Setting safe standards: homegrown bar coding medication administration system helps VA hospitals minimize mistakes at the point of care

Health Management Technology, April, 2004

Medication bar coding has become a mainstay of many patient safety initiatives, helping to reduce the number of medical errors and associated complications. Wireless devices that scan medications at the bedside help caregivers quickly assess whether they are administering the right dose at the right time, and the technology often links to patient records that provide instant access to valuable information like medication allergies.

The Department of Veterans Affairs (VA) is no stranger to such initiatives. The agency has employed medication bar coding for the last five years at its 162 facilities nationwide--and, as a result, has seen significant improvement in the quality and efficiency of patient care.

Grass Roots Beginnings

VA's medication bar coding initiative started 10 years ago at a facility in Topeka, Kan. A staff member noticed the rental car she was driving sported a bar code, which the company used to track the vehicle. She surmised that, if a bar code could help track rental cars across the country to minimize theft, then similar technology could limit medication errors by tracking and monitoring individual medications.

As part of a joint effort by the pharmacy and IT departments, VA soon launched a prototype medication bar coding application that nurses used at the point of care. Initial tests yielded 70 percent fewer medical errors--fewer than three per 100,000 medications dispensed, compared to 20 per 100,000 prior to the prototype.

In 1997, VA administrators set safety goals that included the use of bar code technology to increase patient safety. That turned many eyes to the Topeka facility, and the homegrown radio frequency medication administration program soon became the standard for VA facilities nationwide.

By 1999, bar code medication administration (BCMA) technology was deployed in virtually all VA facilities. The BCMA software is a point-of-care solution for validating the administration of medications. Automation of the medication administration process will reduce inaccurate medication administration and increase efficiency with documentation. The software electronically updates the medication administration history in real time, allowing multiple healthcare providers access to the data electronically to enhance clinical decision-making regarding therapeutic regimens.

Getting Connected

When wireless adoption began within the agency, there was no standard for connectivity. BCMA was one of the first wireless technologies deployed across VA. But because no standards existed, facilities often selected different vendors to create and deploy wireless applications. "Different facilities have different areas of specialty, and it was hard to create a homegrown system that would be flexible enough," says Russell Carlson, B.S.N., a VA nursing consultant. "A development team provided a minimum standard for equipment, and facilities could buy whatever they deemed necessary."

The development team provided pre-implementation guidelines and checklists to each facility. These documents offered suggested minimum equipment levels, suggested minimum hardware requirements and minimum infrastructure requirements. As each facility implemented BCMA throughout the nursing units, local teams reassessed the specific needs of each facility to accomplish full implementation and reported their status monthly to upper management. Any issues that could impact the implementation of BCMA were addressed.

VA administrators also had to clear a number of hurdles to obtain staff support for the new system. "One major hurdle was the cultural change," Carlson notes. "With the old paper-based system, each department was its own silo, but that wasn't going to work for the electronic system. It became more painfully obvious how intertwined all of the departments really are."

Moreover, nurses had traditionally viewed medication administration as a task rather than a clinical function. They also feared that learning a new medication administration system would take away from the time they had to care for patients. VA leaders, however, encouraged nurses to take the opportunity to educate patients at the bedside as they administered medication with the new point-of-care system.

Gaining Staff Support

As nurses used BCMA, they began to realize that administering medications was a complex process involving the coordination of numerous disciplines. Facilities developed interdisciplinary focus groups that promoted changes through an intense review of current system processes. Issues were identified and solutions were implemented with input from the end-users.

Management support for reassessing current medication processes with a focus on patient safety was paramount in the successful implementation and use of BCMA. Nurses were especially supportive of BCMA when a system alert to a potential error prevented the error from occurring. Detail-oriented planning, multidisciplinary communications, ongoing training and careful implementation helped medical facilities and their staffs overcome their natural reticence to adopting computerized systems.