In a hospital, errors can occur in any part of the medication process – from prescribing to dispensing. That’s why, for the past several years, the University of Pennsylvania Health System has implemented several measures to help reduce these errors and ensure patient safety. For example,
- Electronic order entry on Sunrise Clinical Manager (the electronic medical records system for inpatients) eliminates mistakes due to illegible handwriting.
- Online clinical decision support guides physicians to prescribe the best medication -– and the right dose.
- Unit-based clinical pharmacists (http://news.pennmedicine.org/blog/2013/03/pharmacists-of-the-front-line-of-care.html) serve as active members of the medical team.
- A software program on each unit’s automated medication dispensing system ensures that patient meds are verified by a pharmacist and that nurses remove the correct medication from the machine.
Now a final step in the medication safety process – bar code medication administration (BCMA) -- will close the loop.
Here’s how it will work. In the current process, a nurse on a patient care unit first reviews the patient’s electronic medication administration record (e-MAR) to see for what meds needs to be administered. He or she then gives the medications to the patient and signs them out on e-MAR. With BCMA in place, the nurse will need to scan the barcode on each of the medications. Sunrise will verify the ‘five rights’ -- right medicine in the right dose at the right time by the right route and the right caregiver. If any of these conditions are not met, “the screen will show an alert,” explained Terese Kornet, MSN, RN, director of Clinical Nursing Systems at the Hospital of the University of Pennsylvania.
Once the patient takes the medication, the nurse will click ‘done’ and the system will automatically update the patient’s medical record. In the current process, each medication must be keyed into the system individually.
Because bar code medication administration depends entirely on electronic scanning, getting the program up and running has been a complex process, said Paul Miranda, RPh, MBA, associate director of HUP Pharmacy. This means each dose of a medication order requires a bar code that Sunrise recognizes. In addition, the bar code label must be legible, even on items such as syringes and small tubes of ointment, that are smaller than the label itself. To resolve this issue, Pharmacy is looking into a program that allows use of a flag label. “Its thin center can wrap around something as small as a syringe and still provide a bar code suitable for scanning.”
Another safety feature of BCMA ensures that an entire medication order is given. For example, if a physician orders 100 mg of a medication but it only comes in 50-mg pills, the system will prompt with ‘One of two,’ waiting for the nurse to scan the second pill. To keep this safety feature intact -- but keep down the number of required scans for prescribed orders -- the hospital pharmacy is working on standardizing the more common medication doses.
Still, as Miranda noted, “This isn’t a faster way to give meds. But it is a safer way.”