Reducing medication administration errors including positive drug ID/barcoding
In this area, network members were looking to measure different types of medication errors and related improvements. They wanted clarity on the various impacts of the system through using things like missed dose audits, incident report data, peer observations drug rounds and chart reviews by pharmacists. Their experience varied significantly depending on the clinical decision support approaches and system set up including whether Barcode Medicines Administration (BCMA) was included.
What peers in the network found
Find the problem you need to solve
Get a baseline at the start with audits, incident data report (should not be used quantitively), chart reviews and peer observations. Spend this time thinking about what the exact problem is that you want ePMA to solve, what is the best measure of success and how are you going to track it.
Plan your processes
Involve the right people and start with an outline process map of the process, but ensure you walk through that process in a real life ward environment with an appropriate group of clinical staff.
Expect lows before highs
Be prepared for the fact that some measures may get worse before they gets better – if nothing else because the information is visible unlike previously. For example, data on omitted doses may be more obvious on an electronic system than on paper drug charts. You need to manage the messaging on this from the start and throughout, so that others understand this, and expectations are managed.
If you are using Barcode Medicines Adminsatrtio , incorporate guidance on sticking labels into your Standard Operating Procedure (SOP). Whether using robots or people, many have found there often isn’t a lot of room on the packets and important information gets covered over as a result. Apply local codes , where possible, to products that don’t automatically have barcodes e.g. where medications are packed down or where they are imported products that need a local label applying as they aren’t produced in UK.
Even where BCMA is in place and working well, think about patients who bring in their own drugs to hospital, patients who self-administer their medication and how administering these fits in with other processes.
Top tips from the network
- Workarounds – if jobs take too long, people won’t do them. Be realistic!
- Often, it’s hard to obtain baseline data to measure against. Incremental change using system data may be sufficient rather than relying on audits based on previous paper processes.
- Workflow is key to getting BCMA working as well as ensuring that scan rate is high as possible i.e. enough bare codes are recognised.
What to read
Short reads
GDE Blueprint – Barcode Medication Administration (BCMA)
The 10-minute blueprint: Helen Balsdon shares Cambridge’s Barcode Administration journey
Long reads
Impact of BCMA on Medication Errors and Patient Safety: A Summary – Report which summarise’s key recommendations and supporting evidence from the most recent studies evaluating the impact of barcoded medication administration (BCMA) systems, and the complementary technologies: Computerized Physician Order Entry (CPOE) and automated dispensing carts (ADC) in preventing medication errors and enhancing patent safety.
Who to contact
Helen Balsdon – Assistant Director of Nursing, Cambridge University Hospitals NHS Foundation Trust