Making Barcode Scanning a Standard of Care
An Interview by ComputerTalk with Carol Sirianni of AmerisourceBergen
Barcodes are a common feature in many pharmacies, as they are in many parts of life. They are also a standard part of the process for barcode medication administration (BCMA) in hospital settings, where they help avoid preventable medication errors by ensuring the right patient receives the right dose of the right medication. However, they are not yet widely in use during medication administration in long-term care facilities. In this interview Carol Sirianni, R.Ph., vice president at AmerisourceBergen, follows up a recently co-authored article on the subject in the January 2013 America’s Pharmacist (“Getting Up to Code”) by talking with ComputerTalk senior editor Will Lockwood about why this is and what’s being done to promote broader use of BCMA.
ComputerTalk (CT): Carol, I have to admit I’m surprised that BCMA is not a standard of care in LTC. Outline why this is.
Carol Sirianni: I think it comes down to two main reasons. First, there’s the perception that BCMA takes too much time. Second, is the question of who will bear the costs. And it is important to note that it took a long time and an FDA mandate for BCMA to become a standard in acute care. This was the motivation for technology vendors to develop the capabilities and the tools needed for BCMA. There was a convergence on looking at the medication error rate and something needing to be done, so the FDA mandated barcodes for medications. We saw that every other industry was so much more advanced than healthcare in terms of using barcodes, which was another reason it became a pertinent project. After the FDA mandate, the need to read the medication barcodes drove the demand and desire for technology companies to get involved.
CT: And we don’t have that mandate for LTC facilities?
Sirianni: The FDA requires that all medications be barcoded. The Joint Commission’s National Patient Safety Goals specify that the right patient should receive the right medication at the right dose at the right time, and they also require that facilities ensure that they take all measures possible to prevent medication errors. The goals specify that patients must be correctly identified using at least two identifiers before medications are administered. BCMA can facilitate this process and it’s well documented that it can significantly reduce preventable medication errors.
CT: In a perfect world, how would an LTC facility incorporate barcode scanning in the medication administration process?
Sirianni: First and foremost, the patient will have a barcoded armband. These typically feature a two-dimensional QR barcode, which identifies the patient by at least two forms of criteria, usually name and date of birth. The nurse employee ID badge would also be barcoded to identify who is administering the medications. The nurse would scan their ID badge, scan the patient wristband and then scan the medication, which would tie back to the electronic medication administration record (eMAR). The eMAR would validate by an audible beep that it is the correct medication going to the correct patient at the right time.
CT: This seems logical and fairly simple, but the perception is still that it creates a disruption in the workflow?
Sirianni: Yes, that’s the perception, but not necessarily the reality. Many nurses have become ardent supporters of BCMA – especially when they see it preventing errors first hand. As we noted in the article in America’s Pharmacist, when 10,000 VA hospital nurses were asked, if given the choice, would they prefer to go back to dispensing medications without barcodes, not one nurse reported they would. They understand that BCMA an important tool for eliminating preventable errors – and we have a clear precedent in the acute care setting of a decline in preventable errors as the result of BCMA.
CT: So what needs to happen to impress people with the benefits of BCMA?
Sirianni: It is a matter of awareness. Industry groups on the pharmacy side, such as NCPA and ASCP, and on the facility side, such as AHCA and ASHA, are instrumental in raising awareness. We don’t want to have to resort to a mandate from the federal government.
CT: What are the best, high impact talking points for those trying to raise awareness?
Sirianni: First and foremost, we need to talk about safety and preventing avoidable errors. But I think there is also efficiency that comes from BCMA that we can emphasize. When you avoid errors, you avoid rework, which is a prevalent issue in the LTC world at both the pharmacy and the facility levels. For example, on the pharmacy side in LTC, there is already significant efficiency because of the use of barcodes. Pharmacy labels are already barcoded to include anything from basic product identification to the prescription label barcode that can include the patient name, prescription number, facility, medical record number, and even location within the facility. This information is used in the pharmacy for a process called “scan to tote” that ensures the prescription is delivered to the right facility. Another aspect of efficiency from BCMA is that you also get documentation of administration within the eMAR, which makes it much easier to respond to audits. You aren’t retrieving paper administration records.
CT: What about the issue of cost?
Sirianni: That is a big hurdle. This is a point on which we need collaboration among industry partners. We also need to collaborate to address implementation, training, and availability. We need to find ways to make BCMA work in the entrepreneurial world of LTC. From the facilities to the pharmacies, this is an area that isn’t dominated by big operations, so it can be a challenge for them to make the necessary investment.
CT: It seems as if this is ultimately a challenge for LTC that’s going to require all the stakeholders to take an active role in order to move forward.
Sirianni: Yes, it really is. So every one with a stake in LTC needs to ask what they can do to get the profession and the industry where it needs to be with BCMA in order to ensure safety, good business practices, and operational efficiency that supports the prevention of potential medication errors. The buck stops with us and we need to band together and collaborate to make this happen.