Rodney Dangerfield of Decreasing Medication Errors - Avoid Interruptions
The practice of avoiding interruptions in the medication administration process is the Rodney Dangerfield of drug administration - It gets no respect. Instead millions of dollars are spent on bar coding everything under the sun. So in my ongoing theme of Bar Code Medication Administration (BCMA) is a complete waste of time, money and a boondoggle (search this blog for BCMA), here is more scientific evidence that the right thing to do is to isolate nurses giving medications so that interruptions are kept at a minimum. This will produce the same or better results than sending money down a rat hole with BCMA. I anxiously wait for science to tell me otherwise.
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Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors
Johanna I. Westbrook; Amanda Woods; Marilyn I. Rob; William T. M. Dunsmuir; Richard O. Day
Arch Intern Med. 2010; 170:683-690. ABSTRACT | FULL TEXT | PDF -
Giving Medication Administration the Respect It Is Due: Comment on: "Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors"
Julie Kliger
Arch Intern Med. 2010; 170:690-692. EXTRACT | FULL TEXT | PDF
Comments
BCMA isn't evil
Thanks for the information, John. We came to similar conclusions regarding interruptions to nursing workflow when we did our FMEA for BCMA.
Three things. First I agree that interruptions are a big contributor to errors and need to be addressed with the same zeal you would use to pursue anything else. Second, I’ve spoken with you in person and corresponded with you via email so I am willing to concede that BCMA has not been shown to increase patient safety in any well designed, prospective study. Third, I need you to remove your BCMA/BPOC haters cap for a minute or at least turn it around backwards until the end of my comments.
The difficulty with doing BCMA studies is that they are nearly impossible to design secondary to the nature of the process. Data collection prior to implementation is difficult. People have tried, but filed. There are just too many variables and assumptions. Until someone figures out a good way to prospectively collect pre-implementation data I’m afraid we won’t have a real picture of the impact of BCMA on patient care. However, with all things being equal, it is intuitive to me that the addition of a double check in the form of a barcode verification between the nurse and the patient could potentially prevent an error. The same could be said for an extra pair of eyes as a double check, but that won't happen because resources are a real life problem.
Removing patient safety from the picture does not necessarily eliminate the utility or need for BCMA in my opinion. It does offer some other potential benefits. BCMA can be used to track, control and monitor inventory as well as be used to collect medication usage data. Throw in the ability for pharmacists to track administration of medications in real-time and I think it’s a worthwhile endeavor. Of course this all depends on BCMA being implemented and used properly, which is no different than any other technology, process or procedure. No technology, including CPOE, CDS, ADC, etc. will have a positive impact if used improperly or bypassed all together.
I'm going to climb down off my soapbox now and you can put your haters cap back on.
Outcome study design?
Do not like to think of myself as hating anything. I am just pushing for evidence. So much spending in time and $ on "public relations based" practice. If you went to the P&T committee to approve a drug with the same evidence as BCMA, you would be laughed out of the room. I applaud you and everyone that is implementing this technology with the notion that it is evolving and needs study and attention. Too many view it as a feel good panacea and pat themselves on the back for decreasing med errors, when it may or may not be doing so.
So how about a multi facility OUTCOMES based study? If decrease of errors is really happening then patient's should be having better outcomes. This is were a lot of the EHR research is starting to appear. A focused effort on drug administration and outcomes would be interesting.
I have always postulated that BCMA for IV administration would have a positive outcome. Doing bcma for everything just seems like much ado about nothing, and would have zippo outcome difference. Better folks than me might design such a study to determine the value.
Healthy discourse.