Barcoded Medication
Administration
Systems (BCMA) to
Improve Patient Safety
IOM Report

To err is human: Building a safer health system (IOM, 1999)
44,000 – 98,000 die yearly due to medical errors
 7,000 due to medication administration errors
 1 of every 854 hospital deaths due to a medication
error
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How to Improve Patient Safety?
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Congressional hearings – technologies may help
with patient safety. Things like
Bar coding
 Computerized physician order entry (CPOE)
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How BCMA Works
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Manufacturers, repackagers, relabelers, and label
distributors required to put NDC code on drugs
(no expiration date, lot #) by 2006
Hospitals not required to use the bar codes
How BCMA Works
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Patient’s treatments and MAR entered into
hospital database
Same encoded into patient wristband
Both accessible to RN via handheld device
Scan wristband to display MAR for patient
At time of med administration
RN scans drug bar code, pt. wristband, RN ID
badge
 Computer updates MAR accordingly
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Successes with BCMA – Veteran’s
Adminstration
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Began using system in 1993
1998 – medication documentation software
1993-2001 – 86.2% decrease in medication
errors
75.5% - wrong medication
 93.5% - wrong dose
 87.4% - wrong patient
 70.3% - missed dose
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Bar coding mandated in all VAs (including for
IVs)
Successes with BCMA

NICU study reported 47% decrease in adverse
drug events (Morriss et al., 2009)
Benefits of BCMA
Helps enforce 5 rights (medication, dose,
time, patient, route)
 Catches medication errors otherwise
undetected
 Catches drug allergies
 When US fully automated, estimated $2.5
million savings to hospitals annually
(preventing adverse drug events)

Benefits to BCMA
Nurse satisfaction
 Can save time due to fewer problems,
errors (some say increases time for
medication administration)
 Improve patient satisfaction
 Generate community goodwill (hospitals
taking steps to improve safety)
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Problems with BCMA
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No drug expiration dates
Need to increase dosing windows
Costs associated with developing, supporting,
implementing systems
Problems with BCMA
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Requires significant training (nurses, pharmacy
staff, IT personnel)
Scanning technology may not be compatible
with other systems
Scanners difficulty reading curved surfaces
2003 – 2% US hospitals used bar coding
Problems with BCMA

Not consistently nurse friendly
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Medication refusals – ‘unscanning’ a problem
Medication deletions from MAR when not
administered
Less MD/RN consultation
Problems with BCMA

RNs by-passing system features when perceived
cumbersome (unsafe workarounds), e. g.,
Placing patient ID band on object rather than patient
 Scanning multiple patients’ meds at a time
 Scanning label after removing it from actual
medication
 Removing scanner from cart away from computer
information
 Disabling alarms
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Problems with BCMA
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RNs ‘controlled’ by technology
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Interfered with other responsibilities, judgment,
flexibility
Titration problematic
Time consuming
Problems with BCMA
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Short lifespan of hardware
Batteries have short lifespan
Long-term care problems
Armbands become illegible
 Durable armbands uncomfortable
 Demented patients remove armbands
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RN discomfort with technology
References
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Koppell, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds
to barcode medication administration systems: Their occurrences, causes and
threats to patient safety. Journal of the American Medical Informatics Association, 15,
408-423.
Meadows, M. (2003). Strategies to reduce medication errors. FDA Consumer,
May-June, 21-27.
Morriss, F. H., et al. (2009). Effectiveness of a barcode medication
administration system in reducing preventable adverse drug events in a
neonatal intensive care unit: A prospective cohort study. Journal of Pediatrics,
154 (3), 363-368.
Roark, D. C. (2004). Bar codes and drug administration: Can new technology
reduce the number of medication errors? AJN, 104 (1), 63-66.
Work, M. (2005). Improving medication safety with a wireless, mobile
barcode system in a community hospital. Patient Safety & Quality Healthcare.
Retrieved October 31, 2005 from
http://www.psqh.com/mayjun05/casestudy.html