Best Practices for Patient Safety and BCMA
(Patterson, Rogers, & Render, 2004)
1. Put in place a standing interdisciplinary committee
- Recommendation: This committee should be composed of nurses, pharmacy representatives and IT/computer support that would continuously improve use of the BCMA system. This committee will also serve as a method to obtain feedback from users through rounding the hospital units at set times such as weekly, and address problems reported.
- Rationale: Attempts to be proactive in solving problems, and attain feedback improves BCMA usability
2. Train all users
- Recommendation: all persons administering medications and treatments need to be trained in how to navigate through BCMA software. Have designated “Super Users”. Cross-train pharmacists and physicians as well. (Orders written in the order entry software should be compatible with BCMA software so that the mediations can be administered with ease)
- Rationale: Using a new program without training leads to errors. The purpose of the program is to increase patient safety and decrease patient errors.
3. Communicate known Problems
- Recommendation: Develop a website of help line for interested people to view common problems 24/7, 365 days a year
- Reasoning: This resource would decrease the need to contact corporate “Help desks” and use time more efficiently to see if the problem within the BCMA software system is local or national
4. Display contact information for resources to resolve different types of problems
- Recommendation: Display the contact information in a visible place or have it in a common location that is easily accessible
- Rationale: Having contacts to go to readily available makes solving recurring problems easier. There’s no need to waste time locating appropriate resources to solve problems that arise. Contacts could include: “computer personnel for hardware issues, healthcare clerks for problems scanning patient wristbands, pharmacy for problems canning medication barcodes, specialized personnel for BCMA specific software problems and engineering or computer personnel for problems with the wireless network” (in text citation from 15 best here)
5. Do not employ a double-documentation system
- Recommendation: paper-based medication administration systems should not be concurrently used with BCMA
- Rationale: Doubling the documentation systems decreases nursing productivity. This leads to missed medications, double-dose medications and gaps within the documentation
6. Schedule planned downtimes to minimize disruptions
- Recommendation: BCMA software maintenance should be scheduled to occur (rather than sporadic) to reduce times that users have to do without using the program
- Rationale: Expected downtime allows for users to plan when they need to give their medications. Knowing when the maintenance/downtimes will occur ensures adequate planning of care and medication administration
7. Replace malfunctioning equipment during servicing
- Recommendation: Each hospital should have at least 2 complete replacement units available in case of malfunctioning equipment (This includes laptop, mouse, battery, scanner, cables and power pack)
- Rationale: Having back-up equipment allows for nurses to maintain productivity. Productivity is reduced is users have to wait for equipment to be serviced
8. Have procedures in place to clean the equipment
- Recommendation: Procedures by the hospital or by each individual unit in collaboration with infection control teams should be set up to routinely clean BCMA-related equipment including Pyxis machines, scanners, and computers
- Rationale: Routine cleaning prevents the spread of nosocomial infections
9. Scan wristbands and medications prior to medication administration
- Recommendation: nurses should scan patient’s wristband first, and then scan medication only immediately prior to giving to verify the correct patient, dose, route, and time to administer.
- Rationale: BCMA software is designed to reduce medication errors by having the machine verify the identity of the patient and of the ordered medications immediately prior to administration
10. Caregivers (RN’s) should personally document the time of medication administration
- Recommendation: Those who give the medication should be the ones who document the medication
- Rationale: Relying on communication with others to known when a medication was administered is less reliable than just doing it yourself
11. Verify allergy information displayed in BCMA prior to administration
- Recommendation: Nurses should verify the allergy information displayed in BCMA systems before administration, with information from another source (such as an allergy bracelet or patient verbally re-reciting their allergies)
- Rationale: BCMA software is not sufficient to deter the nurse from giving patient medication that the patient could have an allergy to. BCMA is not always accurate.
12. Support staff personnel should print a report at the beginning of a shift for nurses to use as an overview worksheet
- Recommendation: Have an overview sheet printed with what medications the patient has recently been receiving
- Rationale: The can be glanced at and used as a quick overview of recent medication history as well as what medications are ordered for the shift
*This should serve as a reference and back-up, but not to be relied on heavily. The BCMA and MAR are the most accurate list of orders for patient medications ad are updated in real-time
13. Nurses should print missed medication reports once a shift
- Recommendation: Missed medication reports should be printed once every shift to keep track of what medications we not given. Some sort of tracking process should be established by the healthcare facility as well.
- Rationale: Having the ability to track medications that are commonly missed or orders that are commonly misses, such as one-time order medications will better prepare nurses to watch out for those medications and orders
14. Alert nurses to new stat orders
- Recommendation: Nurses are still often verbally notified by the physician of stat orders. The benefit of the BCMA in stat orders is the it updates with the order immediately after the physician puts it into the patient’s chart, and often alerts the nurse with some sort of noise
- Rationale: Relying on the nurse to continuously check the MAR for new orders is inefficient, time consuming, and stat medications can often be missed or delayed. BCMA databases automatically update with new orders as well as orders that have been discontinued
15. Replace wristbands as needed and periodically in long-term care
- Recommendation: replace worn, missing, or inaccurate wristbands as soon as discovered by any personnel.
- Rationale: Scanning the wristbands to verify patient identity is more likely to occur smoothly when wristbands are accurate ad can be scanned on first attempt when administering medications
Methods for evaluation
According to this source, data was collected on the barriers to the effectiveness of BCMA with the purpose of improving patient safety. Data was gathered through “direct observation of medication administration, simulated BCMA use in laboratory settings, surveying of nursing informatics specialists regarding policies and procedures, and 30 unstructured interviews with diverse stakeholders” (Patterson, Rogers, & Render, 2004).
Implications for nursing practice
· The main purpose of BCMA is to increase patient safety and patient outcomes
· Allows for consistent patient identification, fewer missed medication doses, and fewer adverse effects (system alerts notify the nurse of allergies and possible drug to drug interactions)
· Ensures enforcement of the Rights of Medication administration including: right medication, right dose, right time, right route and right patient
Reference:
Patterson, E., Rogers, M., & Render, M. (2004). Fifteen best practice recommendations for bar-code medication administration in the veteran’s administration. Joint Commission Journal on Quality and Safety, 1-11.
In-text Citation: (Patterson, Rogers, & Render, 2004)