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Closing the Loop on Medication Safety

Medication-ScanningErrors can occur in any part of the medication process – from prescribing to dispensing.  That’s why, for the past several years, UPHS has implemented several measures to help reduce these errors and ensure patient safety.

For example:
  • Electronic order entry on Sunrise 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 serve as active members of the medical team.
  • PYXIS Profile 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. 

In the current process, the nurse first identifies a patient (confirming name and date of birth with information on the patient’s ID band).  Then he or she reviews the electronic medication administration record (e-MAR) for what needs to be administered, gives the medications to the patient and signs them out on e-MAR.  

With BCMA in place, the nurse will scan the barcode on each of the medications before adminstering to the patient. 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.

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.

Pharmacy’s Role: Making it Work

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 Pharmacy.

To begin with, each dose of a medication order requires a bar code that Sunrise recognizes or it won’t work on the patient floors. As a result, “every wholesaler order we receive [each of which contains hundreds of medications] has to be manually scanned to confirm which are registered in the system and which aren’t.”

In addition, the bar code label must be legible. Miranda said this presents a problem on small items, such as syringes and small tubes of ointment, where the label is too big to fit properly.  To resolve this issue, “we’re looking at a program that allows us to use a flag label. Its thin center can wrap around something as small as a syringe and provide a bar code suitable for scanning.”

Pharmacy is also working to keep the number of required scans when dispensing the med to a minimum. The need to scan each dose given to a patient is one of BCMA’s safety features -- ensuring that an entire order is given.  For example, if a physician orders 100 mg of a medication but it only comes in 50-mg pills, the system would prompt, saying ‘One of two,’ waiting for the nurse to scan the second pill.

However, Sunrise was built with common units, to simplify billing. In other words, if a patient needed 500 ml of a medication that came in 100-ml doses, the nurse would simply note the dosage on the computer.  With BCMA, that order would require five separate scans.  To keep the safety feature intact -- but eliminate the need for multiple scans -- “we’re trying to standardize common doses as much as possible,”  Miranda said.  “This isn’t a faster way to give meds.  But it’s a safer way.”

In addition to its safety benefits,  BCMA implementation is required for UPHS to be eligible for Meaningful Use dollars, if certain criteria are met.  Meaningful Use dollars are incentive payments from the Centers for Medicare and Medicaid Services for appropriate use of certified electronic health records. 

Kornet said that Founders 12 and 14 will pilot the program at HUP this month.  If all goes well, it will be expanded to other units throughout the hospital.

Photo caption: As Colleen Mallozzi, BSN RN, BSIS, manager of Nursing Informatics, demonstrates, each medication given to a patient will need to be scanned, as part of bar code medication administration.

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