Hausarbeit

Adminstration of Medicine’s Software

GruppenmitgliederName Matrikelnummer E-Mail-AdresseGabriel Lucas Ferreira 3020398 gabriel.l.ferreira@stud.leuphana.de

Proseminar: Betriebliche StandardsoftwareLehrender: Paul Drews

Semester: Wintersemester 2013/2014

Fachsemester: 3 Abgabedatum:28/02/2014

Lüneburg

2014

INDEX

1. INTRODUCTION___________________________________________________2

1.1 BCMA (BAR CODED MEDICATION ADMINISTRATION)______________________2

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 7

4. CONCLUSION_____________________________________________________8

5. APPENDIX_______________________________________________________9

5.1 PROJECT PLANNING______________________________________________9

5.3 PICTURES_____________________________________________________10

6. REFERENCES_____________________________________________________13

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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

1 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):644–5.3 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.

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correct time by electronically validating and documenting medications. The information

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

4Bar Coded Medication Administration (BCMA), http://searchhealthit.techtarget.com/definition/Bar-Coded-Medication-Administration, acessed 05.01.2014

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2. ADMINISTRATION OF MEDICINES

2.1 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, BCMA’s system became mandatory for all VA’s medical

centers in the United States. In the next topics will be discussed more specifically on BCMA

and the VA’s 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 hand-

held 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.

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

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Each patient's barcode holds all the vital information about the patient and his

medication, this information is referred to as the "Five Rights."

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,

6 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.

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while at the same time documenting the actual administration of the medication. This process

ensures the “Five Rights” universal standard of medication administration is

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.

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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 research’s 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 Hôpital Européen 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 8

focused physicians’ targeted alerts and thereby enhance the safety of the process of drug

prescription.

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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.

7Bar Code Label Requirements http://www.fda.gov/downloads/biologicsbloodvaccines/guidancecomplianceregulatoryinformation/guidances/ucm267392.pdf.

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5. Appendix

5.1 Project planning

This is the current project plan.

18.12.2013~15.01.2014 Literature research16.01.2014 Beginning of the writing work27.02.2014 Delivery

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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

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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.

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Figure 3 - Examples of valid and invalid BCMA barcode samples

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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 964-

972, 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-time-jena-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-to-barcode-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

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(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/

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