Many hospitals have already adopted barcode med administration (BCMA) due to its benefits which include safe medication administration practices and reduction of medication errors. Implementing BCMA can be a large and complex undertaking with many facets to be considered. Having worked on a full BCMA implementation at an academic medical center, there are a few lessons I’ve learned that can benefit those just beginning their BCMA project. Here are 10 tips to consider when implementing BCMA that will help you have a smooth and successful transition.
- Adjust policies and procedures prior to your implementation in order to support the transition and compliance of BCMA. You will need to update your medication administration policies to include the BCMA technology and workflow changes. You should also add any new compliance standards you’ll have for staff concerning the use of BCMA.
- Give the pharmacy time to validate all medication barcodes in their inventory and adjust purchasing practices. Your inpatient pharmacy will need time to prepare for BCMA. They’ll probably need a new inventory validation process which will involve making sure all existing and newly purchased medications have valid barcodes. They may find that it’s necessary to make purchasing adjustments by buying unit dose packages with individual barcodes already on the medication as opposed to buying in bulk and repackaging with printed barcodes.
- Scanner selection: Who to involve? You will learn that implementing BCMA is huge collaborative effort among many departments. When selecting a scanner, make sure you consult your EHR vendor first; they may have recommendations. You should also involve the end users who will be using the scanners (nursing and pharmacy), and don’t forget to include your technical service team who will be maintaining the scanners. The technical service team will be responsible for installation of the scanners (whether on carts or in the rooms) and troubleshooting any equipment failures. You may also want to involve your environmental service team before purchasing the scanners. They will know your hospitals cleaning policies and which disinfectants are currently used. They will want to hear what products and what practices the vendor recommends for safe cleaning of the scanners.
- Wristband considerations. If purchasing new wristbands, you’ll want to consider that certain patient populations may need different types of wristbands. For example, you may be able to use a standard wrap-around wristband for adults, but may need a “tag” type to accommodate the small wrists/ankles of a neonate. It’s also very important to the end user to place the barcodes on the wristband in a way that makes for easy scanning. Keep in mind that you may need multiple types of barcodes (linear, 2D) on a wristband if you have multiple systems that use wristbands for identification. When starting out, you’ll also want to test the wristband barcodes with any unique registration workflows and all visit/encounter types, especially if you won’t be printing the wristbands directly from your EHR system.
- Training, training, training. Your staff should feel comfortable using the BCMA system prior to implementation. Just knowing the steps of BCMA may not be enough when performing BCMA at a patient’s bedside. “Practice makes perfect” is a great way to ensure ease of adoption. If possible, have the scanners in place prior to the go-live date so staff can practice with them before they start seeing the alerts and warnings.
- Be prepared for non-compliant workarounds. No matter how much you emphasize the safety benefits of using BCMA, there’s always going to be someone looking for a workaround. If you have alerts setup for medications that needs dual-sign-off, make sure that the second user has to enter their password instead of scanning their badge. People are more reluctant to give someone their password than give them their badge to scan. You may also want to limit who can print wristbands and where they are printed. BCMA should be done at the bedside using the wristband on the patient; having extra wristbands available makes it possible to perform BCMA without proper patient identification. Also, be careful with spare medication barcode stickers. Sometimes it’s necessary to have a separate barcode sticker for medications that have to be transferred from one package with the barcode to another that needs to be labeled with a barcode (ex. transferring a med from an ample to a syringe). Staff may place the spare barcode stickers on their carts to use repeatedly instead of labeling the medication each time. Inspection of med rooms/carts and leadership enforcing the rules will help with this issue.
- Develop and communicate a BCMA issue reporting process. No matter how much you prepare for your go-live, there will always be reportable problems. You should have a simple way for the end-users to report issues and make it clear what information is needed in order to research the problem. Also, make sure the reporting mechanism is feasible for a busy nurse; you may need to have multiple ways of communication such as calling the HelpDesk or a drop-box for written issues and med barcode examples. Unfortunately with BCMA issues, it can be difficult to identify where the problem is being generated from; it could be a broken scanner, something wrong with the barcode on the med, or something not configured correctly in the EHR. Have a plan to quickly diagnosis and triage the issues as they come in.
- Specialty areas may need extra planning. Sometimes you will need to think outside the box for specific areas within your facility. The emergency department may need extra help to deal with their department specific workflows such as codes, non-identified patients, and the high frequency of verbal orders. The psych department may also need special considerations around what type of scanner you use. You will probably need wireless scanners since scanners with a cord could be a safety issue. You might also need to purchase tablets or mobile devices with a scanner installed versus using the traditional scanner that can resemble a gun.
- Non-medication barcode scanning. Some organizations use barcode scanning for non-medications such as blood, breast milk, and tube feeds. If this is true for you, try to standardize the workflow by using the MAR for all, or try to combine scanner equipment. The more standardized the workflows are, the easier it is for the staff to comply.
- Have a plan to maintain compliance. Once you are live with BCMA, make sure you have the appropriate steps in place to monitor progress and enforce compliance. Reports are the best way to keep track of your compliance percentage. You should have the ability to view compliance at multiple levels such as by facility, department, and user. You may also want to view compliance by medication to easily spot medications with non-working or difficult barcodes to scan. If you have problem-users, make sure you have some kind of follow-up training and/or support for those users. Also, as discussed in tip #1, your policies should help reinforce compliance and support your leaders in administering corrective action, if needed.
Transitioning to BCMA can seem like a daunting process but with an open mind and a lot of preparation, it doesn’t have to be. There’s a lot more to be considered than what’s mentioned here, but hopefully these few tips will make for an easier, more successful implementation. For more information, contact us: