., 2002). Many BCMA systems generate reports and charts with observable details of the administered medication, the person who did the administration, and the means that were used to acquire the information (Hook et al., 2008, Wisor, 2016). For instance, the most common or critical errors can be easily pointed out and using charts, comparative analysis are possible. 

Using self-reported studies that involve nurses and other practitioners can provide critical insight into the performance of a system. The users of a system understand better how it suits them and the challenges that face them ( Taliercio, Bibiana, Borbolla, Luna, Villalba, & Quirós, 2014) . Comparing the user experience information and system user experience can help point out underlying factors that contribute to poor compliance (Wisor, 2016). For example, the further investigation revealed to meet with the organization's select nurses who have low scans rates, to determine any barriers or challenges these nurses are experiencing. Information regarding the BCMA use can be drawn from its users through questionnaires, crash and error reports and interaction with super-users and support staffs. 

Proposed specific achievements 

Adverse drug events are highly preventable compared to other adverse events. A study on the impact of BCMA on patient safety done by Poon and others showed that implementing BCMA relatively reduces risk by 95% (Shah et al., 2016). In the study, the non-timing errors reduced from eleven point five percent to six point eight percent. In detail, the relative risk reduction (RRR) for various sub-types of the non-timing errors are as outlined below. Wrong medication errors reduced by RRR of 57.4%. Wrong dose errors 41.7%, wrong route administration errors by 68% and errors in administration documentation by 80%. 

By complying with BCMA, the organization stands a chance to completely do away with transcription errors into the MAR. Transcription errors happen when instructions from the physician are wrongly transcribed into the MAR, not transcribed at all, or erroneous transcribing the formulations (Shah et al., 2016). In three studies using BCMA alongside eMAR technology, transcription errors initially stood at a baseline of just a point above six percent. In this figure, cases of potential adverse drug events made forty-eight percent, a quarter of them was considered to be significantly adverse, while 22% were severe cases. 

The organization will be able to significantly reduce total medication errors by complying to BCMA. The Institute of Safe Medication Practices compiles a list of high alert medications shareable in BCMA systems (Wisor, 2016). This draws evidence from studies by Higgins in a USA teaching hospital and Richardson's studied in a small hospital in New England. Using self-reporting method, the two studies found that BCMA used alongside CPOE and ADD systems in emergency rooms yielded RRR for the above error by 49% and 75% (Shah et al., 2016). Errors that reached patients reduced by RRR of 75%, in turn increasing the cases of near-miss errors by 90 percent. In Richardson's study, the compliance rate of nurses’ use of BCMA had increased from ninety-four to ninety-eight percent. 

Gaps between the organization's current performance and performance targets. 

The industry scan rate standard is 95% compliance. Over the past year, our scan rate has varied between 58 -72% and poor error reporting. There is a need to comply with the industry scan rate standard of 95% to achieve a safer environment for patients (Thompson et al., 2018). Review of data show some nurses with compliance as low as 20%. The poor reporting rate can be enhanced by creating hot-lines, report desks and through superusers (Patterson et al., 2014). Many nurses blame their workaround culture on system errors but does not report these errors. Nurses wouldn’t have to contact the pharmacy for scan errors but hopefully they will appreciate that scanning is effective in catching potential errors and important to report the barriers they encounter during the scanning process. 

References 

Hook, J., Pearlstein, J., Samarth A., & Cusack, C. (2008). Using Barcode Medication Administration to Improve Quality and Safety: Findings from the AHRQ Health IT Portfolio . Rockville, MD: Agency for Healthcare Research and Quality. 

Hughes, R. G. (ed). (2008). Patient safety and quality; an evidence-based handbook for nurses . Rockville MD: Agency for Healthcare Research and Quality. 

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423 

Nancy S., Iribarren, S., Guo, J. W., & Weir, C. (2015). Evaluation of a BCMA’s electronic medication administration record. Western Journal of Nursing Research. 2015 Jul; 37 (7), 899–921. 

Patterson, E. S., Cook, R. I., & Render, L. M. (2002) Improving patient safety by identifying side effects from introducing bar coding in medication administration. Journal of the American Medical Informatics Association, 9 (5), 540–553. 

Polchin, R. (2014). Measuring the effectiveness of your training program. UBM . Retrieved on 18 April 2019, from https://www.icmi.com/Resources/2014/Measuring-the-Effectiveness-of-Your-Training-Program 

PSNET. (2019). Medication errors and adverse drug events. Agency for Healthcare Research and Quality; AHRQ . Retrieved on 18 April 2019, from https://psnet.ahrq.gov/primers/primer/23 

Schmidt, B. (2012). Applying lessons learned to accelerated adoption of BCMA. Patient Safety & Quality Healthcare . Retrieved on 18 April 2019, from https://www.psqh.com/analysis/applying-lessons-learned-to-accelerated-adoption-of-bcma/ 

Shah, K., Lo, C., & 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. The Canadian Journal of Hospital Pharmacy 69 (5), 394–402 

Taliercio, V., Bibiana, S., Borbolla, D. Luna, D. Villalba, E. & Quirós, F. (2014). The expectations of nurses about the implementation of a Barcoded Medication Administration System: a qualitative study. Studies in health technology and informatics, 205, 191-195. 

Thompson, K. M., Swanson, K. M., Cox, D. L., & Kirchner, R. B. (2018). Implementation of bar-code administration to reduce patient harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2 (4): 342–351. 

Walton, S. (2015). BCMA helping to maintain >95% compliance in medication administration. Science Life. Retrieved on 18 April 2019, from https://sciencelife.uchospitals.edu/2015/06/23/bcma-helping-to-maintain-95-compliance-in-medication-administration/ 

Wideman, M. V., Whittler, M. E., & Anderson, T. M. (n.d). Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation. Advances in Patient Safety, 3 , 437-451. 

Wisor, C. (2016). Increasing compliance of bar code medication administration in the emergency room (Diss.). Seton Hall University, South Orange, New Jersey, USA.