1. Barcoded Medication Administration Systems (BCMA) to Improve Patient Safety

2. A visual of the use of a bar code system for medication administration.

3. IOM Report To err is human: Building a safer health system (IOM, 1999)
44,000 – 98,000 die yearly due to medical errors
7,000 due to medication administration errors
1 of every 854 hospital deaths due to a medication error
An Institute of Medicine report reveals startling facts about medication errors.

4. How to Improve Patient Safety?
Congressional hearings – technologies may help with patient safety. Things like
Bar coding
Computerized physician order entry (CPOE)
It was reported in congressional hearings that technology could help to improve patient safety.

5. How BCMA Works
Manufacturers, repackagers, relabelers, and label distributors required to put NDC code on drugs (no expiration date, lot #) by 2006
Hospitals not required to use the bar codes
By 2006 manufacturers, repackagers, relabelers, and label distributors were required to put the NDC code on drugs, but hospitals were not required to use bar codes.

6. How BCMA Works
Patient’s treatments and MAR entered into hospital database
Same encoded into patient wristband
Both accessible to RN via handheld device
Scan wristband to display MAR for patient
At time of med administration
RN scans drug bar code, pt. wristband, RN ID badge
Computer updates MAR accordingly
This is a description of how bar codes work in medication administration.

7. Successes with BCMA – Veteran’s Adminstration
Began using system in 1993
1998 – medication documentation software
– 86.2% decrease in medication errors
75.5% - wrong medication
93.5% - wrong dose
87.4% - wrong patient
70.3% - missed dose
Bar coding mandated in all VAs (including for IVs)
The VA has been using bar coding since 1993 and has achieved significant decreases in medication errors.

8. Successes with BCMA
NICU study reported 47% decrease in adverse drug events (Morriss et al., 2009)

9. Benefits of BCMA
Helps enforce 5 rights (medication, dose, time, patient, route)
Catches medication errors otherwise undetected
Catches drug allergies
When US fully automated, estimated $2.5 million savings to hospitals annually (preventing adverse drug events)
It is reported that 1 preventable adverse drug event = $5,857.

10. Benefits to BCMA Nurse satisfaction
Can save time due to fewer problems, errors (some say increases time for medication administration)
Improve patient satisfaction
Generate community goodwill (hospitals taking steps to improve safety)
Other benefits to bar coding include these things. 1 preventable adverse drug event = $5,857.

11. Problems with BCMA No drug expiration dates
Need to increase dosing windows
Costs associated with developing, supporting, implementing systems
There are some problems associated with bar coding. These are a few.
According to the FDA – average hosp. costs to buy and implement bar coding system is $13.7 million. One company says it costs 1.5 million for a 300 bed hosp.

12. Problems with BCMA
Requires significant training (nurses, pharmacy staff, IT personnel)
Scanning technology may not be compatible with other systems
Scanners difficulty reading curved surfaces
2003 – 2% US hospitals used bar coding
Other problems associated with bar coding.
Per FDA, it will be 20 years until all US hospitals fully on line with bar coding.

13. Problems with BCMA Not consistently nurse friendly
Medication refusals – ‘unscanning’ a problem
Medication deletions from MAR when not administered
Less MD/RN consultation
Other problems with bar coding.

14. Problems with BCMA
RNs by-passing system features when perceived cumbersome (unsafe workarounds), e. g.,
Placing patient ID band on object rather than patient
Scanning multiple patients’ meds at a time
Scanning label after removing it from actual medication
Removing scanner from cart away from computer information
Disabling alarms

15. Problems with BCMA RNs ‘controlled’ by technology
Interfered with other responsibilities, judgment, flexibility
Titration problematic
Time consuming
Other problems with bar coding

16. Problems with BCMA Short lifespan of hardware
Batteries have short lifespan
Long-term care problems
Armbands become illegible
Durable armbands uncomfortable
Demented patients remove armbands
RN discomfort with technology
Other problems with bar coding

17. References
Koppell, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes and threats to patient safety. Journal of the American Medical Informatics Association, 15,
Meadows, M. (2003). Strategies to reduce medication errors. FDA Consumer, May-June,
Morriss, F. H., et al. (2009). Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: A prospective cohort study. Journal of Pediatrics, 154 (3),
Roark, D. C. (2004). Bar codes and drug administration: Can new technology reduce the number of medication errors? AJN, 104 (1),
Work, M. (2005). Improving medication safety with a wireless, mobile barcode system in a community hospital. Patient Safety & Quality Healthcare. Retrieved October 31, 2005 from