Alyson Kinley Wright State University EVIDENCEBASED PRACTICE B

Alyson Kinley Wright State University EVIDENCE-BASED PRACTICE : B ARC C ODE M EDICATION A DMINISTRATION (BCMA )

What is BCMA? § A computerized system used by nurses to administer medications to patients § BCMA utilizes a bar code system: the medication package, the patient’s wristband, and the nurse’s badge all have a bar code that § Documentation of the administration occurs in the is scanned during each EMAR (electronic medication transaction administration record)

Why is BCMA important? � Decrease of costly medication errors � Provides a standardized method of medication administration � 25% of adverse drug events are preventable � BCMA targets preventable drug events � Ultimately, protection of the patient is the most important goal of BCMA (Seibert, Maddox, Flynn, & Williams, 2014)

PICOT question Ø For patients in the intensive care unit (ICU) (P), how does barcode medication administration (BCMA) (I) compared to no BCMA system (C) affect the rate of medication administration error as recorded by direct observation (O) over a period of implementation lasting three months (T)?

Significance of the ICU population More errors occur in the ICU than in any other inpatient unit � Increased number and complexity of medications � Sedated and critically ill – no ability to question medication administration process � (De. Young, Vanderkooi, & Barletta, 2009, Frith, 2013)

EBP Theory: Iowa Theory “Provides guidance for nurses and other clinicians in making decisions about day-to-day practices that affect patient outcomes” (Melnyk & Fineout Overholt, 2011, p. 251) � Iowa Model supports the changes made at the organizational level rather than individually � Many successful examples are found in the literature of the Iowa’s Model successful use � (Schaffer, Sandau, & Diedrick, 2012)

Why the Iowa Model? � Fits well with a pilot study implementation � Fits with changes made at the organizational level � The design supports an interdisciplinary team approach (Melnyk & Fineout-Overholt, 2011, Schaffer, Sandau, & Diedrick, 2012)

Literature review for PICOT Key words searched: medication error, barcode and bar-code, intensive care unit, medication administration � Boolean connector “AND” � CINAHL, Pub. Med, and Google Scholar � Searched articles published within the last 5 years. �

Literature review for PICOT cont. � Inclusion criteria for articles: �The study must document medication error rates before and after BCMA implementation �Must use an observational method of gathering data about medication errors �BCMA system implemented independently of other technologies �Must be in the ICU setting �Include the highest level of evidence available

Cohort Study: NICU setting Studied neonates in a single NICU setting for a total of 50 weeks. � Purpose: to identify if using a BCMA system reduces preventable adverse drug events in the NICU. � Findings: The BCMA system reduced these preventable drug events by 47% � (Morris et. al, 2009)

Descriptive study : ICU setting � Quality improvement (QI) study that observes medication errors made by nurses in a single ICU setting for a total of 1465 administrations � Purpose: to see the effect of BCMA on the rate of medication errors in the ICU � Findings: The medication error rate was reduced by 56% after implementation of BCMA (De. Young, Vanderkooi, & Barletta, 2009)

Quasi-experimental study: multiple units Before and after study of BCMA implementation. Performed in a large academic medical center. A total of 14, 041 medication administrations were observed. � Purpose: To see the effect on BCMA with EMAR on the rate of medication error rates in various hospital settings � Findings: Among the various settings in the hospital, there was an overall 41. 4% reduction in errors. ICU specific results revealed 42. 5% reduction in errors comparing before BCMA implementation to after � (Poon et. al, 2010)

Internal Evidence Quantitative � Medication error rates before and after BCMA implementation � How were these medication error rates gathered? � What percentage of errors cause harm to the patient? � Is there enough information recorded to be reliable? � Another technology system simultaneously implemented? � How much did it cost? Qualitative � Nursing satisfaction with the system � Look at the collaborative relationship between nursing, pharmacy, and information technology (IT) (Ross, 2008)

Patient Preferences � Patients and their families prefer the use of BCMA in the ICU setting � ICU patient: vulnerable, critically ill, & unable to question medications being administered � BCMA: comforts patients by giving the impression of reliability and accuracy (Galvin, Mc. Beth, Hasdorff, Tillson, & Thomas, 2007, Frith, 2013)

Statement of Recommendation � The reoccurrence of decreased medication error rates in multiple studies with the use of a barcode medication administration system makes a strong case for its recommendation into practice � BCMA is recommended over no BCMA in the ICU setting.

Step-by-Step Implementation 1. Evaluate the need for BCMA in the ICU 2. Appraise current processes and readiness for BCMA 3. Form an active team of resources/pick a strong leader/ indentify stakeholders 4. Formulate a plan/detailed summary of supportive evidence for BCMA 5. Present evidence to administrators/get financial approval 6. Order and prepare equipment 7. Train nurse super-users 8. Nurse super-users orient staff nurses in a mandatory 3 hour course 9. “Go live” with the program in the pilot setting of the ICU/super-users available 24 -7 10. Discuss barriers/strengths/ encourage feedback 11. Disseminate results of the pilot. Determine the next step for implementation 12. Continue to monitor and analyze processes and results (Melnyk & Fineout-Overholt, 2011, p. 252, Fineout-Overholt et. al, 2011)

The END This concludes the presentation on the evidence -based practice change recommendation for barcode medication administration.

Reference � � � De. Young, J. , Vander. Kooi, M. , & Barletta, J. (2009). Effect of bar-code assisted medication administration on medication error rates in an adult medical intensive care unit. American Journal of Health-System Pharmacists, 66, 1110 -1115. Dubin, C. (2010). Bar-code scanning at four health care facilities in the U. S. Pharmacy and Therapeutics (P&T), 35 (4), 212 -233. Fineout-Overholt, E. , Williamson, K. , Gallager-Ford, L. , Melnyk, B. , & Stillwell, S. (2011). Following the evidence: Planning for sustainable change. American Journal of Nursing, 111(1), 54 -60. Frith, K. (2013). Medication errors in the intensive care unit. American Association of Critical-Care Nurses, 24(4), 389 -404. Galvin, L. , Mc. Beth, S. , Hasdorff, C. , Tillson, M. , & Thomas, S. (2007). Medication bar coding: To scan or not to scan? Computer, Informatics, Nursing, 25(2), 86 -92. Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare, 2 nd edition. Philedelphia, PA: Lippincott Williams & Wilkins.

Reference cont. � � � Morriss, F. , Abramowitz, P. , Nelson, S. , Milavetz, G. , Michael, S. , Gordon, S…. Cook, E. (2009). Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: A prospective cohort study. The Journal of Pediatrics, 3, 363 -368. Poon, E. , Keohane, C. , Yoon, C. , Ditmore, B. , Bane, A. , Levtzion-Korach, O…. Gandhi, T. (2010). Effect of bar-code technology on the safety of medication administration. The New England Journal of Medicine, 362, 1698 -1707. Ross, J. (2008) Collaboration: Integrating nursing, pharmacy, and information technology into a barcode administration system implementation. Caring: Connecting, Sharing, & Advancing Heathcare Informatics, 23(1), 117. Schaffer, M. , Sandau, K. , & Dietrick, L. (2012). Evidence-based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing 69(5), 1197– 1209. Siebert, H. , Maddox, R. , Flynn, E. , & Williams, C. (2014). Effect of barcode technology with electronic medication administration record on medication accuracy rates. American Journal of Health-System Pharmacy, 71, 209 -217.