This document summarizes research on the impact of bar-code medication administration (BCMA) technology in reducing medication errors. Studies show BCMA reduced dispensing errors by 36-63% and potential adverse drug events by 63%. BCMA also reduced medication administration errors in intensive care units by 19.7% to 8.7%. While BCMA's impact varied between ICUs and general wards, it reduced clinically important error types. 9% of intercepted errors using BCMA were considered moderate or severe risks. BCMA has potential to reduce errors but continued improvements are still needed given medication errors can still occur.
Assessing the Costs of Medication-Assisted Treatment for HIV Prevention in Ge...Irma Kirtadze M.D.
This study assesses the unit costs of MAT provision in Georgia from the perspective of the two service providers in-country—the Ministry of Labor, Health, and Social Affairs (MOLHSA) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). Both MOLHSA and GFATM-funded sites offer MAT in multiple facilities throughout urban and rural Georgia. Treatment protocols and personnel requirements are centrally mandated, thus allowing for little variation per patient characteristics. While service delivery tends to be comparable across MOLHSA and GFATM sites, there is one significant difference—the ministry requires that MAT clients pay for services while GFATM offers free services. The analysis found that a majority of HIV-positive patients are enrolled in the GFATM MAT program.
The study compared average unit costs between two years (2009 and 2010) and found a minimal increase. Unit costs increased only slightly at MOLHSA facilities from 229 GEL ($133 ) per month to 236 GEL ($137) per month. At GFATM sites, the monthly per patient cost of MAT rose slightly between 2009 and 2010 from 217 GEL ($126) to 229 GEL ($133). Further, data analysis revealed that GFATM programs are only slightly less expensive than at MOLHSA facilities. An important caveat—unit cost calculations for the MOLHSA sites include patient contributions that amount to 150 GEL ($87) per month for each patient. In the case of both providers, direct costs of MAT provision far exceed indirect costs. Three inputs—personnel, drugs/medical supplies, and utilities—account for a major portion of costs associated with running MAT programs in Georgia. The most significant budget item in both MOLSHA and GFATM programs is the cost of personnel (salaries of clinical and support staff).
Assessing the Costs of Medication-Assisted Treatment for HIV Prevention in Ge...Irma Kirtadze M.D.
This study assesses the unit costs of MAT provision in Georgia from the perspective of the two service providers in-country—the Ministry of Labor, Health, and Social Affairs (MOLHSA) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). Both MOLHSA and GFATM-funded sites offer MAT in multiple facilities throughout urban and rural Georgia. Treatment protocols and personnel requirements are centrally mandated, thus allowing for little variation per patient characteristics. While service delivery tends to be comparable across MOLHSA and GFATM sites, there is one significant difference—the ministry requires that MAT clients pay for services while GFATM offers free services. The analysis found that a majority of HIV-positive patients are enrolled in the GFATM MAT program.
The study compared average unit costs between two years (2009 and 2010) and found a minimal increase. Unit costs increased only slightly at MOLHSA facilities from 229 GEL ($133 ) per month to 236 GEL ($137) per month. At GFATM sites, the monthly per patient cost of MAT rose slightly between 2009 and 2010 from 217 GEL ($126) to 229 GEL ($133). Further, data analysis revealed that GFATM programs are only slightly less expensive than at MOLHSA facilities. An important caveat—unit cost calculations for the MOLHSA sites include patient contributions that amount to 150 GEL ($87) per month for each patient. In the case of both providers, direct costs of MAT provision far exceed indirect costs. Three inputs—personnel, drugs/medical supplies, and utilities—account for a major portion of costs associated with running MAT programs in Georgia. The most significant budget item in both MOLSHA and GFATM programs is the cost of personnel (salaries of clinical and support staff).
Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative
Presentation from Webinar on Nov 16, 2011 from discussion with Dr. Lindsey Poppe, the Pharmacy Clinical Manager for Oncology for the University of North Carolina hospital system. She talked about the alternatives and options that patients have when directly faced with this situation.
American College of Cardiology - Cardiovascular Summit 2013Saji Salam MD,MBA
As healthcare reimbursement shifts from quantity to quality, particularly in Cardiology, the importance of capturing complete and accurate quality data metrics continues to grow. Yet, significant challenges exist in the collection, abstraction and submission of Cardiology quality data. Appropriately meeting these challenges can help your organization improve patient care, increase efficiency, enhance its reputation and maximize reimbursements.
Joseph Dal Molin: Implementing VistA internationally: Myth-busting lessons fr...Nuffield Trust
In this slideshow Joseph Dal Molin, President of the E-cology Corporation and Chairman of WorldVistA, outlines Jordan’s health system and its approach to implementing VistA.
Joseph Dal Molin presented at the Nuffield Trust seminar: Sharing international experience: Is implementing the VA's electronic health record system an option for the NHS? in July 2012.
IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Dist...Alex J Mitchell
Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression
Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative
Presentation from Webinar on Nov 16, 2011 from discussion with Dr. Lindsey Poppe, the Pharmacy Clinical Manager for Oncology for the University of North Carolina hospital system. She talked about the alternatives and options that patients have when directly faced with this situation.
American College of Cardiology - Cardiovascular Summit 2013Saji Salam MD,MBA
As healthcare reimbursement shifts from quantity to quality, particularly in Cardiology, the importance of capturing complete and accurate quality data metrics continues to grow. Yet, significant challenges exist in the collection, abstraction and submission of Cardiology quality data. Appropriately meeting these challenges can help your organization improve patient care, increase efficiency, enhance its reputation and maximize reimbursements.
Joseph Dal Molin: Implementing VistA internationally: Myth-busting lessons fr...Nuffield Trust
In this slideshow Joseph Dal Molin, President of the E-cology Corporation and Chairman of WorldVistA, outlines Jordan’s health system and its approach to implementing VistA.
Joseph Dal Molin presented at the Nuffield Trust seminar: Sharing international experience: Is implementing the VA's electronic health record system an option for the NHS? in July 2012.
IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Dist...Alex J Mitchell
Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression
Improving Patient Safety Outcomes: Impact of Bar-code Technology
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
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. 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. 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. 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-
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
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. 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-