Abstract and Introduction
Abstract
Purpose: The implementation of a multidisciplinary approach to systematically decrease medication errors through the use of observation methodology and the deployment of electronic medication administration records (EMARs) and bar-coded-medication administration (BCMA) is described.
Summary: For a consistent and reliable approach to data collection, a direct-observation technique was used. The measurement of medication errors using the observation process occurred in two phasespreimplementation and postimplementation. Three inpatient nursing units participated. The control group was a 20-bed cardiac telemetry unit. Intervention group 1 was also a 20-bed cardiac telemetry unit. Intervention group 2 was a 36-bed medicalsurgical unit. During the first phase of the study, all three study groups participated in evaluating the medication administration process associated with a manual five-day medication administration record (MAR). A total of 188 errors were reported. The pharmacy, nursing, and information services departments collaborated on the design and deployment of the EMAR and BCMA systems. The systems were implemented in one nursing unit in August 2003, with full implementation on all inpatient units by July 2004. During the second phase of the study, the control group continued to use the manual five-day MAR without a change in the process. Intervention groups 1 and 2 were measured to evaluate the medication administration process using EMAR and BCMA technology. The direct-observation accuracy rate before BCMA was 86.5%; after BCMA, the rate rose to 97%.
Conclusion: The direct-observation methodology was used to monitor medication administration before and after the deployment of the EMAR and BCMA systems. A 54% reduction of medication administration errors was observed following implementation of a multidisciplinary, collaborative approach to medication safety.
Introduction
Over the past several years, literature has accumulated to support the need to improve the safety of the medication-use process in hospitals. Medication errors cause an estimated 7000 deaths each year and cost the nation $2 billion annually. The majority of medication errors that actually reach a hospitalized patient occur when a dose of medication is incorrectly administered at the patient's bedside. Bates and associates found 34% of preventable adverse drug events occur at the administration step of the medication process. Careful, systematic deployment of information technology holds the potential to reduce medication errors, the most common type of medical errors made in hospitals today. The 2005 ASHP national survey of pharmacy practice in hospital settings revealed that in 2002, only 3% of like-sized institutions (>400 staffed beds) had completed implementation of bar-coded-medication administration (BCMA), and this number rose to 17.2% in 2005. BCMA implementation is increasing overall as well, with 9.4% of hospitals reporting its implementation in 2005, compared with just 1.5% in 2002. The use of handwritten medication administration records (MARs) is decreasing, with a shift toward computer-generated paper MARs and electronic medication administration records (EMARs), both of which reduce the risk of errors related to handwriting, omission, and transcription.
A multidisciplinary approach to systematically decrease medication errors through the use of observation methodology and the deployment of an EMAR and BCMA verification system was implemented at Lancaster General Hospital. The goal of this project was to reduce medication errors occurring during medication administration by 50%. The project objectives were (1) to effectively use an observation-based medication error detection system to provide a reliable and effective mechanism for identifying medication errors during administration, (2) to identify and implement a best-practice technology solution for EMAR and BCMA verification, (3) to improve pharmacy and nursing communication, (4) to maintain nursing satisfaction through the minimization of additional workload, (5) to project a leadership role to our community in the area of patient safety, and (6) to establish a data source to allow for continual and effective identification of systems issues in order to facilitate a proactive approach to prevent medication error occurrence. This article serves to describe the first three years of this hospital's efforts to improve the safety of medication administration and restructure our medication-use process.