Hausarbeit

Adminstration of Medicines Software

Gruppenmitglieder
Name

Matrikelnummer

E-Mail-Adresse

Gabriel Lucas Ferreira

3020398

gabriel.l.ferreira@stud.leuphana.de

Proseminar: Betriebliche Standardsoftware

Lehrender: Paul Drews
Semester: Wintersemester 2013/2014

Fachsemester: 3

Abgabedatum:28/02/2014

Lneburg
2014

INDEX
1.

INTRODUCTION _________________________________________________ 2
1.1

2.

BCMA (BAR CODED MEDICATION ADMINISTRATION) _____________________ 2

ADMINISTRATION OF MEDICINES ___________________________________ 4

2.1

INTRODUCTION ___________________________________________________ 4

2.2

BCMA (BAR CODED MEDICATION ADMINISTRATION) _____________________ 4

2.3

U.S. VETERANS HEALTH ADMINISTRATION (VHA)S CASE __________________ 5

3.

FUTURE TRENDS _________________________________________________ 7

3.1

VALIDITY OF A CLINICAL DECISION RULE-BASED ALERT SYSTEM FORDRUG DOSE

ADJUSTMENT IN PATIENTS WITH RENAL FAILUREINTENDED TO IMPROVE PHARMACISTS

ANALYSIS OF MEDICATIONORDERS IN HOSPITALS

4.

CONCLUSION ___________________________________________________ 8

5.

APPENDIX ______________________________________________________ 9

5.1

PROJECT PLANNING ____________________________________________ 9

5.3

PICTURES____________________________________________________ 10

6.

REFERENCES ___________________________________________________ 13

1.

INTRODUCTION

Medication errors are a serious public health threat. According to Institute of Medicine
report, between 44,000 and 98,000 Americans die annually due to medical mistakes1. As
part of its efforts to improve patient safety, the FDA-USA (U.S. Food and Drug
Administration) ruled on 2004, to make barcodes mandatory on the labels of thousands of
human medications and biological products by the year 2006. The FDA forsee that this law
will prevent nearly 500,000 adverse events and transfusion errors over the 20 years that
follow, at a cost savings of $93 billion2.
Based on the effort to reduce medical mistakes, in 1994 a nurse from the Veterans
Affairs Medical Center (Kansas) noticed the bar code that a rental car company used to track
vehicles and thought that bar-code scanning technology could enhance patient safety by
reducing medication errors through a series of electronic checks and balances that would
increase the nurse's clinical judgment. A prototype system was developed at the Topeka
Medical Center and then became used throughout the Veterans Affairs (VA) health care
system beginning in 1999.3

1.1

BCMA

(BAR

CODED

MEDICATION

ADMINISTRATION)
The Barcode Medication Administration (BCMA) is an inventory control system that
uses barcodes to prevent errors in the distribution of prescription medications at hospitals.
The goal of BCMA is to make sure that patients are receiving the correct medications at the
correct time by electronically validating and documenting medications. The information

Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. A
report of the Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC:
National Academy Press; 2000.
2
FDA to require bar coding of most pharmaceuticals by mid-2006. Am J Health Syst Pharm
2004;61(7):6445.
3
Ronald Schneider, B.S.Pharm., M.H.A., Jonathan Bagby, R.N., M.B.A., M.S.N., Russ Carlson, R.N.,
B.S.N., M.H.A., Bar-Code Medication Administration: A Systems Perspective, Am J Health Syst
Pharm. 2008;65(23):2216-2219.

encoded in bar codes allows for the comparison of the medication being administered with
what was ordered for the patient and even to alert if some medications have been forgot. 4

Bar Coded Medication Administration (BCMA), http://searchhealthit.techtarget.com/definition/BarCoded-Medication-Administration, acessed 05.01.2014

2.
2.1

ADMINISTRATION OF MEDICINES

INTRODUCTION
The administration of medicines has been demonstrated to fold many areas for

potential medical error. Almost 60,000 medication incidents were reported to the National
Patient Safety Agency (NPSA-UK) via the National Reporting and Learning System between
Jan 2005 and June 2006. The 3 most frequently occurring types of medicine error (wrong
dose/strength/ frequency of medicine; omitted medicine and wrong medicine) accounted for
over half (57.3%) of all reported incidents and of these the most common was wrong
dose/strength/frequency of medicine (28.7%).5
Based on this concern, BCMAs system became mandatory for all VAs medical
centers in the United States. In the next topics will be discussed more specifically on BCMA
and the VAs case.

2.2

BCMA (BAR CODED MEDICATION ADMINISTRATION)

A BCMA system consists of a barcode printer, a barcode reader, a mobile computer,

a server and software. Each drug in the hospital has a unique bar code which identifies the
type of medication and the dose. When is prescribed medication for a patient, it is sent
electronically or hand delivered to the hospital's pharmacy and entered into a computer
system by a pharmacist. The pharmacist dispenses the barcoded doses of the drug to the
patient's floor. When it's time for the clinician to administer the medication, he uses a handheld device to scan the bar codes on his identification badge, the patient's wristband and the
drug. If the BPOC system cannot match the drug to be given with the order in the system, it
alerts the clinician with a visual warning.
Each patient's barcode holds all the vital information about the patient and his
medication, this information is referred to as the "Five Rights."

NPSA (2007) Safety in Doses: Medication Safety Incidents in the NHS, National Patient
Safety Agency UK.

The Five Rights of Barcode Medication Administration6:

a.

The right patient

b.

The right medication

c.

At the right time

d.

At the right dose

e.

By the right route

BCMA has shown great potential for reducing medication errors, as demonstrated
by the United States Bureau of Veterans Affairs. Barcode systems have also been useful for
managing inventory, streamlining billing and saving time both at the pharmacy and at the
bedside.

2.3

U.S. VETERANS HEALTH ADMINISTRATION (VHA)S CASE

BCMA software is presently in use at U.S. Department of Veteran Affairs institutions

operated across the nation by the Veteran's Health Administration (VHA). This software,
which utilizes real-time network (LAN) connectivity with a centralized server, was designed to
improve the accuracy of the medication administration process at the hospital bedside or at
other points of care. The system was first developed in 1994, at the VA Medical Center in
Topeka, Kansas, and was introduced nationwide in 2000.
Briefly, the VHA's medical record structure is contained within an interactive
electronic client/server database system that is used to manage all clinical, infrastructural,
administrative, and financial aspects of military veteran healthcare throughout the nation.(8)
(9). The medication administration workflow begins when a provider makes an electronic
entry detailing a patient's medication orders. The newly entered orders then appear in the
pharmacy software package (Figure 1) to be edited and verified by a pharmacist.
As a handheld barcode reader registers each medication, the software verifies the
correct medication was ordered, administered on time, and measured in the correct dosage,
while at the same time documenting the actual administration of the medication. This process
ensures

the

Five

Rights

universal

standard

of

medication

administration

is

Agrawal A1, Glasser AR., Barcode medication. Administration implementation in an acute care
hospital and lessons learned, J Healthc Inf Manag. 2009 Fall;23(4):24-9.

maintained. Once the medication administration procedure has been completed for a
particular timeframe, the nurse uses the Missed Medication function (Figure 2, #3) to
generate a report of omitted medications and takes steps to resolve any reported
discrepancies.

3.

FUTURE TRENDS

In this section I would like to introduce a great study in development that could be
used along with BCMA to reduce medical mistakes and dispensable dosages.

3.1

VALIDITY OF A CLINICAL DECISION RULE-BASED ALERT

SYSTEM FORDRUG DOSE ADJUSTMENT IN PATIENTS WITH

RENAL

FAILUREINTENDED

TO

IMPROVE

PHARMACISTS

ANALYSIS OF MEDICATIONORDERS IN HOSPITALS.

In this case, the researchs team have designed and implemented a clinical decision
rule-based alert system for drug dose verification integrated into the CPOE systems
(Computerized physician order entry) of the Hpital Europen Georges Pompidou (HEGP),
Paris/France. The alert system was designed to check medication orders and, if necessary,
display recommendations to adjust medication doses for patients suffering from impaired
renal function.
In the following study were used as standards the summary of product
characteristics, the recommendations of the drug prescribing in renal failure: dosing
guidelines for adults and children and the French guide-lines for prescription in renal
disease (GPR) handbook, an expert panel, including nephrologists and pharmacists.
Most interventions shown to be effective in improving correct dosage adjustment of
medications in CKD patients involved inpatient settings, such as concurrent feedback by
pharmacists, or the integration of a decision support system (CDSS) into a computerized
physician order entry (CPOE) system.
In this way, using the alert system with a non-interruptive mode for some alerts
could relieve pharmacists of some of the routine work. Consequently, they could focus on
detecting more dangerous medication orders that would have passed the first barrier of
focused physicians targeted alerts and thereby enhance the safety of the process of drug
prescription.

4.

CONCLUSION

Prevention of ME is crucial for patients safety. Nurses have many opportunities to

improve the medication administration process. Proper use of the augmented/upgraded
BCMA system together with the professional skills of the nurses will undoubtedly play a key
role, and healthcare institutions should adequately and properly prepare the system users
prior to software implementation. The incidence of ME can be significantly reduced and
patients safety can be greatly improved and secured.
Although the BCMA technology has been proven to be effective in making the
medication administration process safer, there are many barriers to its implementation. The
shift from manual to electronic medication administration is an intimidating and expensive
venture for healthcare agencies. The FDA estimates the cost to an average hospital of
buying and implementing IT technology such as the bar coding system to be $13.7 million7.
Moreover, not every registered nurse is enthusiastic about the use of IT for medication
administration. User rejection to use the IT system can be a barrier to successful system
implementation.

Bar
Code
Label
Requirements
http://www.fda.gov/downloads/biologicsbloodvaccines/guidancecomplianceregulatoryinformation/guida
nces/ucm267392.pdf.

5.

Appendix
5.1 Project planning

This is the current project plan.

18.12.2013~15.01.2014
16.01.2014
27.02.2014

Literature research
Beginning of the writing work
Delivery

5.3 Pictures

Figure 1 - Pharmacy order-verifying software program screen displays. Panel A: A sample

patient profile displayed using the characteristic text-based terminal interface. Panel B:
Medication entry finishing profile for an individual drug entry

10

Figure 2 - Nursing point-of-care BCMA program screen displays

Panel A: Bar Code Medication Administration (BCMA) appears as a windows-based display.
Key components include the medication administration route tabs (#1), the Virtual Due List for
medications (#2), the Missing Dose function (#3), and the Nursing Medication Order function
(#4).
Panel B: Missing Dose Request pop-up window.
Panel C: Nursing Medication Order Button pop-up window.

11

Figure 3 - Examples of valid and invalid BCMA barcode samples

12

6.

REFERENCES

ISO/IEC 17025 - General requirements for the competence of testing and calibration
laboratories
ISO/IEC 15189, Medical laboratories - Particular requirements for quality and
competence
A. Boussadi, T. Caruba, A. Karras, S. Berdot, P. Degoulet, P. Durieux, B. Sabatier,
Validity of a clinical decision rule-based alert system for drug dose adjustment in patients
with renal failure intended to improve pharmacists analysis of medication orders in hospitals,
International Journal of Medical Informatics, Volume 82, Issue 10, October 2013, Pages 964972, ISSN 1386-5056, http://dx.doi.org/10.1016/j.ijmedinf.2013.06.006.
Food and Drug Administration: FDA issues barcode regulation; fact sheet.
Washington, DC: 2004.
Hughes RG, Blegen MA. Medication Administration Safety. In: Hughes RG, editor.
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD):
Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 37. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK2656/
Jena

University

Hospital:

Customer

Reference

Video,

http://www.sap.com/asset/detail.the-right-medicine-to-the-right-patient-at-the-right-timejena-university-06-ctv-01-mp4.html, accessed 10.01.2014

US

orders

pharmaceutical

firms

to

barcode

all

hospital

drugs,

http://www.computerweekly.com/news/2240049935/US-orders-pharmaceutical-firms-tobarcode-all-hospital-drug, accessed 10.01.2014

Wideman MV, Whittler ME, Anderson TM. Barcode Medication Administration:
Lessons Learned from an Intensive Care Unit Implementation. In: Henriksen K, Battles JB,
Marks ES, et al., editors. Advances in Patient Safety: From Research to Implementation
(Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and
Quality (US); 2005 Feb. Availabl e from: http://www.ncbi.nlm.nih.gov/books/NBK20569/

13