Bar Code Medication Administration Can Be Used to Help Minimize Medication Error

In an interview with Pharmacy Times® at the American Society of Health-System Pharmacists Summer Meetings and Exhibition, Kayla Cierniak, PharmD, MS, BCPS, FISMP, medication safety officer in oncology at Seidman Cancer Center discusses the Bar Code Medication Administration and some challenges the initiative faced.

Q: What is the Bar Code Medication Administration?

Kayla Cierniak: BCMA is a technology that's used by nurses at the bedside when they're going to prepare a medication for administration. It's an important medication safety technology that was actually invented by a nurse. Back in the 90s, she lived in Topeka, Kansas, she was very innovative, and she was on vacation and had rented a car. When she was done with her vacation, she was returning the car to the car rental business and noticed, they opened the door, and they scanned a barcode on the inside of the door in order to verify that this was the correct car, coming to the correct place, at the correct time.

She thought, wait a minute, this reminds me a lot of administering beds or meds at the bedside, and she thought, why couldn't we apply this to improve patient safety? Can you put a barcode on the patient wristband, barcode on the medication, scan both and have the computer verify that you have the correct product in your hand?

So here we are decades later. We have widely implemented this in many of our inpatient settings all across organizations across the United States.

Q: What was this one-year process like in a multi-site hospital?

Kayla Cierniak: As I mentioned, BCMA is widely implemented in the inpatient setting for most large organizations, and the same is true for our main campus. Our inpatient compliance rate is well above our 95% target goal, meaning out of every 100 medications administered, you have scanned 95 of those and have verified through the EMR, or electronic medical record, that it's the correct med.

However, as a cancer center, we also have a strong presence in the community. We have outpatient infusion centers that are spread all across Northeast Ohio. The focus of this project was to look at the compliance in 10 of these ambulatory remote sites and where we know that they have operational setup to perform BCMA, but their compliance is low compared to inpatient. 75% was our compliance rate at the ambulatory sites at the start of this project, and it was a one-year process improvement project.

We didn't know it at the time, but this project really ties in well with the new ISMP best practice 16, which encourages health systems to expand BCMA beyond the inpatient units and out into those limited or short-term patient stay areas.

Q: How did it affect the multi-site hospital oncology infusion service?

Kayla Cierniak: In order to have an effect on the infusion centers, we needed some methodology. The medication safety office leveraged some low cost and simple interventions. These had worked for us on the inpatient side, and fortunately for us, we had buy in from our leadership. We have a chief nursing officer who is really supportive of medication safety. We created a job aid that explained how to do the scan at the bedside, how to troubleshoot it, if you're a frontline nurse. We ensured that nursing managers had access to these reports that were specific to their unit because that's what's most useful for them for coaching their staff.

We also hosted educational classes, we even had peer-to-peer one-on-one conversations with nurse managers, and we also reported our trends at monthly safety committees that involved nursing. We really invited them to participate, and this made this truly an interdisciplinary effort. After the one year our average compliance rate went up from 78% up to 96%. We landed right on goal at the end of our project.

Q: What were some challenges that the initiative saw?

Kayla Cierniak: Of course, we had challenges along the way. Fortunately, many of our nurse managers had floated through inpatient spaces before, where like I said, our compliance was really good. They had seen a lot of what the best practice was. We just needed to educate to bring it out into the community.

We had challenges where nurse managers would leave to take a new position. What would the handoff look like between leaving nurse manager exit and onboarding nurse manager to transfer over those reports?Specifically to oncology infusion, we had 1 site that had very low compliance, they were around 52% at the beginning, and we went on site to observe what was going on and figure out why are we only scanning half of the medications?

Turns out they thought that only chemotherapy should be scanned, but along with chemotherapy comes pre-meds. You need hydration, maybe infusions of normal saline, or other supportive care. They were not documenting any of that. We needed to reeducate that BCMA is not only important for med safety, but it helps us with billing. It helps us with tracking medication use, and ultimately it improves safety for our patients.

Q: What should pharmacists know about this initiative and how should they apply it to their pharmacy to reduce medication error?

Kayla Cierniak: Pharmacists, please know that you can use the new ISMP best practice 16 to give you firepower. If you find that leadership support is lacking, or if you've had struggles in the past, getting leadership on board with moving BCMA just from the inpatient units and out into all the other patient care areas. The tragic Vanderbilt error and the unjust prosecution of that nurse. It occurred in a CT imaging suite, which is a limited state patient care area that did not have the BCMA technology available for the nurse to use and it could have intercepted that error.

The remaining places we need to expand BCMA are a little notoriously challenging and have resisted in the past. They include radiology, emergency departments, ORs, PACU, dialysis. To start chipping away, find maybe the one area in your organization that might be the low hanging fruit where you may have the most stakeholder buy in initially to try and push this practice forward.

We hope that, as these areas continue to adopt BCMA and recognize the value of this technology and improving patient safety, that maybe they'll all just fall in line like a domino cascade. The reality is it's going to take much more time and effort on behalf of those who advocate for medication safety.