Pharmacists can help speed the adoption of barcoding in LTC settings. By Carol Sirianni, RPh, and Mark Neuenschwander

Transcription

1 Pharmacists can help speed the adoption of barcoding in LTC settings By Carol Sirianni, RPh, and Mark Neuenschwander 32 america s Pharmacist January

2 photo ILLUSTRATION: MARIANELA GUINAND Barcode technology was first employed by the grocery industry in the 1970s. Today, it is everywhere. Virtually all retailers use barcodes to track and sell merchandise. Rental cars, registered mail, and parcels are tracked via barcoding. Barcoded tickets are even required to enter sporting events and to board airplanes. Barcoded medications are widely used in hospitals, an advancement that has proven to increase patient safety and hospital efficiency. Despite success in the hospital setting, implementation and acceptance of barcode technology across other health care settings, such as long-term care (LTC) facilities, has been slow. For the technology to be fully utilized in those facilities, challenges need to be addressed, beginning with awareness. Pharmacists have a unique opportunity to communicate to their customers the need for barcode implementation in LTC and be part of the solution that makes the technology commonplace. January 2013 america s Pharmacist 33

3 It wasn t until almost a decade later, however, that the medical community began to pay attention to barcoding technology. Road to Barcoded Medications in Acute Care One of the first discussions around barcode technology for medication dispensing was a feature article written by Gerald Meyer in The American Journal of Hospital Pharmacy, published in The article, The Use of Bar Codes in Inpatient Drug Distribution, noted that health care professionals have a moral responsibility to use all means available to them including technology to increase patient safety. It wasn t until almost a decade later, however, that the medical community began to pay attention to barcoding technology. The impetus was the 1999 report, To Err is Human: Building a Safer Health System, published by the U.S. Institute of Medicine and widely credited for increasing awareness about medical errors in the United States medication errors in particular. The report estimated that 7,000 hospital patients die annually from preventable adverse drug events, and another 1.5 million are harmed by medication errors. The report prompted the medical community to declare war on medication errors and spurred interest in technology that could increase patient safety. Although the health care community was eager for safer medication administration options, there were still several challenges to overcome in implementing barcode medication administration (BCMA) in the hospital setting. At that time, few U.S. hospitals had the technology necessary to scan medications at the point of care and only approximately 30 percent of medications were barcoded. Hospitals were hesitant to invest in technology until more drug manufacturers began barcoding their medications. Similarly, manufacturers were reluctant to implement barcodes until more hospitals had the technology in place. In 2004, the Food and Drug Administration (FDA) announced that it would require barcodes on the majority of medications by The FDA estimated that the barcode rule, when fully implemented, would help prevent nearly 500,000 adverse events and transfusion errors over 20 years, providing an economic benefit estimated to be $93 billion over the same period. Impact on Patient Safety The FDA ruling proved to be the tipping point for BCMA in the acute care setting. Today, approximately 50 percent of acute care hospitals in the United States utilize barcode technology for medication administration, representing about 60 percent of hospital beds nationwide. Among hospitals with 100-plus beds, more than 80 percent are scanning at the point of care. Many studies have confirmed the effectiveness of BCMA in reducing medication errors and increasing patient safety. One study conducted at a Veterans Affairs medical center found that 5.7 million doses of barcoded medication were administered to patients, with no medication errors. Another landmark study by Brigham and Women s Hospital (published in the May 6, 2010 issue of the New England Journal of Medicine), found that using both barcode technology and electronic medication administration record (emar) together substantially reduces transcription and medication administration errors as well as potential drug-related adverse events. Specifically, the study reported that the use of barcode technology and emar created the following improvements: 34 america s Pharmacist January

4 Photography: IStockphoto 80 percent decrease in documentation errors 27 percent decrease in timing-related errors 41 percent reduction in non-timing medication errors 51 percent reduction in non-timing adverse drug events Along with increasing patient safety, BCMA improves the quality of care that patients receive, as well as their quality of life, by reducing hospital stays and helping patients return to their normal life more quickly. It also allows health care providers to make more informed decisions about whether to continue, discontinue, or amend the therapy by more accurately documenting medications administered at the point of care. BCMA in the LTC Setting Despite its effectiveness in improving quality care and patient safety in the hospital setting, barcoding technology has yet to be successfully implemented in most LTC facilities. There is a clear need. There is no indication that LTC facilities are less prone to medication errors than acute care facilities. Some suggest LTC facilities might even be more prone to errors, given the high volume of medications administered. Data indicates that 50 percent of residents in LTC facilities take nine or more medications. Another factor that can lead to medication errors is the nurse-to-resident ratio in LTC facilities, which is typically greater than the nurse-topatient ratio in hospitals. A study published in the September 2008 issue of The Annals of Long-Term Care ( Preventing Medication Errors, Richard G. Stefanacci) reports an estimated 800,000 preventable medication-related injuries occur annually in nursing homes alone, making a clear case for BCMA implementation in LTC facilities. Proponents of barcoding at the point of care advocate that the system align with many of the Joint Commission s 2013 National Patient Safety Goals for Long-Term Care. Some of these goals include: Identifying residents correctly: Use at least two ways to identify residents. For example, use the resident s name and date of birth. This is done to make sure that each resident gets the correct medicine and treatment. Using medicines safely: Record and pass along correct information about a resident s medicines. Find out what medicines the resident is taking. Compare those medicines to new medicines given to the resident. As was the case with acute care a decade ago, there are many challenges that need to be resolved before BCMA can be implemented in LTC facilities. One of January 2013 america s Pharmacist 35

5 the main challenges is that most emar providers for the market do not currently support BCMA. Although most medications arrive at the facility with barcodes and most facilities have emar systems in place, the two technologies have yet to be integrated. Even if emar providers begin offering technology that integrates medication barcodes, the cost of implementing the technology is another barrier. With already tight budgets becoming more constricted, many LTC facilities may struggle with the expense of adopting BCMA. LTC facilities must also consider the cost of training nurses to properly use barcode technology. Inevitably, there will be a learning curve as nurses adapt to new technology. Understaffed facilities may find training to be even more challenging. As is often the case when it comes to change management, some staff may be opposed to learning a new system for administering medications. In some instances, staff may not realize the extent of medication errors in their facility and therefore may not understand the benefits of a new system. Nurses may also have the misconception that BCMA will take more time than traditional medication administration. Facilities need to ensure a cultural paradigm shift for staff to be onboard in adopting a new system. These same barriers were successfully overcome in the acute care setting. Most hospital nurses trained to use BCMA systems have come to favor them. When 10,000 VA hospital nurses were asked if, given the choice, would they prefer go back to dispensing medications without barcodes, not one nurse reported that they would. Many nurses become ardent supporters of BCMA once the system prevents a medication error that could have harmed their patient. Nurses who are involved in a medication error that causes harm often blame themselves for the error, even if it wasn t directly their fault. Nurses, doctors, and hospitals have been sued or criminally charged for medication errors. Alternatively, BCMA can help to protect the reputation of health care facilities. It is in the best interest of all parties to implement safety measures such as barcoding that protects nurses, caregivers, and facilities, as well as the patients Pharmacists are in a unique position to help raise awareness and steer their LTC customers toward BCMA. Pharmacists can instill cultural change by educating providers about the benefits of barcoding, so it is seen as a necessity. They can also be a part of the solution by ensuring that medications arrive at the points of care with barcodes. By doing what they can to implement barcoding technology, pharmacists can champion the cause, encouraging the industry to make the technology a standard of care. Since their invention more than 50 years ago, barcodes have proven to be an effective and reliable technology in a variety of settings. Within the health care field, and acute care in particular, barcode technology has revolutionized medication administration, drastically reducing medication errors and improving efficiency. The successful implementation of BCMA in acute care has paved the way for other health care settings to adopt the technology. Now, it is time for the health care community to bring the technology to the forefront and utilize it to its fullest capacity to improve patient safety in the long-term care setting. Carol Sirianni, RPh, is vice president, AmerisourceBergen. She has more than 30 years of comprehensive senior-level management experience in health care settings, including long-term care, acute long-term care, infusion therapy, acute care, and retail practice in private and academic environments. Mark Neuenschwander is considered by many as the world s leading expert in the field of drug dispensing automation and barcode point-of-care systems. He is best noted for The Neuenschwander Reports, the latest of which is entitled To The Bedside 2: An Expanded Review of Bar-Code Point of Care Solutions. The Pharmacist s Role in LTC Barcoding The benefits of BCMA for LTC facilities are evident, but there are still many hurdles that must be overcome. 36 america s Pharmacist January