Perfecting the Art of Medication Administration

BCMA systems are helping to reduce medication errors in hospitals. But recent results show many facilities have a long way to go

As with many issues in the healthcare field, the statistics behind prescription-related mistakes tell a troubling story.

Medication errors result in over 1.5 million adverse drug events in the United States each year, and perhaps even more shockingly, the average hospitalized patient experiences just over one medication error daily.

The result of these mistakes is approximately 7,000 deaths annually—a number lower than many would expect, surprisingly, but still an altogether regrettable and preventable situation.

The numbers are based on a report from The Leapfrog Group, a Washington D.C.-based watchdog organization representing employers and other purchasers aiming to improve health care quality and safety. Leapfrog released its 2018 report on bar code medication administration (BCMA) back in May.

Researchers found that among the nearly 2,000 hospitals that responded to the 2017 Leapfrog Hospital Survey, almost all (98.7 percent) have a BCMA system connected to an electronic medication administration record.

But only 34.5 percent fully meet all four requirements for deploying the technology effectively. Designed to prevent medication errors—statistically the most common hospital mistake—BCMA systems can be utilized at the bedside via a nurse of other professional scanning a barcode on the patient’s wristband, then double-checking against a corresponding code on the medication prior to administration.

The Leapfrog Group includes BCMA as part of the annual Hospital Survey, making them the only known organization to collect, verify, and report BCMA information on a hospital-by-hospital basis. Leapfrog has established a four-step system to ensure compliance:

  1. Implement a BCMA system in 100 percent of the hospital’s medical/surgical, labor and delivery and intensive care units;
  2. Scan both patient and medication bar codes in 95 percent of bedside medication administrations;
  3. Include all seven decision-support elements identified as best practices by the Leapfrog BCMA Expert Panel; and
  4. Implement all five best-practice processes and structures to prevent dangerous workarounds that impede safety of the BCMA system

The report maintains that standard #2 and #3 seem to be the requirements where many hospitals are falling short. On the other hand, approximately 80 percent of hospitals meet standard #4 by enforcing all five best-practice processes while employing different strategies to avoid workarounds.

As for standard #3, these are the decision-support element where hospitals are falling short:

Elements Missing from BCMA Solution (percentage represents the rate of hospitals who did NOT meet standard #3:)

  • Vital Sign Check: 78.0%
  • Patient-specific allergy check: 51.1%
  • Second nurse check needed: 12.8%
  • Medication administered at wrong time: 2.7%
  • Wrong dosage: 0.6%
  • Wrong patient: 0.4%
  • Wrong medication 0.0%

“It is encouraging to see almost all hospitals have bar coding in place,” said Leapfrog President and CEO Leah Binder. “But it only protects patients to the extent it’s used correctly. Unfortunately, hospitals have work to do to maximize the potential of this important technology.

“The Leapfrog Hospital Survey is clear and evidence-based in its requirements for meeting the BCMA standard, allowing all hospitals the opportunity to make full use of their bar coding systems and implement improvements. In the meantime, patients’ lives are at risk. We encourage hospital leadership to put a priority on meeting this standard.”
Of the almost 2,000 hospitals evaluated by the survey, here’s how the numbers stacked up:

Fully meeting all four criteria: 34.5 percent
Substantial progress (meeting three of four criteria): 36.8 percent
Some progress (two of four criteria): 20.1 percent
Willing to report (meeting zero or one criteria): 8.7 percent

“Employers are always looking to find the safest care for their employees. Fortunately, the Leapfrog Hospital Survey gives employers the quality transparency needed to identify providers that meet the Leapfrog standard for BCMA at the bedside as well as other important care standards,” said Maeve O’Meara, chief product officer of Castlight, the company that analyzed the survey data.

“At Castlight, we integrate Leapfrog’s data with health plan, benefits, and claims data in our comprehensive health navigation platform that guides employees to the right care at the right time to fit their health needs.”

The Leapfrog Group has made the entire Bar Code Medication Administration Report available on the company’s website.

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