Improving Patient Safety Outcomes:
   Impact of Bar-code Technology
             Bar-



          Mitchell Buckley, Pharm...
Disclosure
• No financial disclosures




                                    2
Objectives
• Review medication error epidemiology
• Evaluate bar-code technology studies impacting dispensing and
        ...
Technology Prevention Strategies


    Electronic Medication                Automated Medication   Bar-
                  ...
Medication Error Epidemiology




                                5
Background
      • 1.5 million patients harmed by medications in U.S. annually
      • Hospitalized patients at risk for m...
Overall Medication Error Rate:
                  Distribution in Medication Use Process



              Administration   ...
Incidence of ICU Medication Errors:
                          Distribution in Medication Use Process

                    ...
Severity of ICU Medication Errors:
                        Distribution in Medication Use Process

                       ...
BCMA Technology Impact:
      Published Data




                          10
Medication Errors & Potential ADEs:
                 Before and After BCMA Implementation
        • Objective
          • ...
Medication Errors & Potential ADEs:
                          Before and After BCMA Implementation

                      ...
Medication Errors in the ICU:
                 Before and After BCMA Implementation
        • Objective
          • Measur...
Incidence of Medication Errors:
                                 Impact of BCMA in the ICU
                  40

         ...
Type of Error
                       p<0.001
  Percentage (%)




                                                        ...
BCMA Impact on Medication Errors:
                                   ICU vs. General Ward
        • Objective
          • ...
Overall and “Wrong-Time” Error Types:
                                   ICU vs. General Ward
                            ...
Types of Errors Excluding “Wrong-Time”:
                                   ICU vs. General Ward

                         ...
Severity of Drug Administration Errors
        • Objective
          • Evaluate the severity of potential medication error...
Results
 • Overall severity
    • 945 total errors detected
    • 9% (n=81) were “Moderate” or “Severe”
 • “Moderate” or “...
Conclusion
• Types of errors impacted by BCMA varied between ICU and
  non-ICU patient care areas
• Although the clinical ...
Questions




            22
Incidence of Medication Errors:
                          Intensive Care Unit vs. General Ward
                           ...
Bar-code Medication Administration
                                Technology Prevalence


                       U.S. Hos...
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Improving Patient Safety Outcomes: Impact of Bar-code Technology

  1. 1. Improving Patient Safety Outcomes: Impact of Bar-code Technology Bar- Mitchell Buckley, PharmD, BCPS Clinical Pharmacy Specialist Banner Good Samaritan Medical Center Phoenix, AZ January 11, 2010 1
  2. 2. Disclosure • No financial disclosures 2
  3. 3. Objectives • Review medication error epidemiology • Evaluate bar-code technology studies impacting dispensing and bar- administration errors • Discuss types and severity of errors affected by bar-coding bar- 3
  4. 4. Technology Prevention Strategies Electronic Medication Automated Medication Bar- Bar-coded Medication Administration Record Dispensing Machine Administration Prescribing Transcription Dispensing Administration Computerized Physician IV Infusion Order Entry Safety Pumps 4 Oren E. Am J Health Syst Pharm 2003;60:1447-1458 2003;60:1447-
  5. 5. Medication Error Epidemiology 5
  6. 6. Background • 1.5 million patients harmed by medications in U.S. annually • Hospitalized patients at risk for medication errors • 19% of all medical errors were medication-related medication- • 400,000 preventable ADEs per year (~1 medication error / patient / year) • 78% of medical errors in ICU associated with medications • 28% of ADEs estimated to be preventable • Increased hospital length of stay, cost and mortality Bates DW. Am J Health Syst Pharm 2007;64(Suppl 9):S3-S9 9):S3- Rothschild JM. Crit Care Med 2005;33:533-540 2005;33:533- 6 Leape LL. N Engl J Med 1991;324:377-384 1991;324:377- Bates DW. JAMA 1995;274:29-34 1995;274:29-
  7. 7. Overall Medication Error Rate: Distribution in Medication Use Process Administration Prescribing 38% 39% Dispensing Transcription 11% 12% 7 Leape LL. N Engl J Med 1991;324:377-384 1991;324:377-
  8. 8. Incidence of ICU Medication Errors: Distribution in Medication Use Process Potential ADEs (n=110) 100 Actual Preventable ADEs (n=22) 77 Percentage (%) 80 60 40 34 34 28 23 20 5 0 0 0 Prescribing Transcription Dispensing Administration Stage of the Medication Use Process 8 Kopp BJ. Crit Care Med 2006;34:415-425 2006;34:415-
  9. 9. Severity of ICU Medication Errors: Distribution in Medication Use Process Fatal Serious Life- Life-Threatening Significant 100 80 Percentage (%) 60 40 20 0 Prescribing Transcription Dispensing Administration (n=48) (n=5) (n=37) (n=42) 9 Kopp BJ. Crit Care Med 2006;34:415-425 2006;34:415-
  10. 10. BCMA Technology Impact: Published Data 10
  11. 11. Medication Errors & Potential ADEs: Before and After BCMA Implementation • Objective • Evaluate BCMAs impact of on dispensing errors • Methods • 735-bed tertiary care academic center • Before and after observational study • Data collected over 20 month period 11 Poon EG. Ann Intern Med 2006;145:426-434 2006;145:426-
  12. 12. Medication Errors & Potential ADEs: Before and After BCMA Implementation p<0.0001 100 1.0 Annual Error Prevention Projections • >13,500 dispensing errors Percentage (%) 80 0.8 36% • >6000 potential ADEs Reduction 60 0.6 0.4 40 p<0.0001 0.2 20 63% Reduction 0 0 Dispensing Error Rate Potential ADE Rate Pre- Pre-Bar Code Period Post-Bar Code Period Post- 12 Poon EG. Ann Intern Med 2006;145:426-434 2006;145:426-
  13. 13. Medication Errors in the ICU: Before and After BCMA Implementation • Objective • Measure the impact of BCMA on medication administration error rates in MICU • Methods • 744-bed community, teaching hospital • 38-bed MICU • Direct observation technique 13 DeYoung JL. Am J Health Syst Pharm 2009;66:1110-5 2009;66:1110-
  14. 14. Incidence of Medication Errors: Impact of BCMA in the ICU 40 35 p<0.001 30 • Before BCMA Incidence (%) 25 • n=47 patients 19.7 20 • 153 errors / 775 administrations • After BCMA 15 • n=45 patients 10 8.7 • 60 errors / 690 administrations 5 0 Before After Implementation Phase 14 DeYoung JL. Am J Health Syst Pharm 2009;66:1110-5 2009;66:1110-
  15. 15. Type of Error p<0.001 Percentage (%) p=NS p=NS p=NS Wrong Time Omission Wrong Drug Documentation 15 DeYoung JL. Am J Health Syst Pharm 2009;66:1110-5 2009;66:1110-
  16. 16. BCMA Impact on Medication Errors: ICU vs. General Ward • Objective • Measure the impact of BCMA on administration error rates in multiple patient care areas • Methods • Prospective, observational study • 386-bed academic teaching hospital • Multiple patient care areas • 2 medical-surgical wards • MICU • SICU 16 Helmons PJ. Am J Health Syst Pharm 2009;66:12021210
  17. 17. Overall and “Wrong-Time” Error Types: ICU vs. General Ward p=NS Overall • No difference in error rate p=NS (ICU or non-ICU) General Ward • Increase in “wrong-time errors” after BCMA • 58% decrease after BCMA (excluding “wrong-time”errors) ICU • No differences 17 Helmons PJ. Am J Health Syst Pharm 2009;66:12021210
  18. 18. Types of Errors Excluding “Wrong-Time”: ICU vs. General Ward General Ward • Decrease in “omission” errors (p<0.0001) • Decrease in “drugs not available” errors (p<0.05) ICU • No differences 18 Helmons PJ. Am J Health Syst Pharm 2009;66:12021210
  19. 19. Severity of Drug Administration Errors • Objective • Evaluate the severity of potential medication errors during administration phase intercepted by BCMA • Methods • 6 community hospitals • Same BCMA system • Multidisciplinary reviewing panel (n=6) • Medication Errors classified by severity • Minimal • Moderate • Severe 19 Sakowski J. Am J Health-Syst Pharm 2008;65:1661-1666 Health- 2008;65:1661-
  20. 20. Results • Overall severity • 945 total errors detected • 9% (n=81) were “Moderate” or “Severe” • “Moderate” or “Severe” errors by type • 21% “no order” • 9% “discontinued or expired order” • 4% “dose early” • 4% “wrong dose” • Errors involving “high-alert” medications • 20% = insulin, narcotics, potassium, sodium, anticoagulants • Narcotics most common of “high-alert” drugs (74%) 20 Sakowski J. Am J Health-Syst Pharm 2008;65:1661-1666 Health- 2008;65:1661-
  21. 21. Conclusion • Types of errors impacted by BCMA varied between ICU and non-ICU patient care areas • Although the clinical significance of “wrong-time” errors remains controversial, BCMA has the potential reduce other clinically important medication errors • Medication errors still occur despite BCMA suggesting the necessity for continued process improvement and further system changes to compliment this technology • Studies limited by low baseline prevalence of medication error • Dispensing and administration errors were significantly decreased with BCMA technology 21
  22. 22. Questions 22
  23. 23. Incidence of Medication Errors: Intensive Care Unit vs. General Ward ICU General Ward p=NS 50 p=NS Percentage (%) 40 30 p=NS p=NS 20 10 0 Prescribing Transcription Dispensing Administration Stage of the Medication Use Process 23 Cullen D. Crit Care Med 1997;1289-1297 1997;1289-
  24. 24. Bar-code Medication Administration Technology Prevalence U.S. Hospitals with BCMA 40 BCMA Acquisition Plans 40 Percentage (%) Percentage (%) 30 30 20 20 10 10 0 0 <1 1- 3 >3 No Plan 2002 2005 2007 2008 Implementation Timeframe (Years) Year 24 Pedersen C. Am J Health Syst Pharm 2008;65:2244-2264 2008;65:2244-

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