Evidence-based Practice Change: Barcode Medication Administration

Alyson Kinley
Wright State University
What is BCMA?
A computerized system used
by nurses to administer
medications to patients
BCMA utilizes a bar code
system: the medication
package, the patient’s
wristband, and the nurse’s
badge all have a bar code that  Documentation of the
administration occurs in the
is scanned during each
EMAR (electronic medication
administration record)
Why is BCMA important?
Decrease of costly medication errors
 Provides a standardized method of
medication administration
 25% of adverse drug events are
 BCMA targets preventable drug events
 Ultimately, protection of the patient is the
most important goal of BCMA
(Seibert, Maddox, Flynn, & Williams, 2014)
PICOT question
For patients in the intensive care
unit (ICU) (P), how does barcode
medication administration
(BCMA) (I) compared to no
BCMA system (C) affect the rate
of medication administration
error as recorded by direct
observation (O) over a period of
implementation lasting three
months (T)?
Significance of the ICU population
More errors occur in
the ICU than in any
other inpatient unit
Increased number
and complexity of
Sedated and critically
ill – no ability to
question medication
(DeYoung, Vanderkooi, & Barletta, 2009, Frith, 2013)
EBP Theory: Iowa Theory
“Provides guidance for nurses and other clinicians in
making decisions about day-to-day practices that
affect patient outcomes”
(Melnyk & Fineout Overholt, 2011, p. 251)
Iowa Model supports the changes made at the
organizational level rather than individually
Many successful examples are found in the literature
of the Iowa’s Model successful use
(Schaffer, Sandau, & Diedrick, 2012)
Why the Iowa Model?
Fits well with a pilot
 Fits with changes
made at the
organizational level
 The design supports
an interdisciplinary
team approach
(Melnyk & Fineout-Overholt, 2011,
Schaffer, Sandau, & Diedrick, 2012)
Literature review for PICOT
Key words searched: medication error, barcode
and bar-code, intensive care unit, medication
Boolean connector “AND”
CINAHL, PubMed, and Google Scholar
Searched articles published within the last 5 years.
Literature review for PICOT cont.
Inclusion criteria for articles:
 The study must document medication error
rates before and after BCMA implementation
Must use an observational method of
gathering data about medication errors
BCMA system implemented independently
of other technologies
Must be in the ICU setting
Include the highest level of evidence
Cohort Study: NICU setting
Studied neonates in a single NICU setting
for a total of 50 weeks.
 Purpose: to identify if using a BCMA
system reduces preventable adverse drug
events in the NICU.
 Findings: The BCMA system reduced these
preventable drug events by 47%
(Morris et. al, 2009)
Descriptive study : ICU setting
Quality improvement (QI) study that
observes medication errors made by
nurses in a single ICU setting for a total
of 1465 administrations
 Purpose: to see the effect of BCMA on
the rate of medication errors in the ICU
 Findings: The medication error rate was
reduced by 56% after implementation of
(DeYoung, Vanderkooi, & Barletta, 2009)
Quasi-experimental study:
multiple units
Before and after study of BCMA
implementation. Performed in a large
academic medical center. A total of 14,041
medication administrations were observed.
Purpose: To see the effect on BCMA with
EMAR on the rate of medication error rates in
various hospital settings
Findings: Among the various settings in the
hospital, there was an overall 41.4% reduction
in errors. ICU specific results revealed 42.5%
reduction in errors comparing before BCMA
implementation to after
(Poon et. al, 2010)
Internal Evidence
Medication error rates
before and after
BCMA implementation
Nursing satisfaction with
the system
 How were these
Look at the collaborative
relationship between
nursing, pharmacy, and
information technology
medication error rates
What percentage of
errors cause harm to
the patient?
Is there enough
information recorded to
be reliable?
Another technology
system simultaneously
How much did it cost?
(Ross, 2008)
Patient Preferences
Patients and their families prefer the use
of BCMA in the ICU setting
 ICU patient: vulnerable, critically ill, &
unable to question medications being
 BCMA: comforts patients by giving the
impression of reliability and accuracy
(Galvin, McBeth, Hasdorff, Tillson, & Thomas, 2007,
Frith, 2013)
Statement of Recommendation
The reoccurrence of decreased
medication error rates in multiple studies
with the use of a barcode medication
administration system makes a strong
case for its recommendation into
 BCMA is recommended over no BCMA
in the ICU setting.
Step-by-Step Implementation
1. Evaluate the need for
BCMA in the ICU
2. Appraise current processes
and readiness for BCMA
3. Form an active team of
resources/pick a strong
leader/ indentify
4. Formulate a plan/detailed
summary of supportive
evidence for BCMA
5. Present evidence to
financial approval
6. Order and prepare
7. Train nurse super-users
8. Nurse super-users orient
staff nurses in a
mandatory 3 hour course
9. “Go live” with the program
in the pilot setting of the
ICU/super-users available
10. Discuss barriers/strengths/
encourage feedback
11. Disseminate results of the
pilot. Determine the next
step for implementation
12. Continue to monitor and
analyze processes and
(Melnyk & Fineout-Overholt, 2011, p. 252,
Fineout-Overholt et. al, 2011)
This concludes the
presentation on the
evidence-based practice
change recommendation for
barcode medication
DeYoung, J., VanderKooi, M., & Barletta, J. (2009). Effect of bar-code
assisted medication administration on medication error rates in an adult
medical intensive care unit. American Journal of Health-System
Pharmacists, 66, 1110-1115.
Dubin, C. (2010). Bar-code scanning at four health care facilities in the U.S.
Pharmacy and Therapeutics (P&T), 35 (4), 212-233.
Fineout-Overholt, E., Williamson, K., Gallager-Ford, L., Melnyk, B., &
Stillwell, S. (2011). Following the evidence: Planning for sustainable
change. American Journal of Nursing, 111(1), 54-60.
Frith, K. (2013). Medication errors in the intensive care unit. American
Association of Critical-Care Nurses, 24(4), 389-404.
Galvin, L., McBeth, S., Hasdorff, C., Tillson, M., & Thomas, S. (2007).
Medication bar coding: To scan or not to scan? Computer, Informatics,
Nursing, 25(2), 86-92.
Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in
nursing and healthcare, 2nd edition. Philedelphia, PA: Lippincott Williams &
Reference cont.
Morriss, F., Abramowitz, P., Nelson, S., Milavetz, G., Michael, S., Gordon,
S….Cook, E. (2009). Effectiveness of a barcode medication administration
system in reducing preventable adverse drug events in a neonatal intensive
care unit: A prospective cohort study. The Journal of Pediatrics, 3, 363-368.
Poon, E., Keohane, C., Yoon, C., Ditmore, B., Bane, A., Levtzion-Korach,
O….Gandhi, T. (2010). Effect of bar-code technology on the safety of
medication administration. The New England Journal of Medicine, 362,
Ross, J. (2008) Collaboration: Integrating nursing, pharmacy, and
information technology into a barcode administration system implementation.
Caring: Connecting, Sharing, & Advancing Heathcare Informatics, 23(1), 117.
Schaffer, M., Sandau, K., & Dietrick, L. (2012). Evidence-based practice
models for organizational change: Overview and practical applications.
Journal of Advanced Nursing 69(5), 1197–1209.
Siebert, H., Maddox, R., Flynn, E., & Williams, C. (2014). Effect of barcode
technology with electronic medication administration record on medication
accuracy rates. American Journal of Health-System Pharmacy, 71, 209-217.

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