In April 2008, Baystate Medical Center (BMC), a 653-bed teaching hospital in Springfield, MA, began implementation of its Bar Code Point of Care (BCPOC) technology to positively impact medication administration in reducing errors.
In the early pilot programs, BMC reported a 50% bedside scanning rate for all medications and a medication error rate of 1.2 errors per 1,000 patient days.
Following the implementation of an organizationwide bar code scanning process in September 2008, BMC improved its medication scanning rates to 87%-90%. The medication error rate also decreased to 0.3 errors per 1,000 patient days, a 75% reduction.
Implementation and pilot programs
Planning and implementing a bar code scanning system at the bedside was a major undertaking for BMC, because the patient safety-focused process is designed to significantly reduce medication administration errors.
"What is so impactful about the whole process is that all departments—with the exception of some emergency departments—are fully bar coded," says Gary Kerr, MBA, PharmD, director of pharmacy services at BMC. "The central pharmacy has been re-engineered to support the outputs necessary to drive and sustain medication bar codes."
BMC started small, with a six-month pilot program that involved three nursing units. It was during this six-month pilot program that Kerr and Mark Heelon, PharmD, medical/surgical director at BMC, committed themselves to learning everything about the bar coding process.
It became clear early on that there were numerous obstacles when scanning a patient every time he or she received a medication, from packaging to process. Examples of identified scanning challenges included large-volume IVs, medications without bar codes, medications with reflective packaging (e.g., suppositories), and computerized physician order entry (CPOE) mismatching products or administration times of medications.
One specific example of a CPOE scanning issue occurred in the pediatric ICU, where continuous Albuterol updrafts needed to be scanned on an hourly basis, resulting in suboptimal scan rates for the unit. To help resolve the issue, interdisciplinary collaboration among nursing, informatics, and pharmacy focused on educating staff about how to correctly enter continuous Albuterol orders.
This process was accomplished by developing a medication care set to guide the provider in selecting the appropriate products that ultimately influenced scan rates. This intervention also reduced the number of times the respiratory therapist needed to scan the medication. "There was really no reason to have the respiratory therapist repetitively scanning on the hour for Albuterol," says Heelon. "Or for any nurse, for that matter."
The process was changed from needing to scan constantly to the staff member or nurse scanning the medication only when the Albuterol updraft was replaced.
"The foundation of the success of this project was the open line of communication between pharmacy and nursing," says WendySue Woods, RN, MSHA, CSHA, senior consultant at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, and senior advisor to BMC.
BMC felt comfortable implementing this process organizationwide after trialing it for six months and receiving feedback from the nurses on the unit.
Current bar coding success
On each unit, BMC nurses have ready access to bar code scanners. With the scanner in hand, the nurse is able to enter the patient's room with the patient's medication and scan the label on the medication.
This process augments the five rights of medication administration at the patient's bedside to ensure that the correct patient receives the correct medication.
"In the past, a medication error that might have reached the patient could have been backtracked to a pharmacy technician placing a wrong medication or strength in the automated dispensing cabinet," says Heelon. "With the new processes and scanners at the patient bedside, we have seen a dramatic decrease in medication errors reaching our patients."