Nurs 3313 - Ebp Paper on Emr - the Effect of Bar-Code Technology on Medication Errors

The Effect of Bar-code Technology on Medication Errors

Kathryn M. Dykes

Kennesaw State University

NURS 3313

Miriam Rohlfs MSN, RN

3/26/2011

Introduction

The use of bar-code medication administration systems (BCMAs) is growing more prevalent in the United States Health Care system. An important question that must be asked when considering the implementation of a BCMA system is: What is the impact of BCMA systems versus no BCMA system on the prevalence of adverse drug events (ADEs) among hospitalized patients? The primary purpose of implementing a BCMA system is to reduce ADEs and improve patient safety. According to the National Coordinating Council for Medication Error Reporting and Prevention, or NCC-MERP (n.d.), a medication error is defined as:

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use (Definition, pp. 1).

According to the NCC-MERP (n.d.), "Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. A significant number of those deaths is due to medication errors. That is more than die from motor vehicle accidents, breast cancer, or AIDS" (Consumer Information for Safe Medication Use, pp.1). Because ADEs lead to stress, injury, or worse to both the patient and their family, medical professionals must explore all tools that have the potential to reduce the rate of such errors.

The purpose of this report is to examine the use of BCMA tools and determine how the use of these systems impacts the prevalence of ADEs in an acute care setting. This analysis will examine both the overall number of ADEs and the type of errors that are most affected by the system. The paper will also address key considerations in the implementation of a BCMA system.

Background

Clinical Setting

The patient is currently being treated for Clostridium difficile (C. difficile) on a general medical-surgical unit in a large urban hospital. Patient history includes hypertension, congestive heart failure, hyperlipidemia, Chronic Obstructive Pulmonary Disease (COPD), diabetes, and a recent shingles infection. The patient is on bedrest, but is alert. This patient is currently taking 28 scheduled medications and 3 unscheduled medications. There is a new system in place for BCMA, as well as written drug guides available for reference. The patient is on contact precautions due to her C. difficile infection, which means that the computer cannot physically be brought into the patient's room.

Patient's/Family's Preferences and Actions

The patient has a caregiver present at all time. Both the patient and the caregiver are extremely familiar with the majority of medications being administered. The patient is attentive and asks questions about medications that she is not accustomed to taking. Patient is compliant with all medications. The patient does not question the use of BCMA system, suggesting that she does not have a strong preference for or against the use of the system. Because of the substantial quantity of medications, the use of BCMA is certainly appropriate for the present patient situation.

Health Care Resources

The expected benefit of BCMA is decreased incidence of ADEs leading to improved patient safety. The immediate availability of drug information and alerts will improve both nurse and patient awareness of adverse effects and interactions associated with different drugs. The risks of a BCMA system are primarily related to nurses finding workarounds for the system, difficulty scanning, and mislabeling. The alternative method used for medication administration is a manual use of the five rights. In this system, the nurse simply does 3 checks of the 5 rights without the additional support of a BCMA. There is no monetary cost associated with this alternative, but errors related to missed information can lead to financially, legally, and emotionally costly outcomes.

In order for effective implementation of a BCMA system, the hospital must have enough computers available to meet the needs of their staff and patients. St. Joseph's does have enough available computer stations to accommodate implementation of a BCMA system. However, there is not a computer in every patient room, which may be a better alternative if the new system is deemed successful. Because St. Joseph's uses computers for other elements of care, the knowledge base of the nurses is sufficient for purposes of learning BCMA. Consideration must also be given to the amount of time that staff will need to devote to training and time lost due to the learning curve during the stages of implementation. There must also be plenty of IT staff available for both troubleshooting and training on the new system. St. Joseph's dispenses large amounts of medication and utilizes computers in care. Therefore, BCMA is certainly an appropriate consideration at the hospital.

Research Evidence

According to research evidence, the impact of ADEs is extremely significant, but also variable. "Medication errors are the second most frequent type of all medical errors and 7000 people are predicted to die yearly from medication errors...The number of medications a patient receives greatly increases the opportunities for a medication error" (Young, Slebodnik & Sands, 2010, p. 115). According to Bates et al., as cited by DeYoung, Vanderkooi & Barletta (2009), "6.1 ADEs occurred per 100 admissions and 11.5 ADEs occurred per 1000 patient-days. Of these, 28% were judged to be preventable" (p.1110). "A more recent report estimated that ADEs occurred in 3.1% of all inpatient stays, and 8.6% of these ADEs were deemed preventable" (DeYoung et al., 2009, p.1110). Another study indicated that "errors occur in 19% of all doses administered and that 7% of these errors have the potential to result in an adverse effect (Leape's study as cited by Ross, 2008, p.1).