1. Yvette Ugarte, MSN, RN, DNP (c)
Patient Safety and Medication Management: Nurse Compliance with BCMA Scanning
Yvette Ugarte, MSN, RN, DNP (c)
Discussions
Recommendations
Purpose
Results
To compare the Barcode Medication administration System (BCMA) medication scanning failures during PDSA with the first quarter of the year 2018 (October-December 2017=FY18 Q1) at the James A Haley Veterans Hospital (JAHVH).
Compliance was set at 99% by Pharmacy Department. The Veterans Health Administration Support Service Center (VCCS) set target at >93% compliance for wristband scanning errors and >97% compliance on medication scanning errors.
To promote patient safety.
Implications for Patient Safety: National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP, 2017) discourage the use of medication error for benchmarking but supports use of lessons learned. JAHVH recognizes need for stronger/closer monitoring of BCMA scanning compliance and risks to patient safety.
Implications to Leadership: Meeting VCCS target goals may be perceived as complacency and may preclude efforts to improve BCMA scanning use,
Implications to Compliance and Practice: FY18 Q1 medication errors surpassed the pre-PDSA by >50%. High clinical significance.
PDSA Unit specific PDSA Pilot in 4S showed 93.93% improvement in BCMA scanning errors in all medication, and 85.92% in Controlled Substances errors.
Controlled Substance rate of BCMA scanning errors throughout the in-patient area improved 77.2% during PDSA FY1’18 showed an increased in scanning errors (90.5 %).
Improvements in BCMA scanning are necessary. Successful PDSA must be considered as an example to follow. Leadership should consider support efforts towards reduction of number of BCMA medication failures rather than relying on solely target goals.
Because of the need for constant and multimodal surveillance and the need to solve emerging challenges to ensure compliance, it is suggested that a full-time position like NPL is created.
JAHVH in-patient unit showed 1.52% of medication scanning errors and 4.57% of wristband scanning errors occurred in FY18 Q1 (below pharmacy standards/on-target goal for VCCS).
Rate and percentage varies from unit to unit. Units with higher percentages of errors were identified in both, wristband and medication scanning errors.
Comparing percentages of errors per unit, by type of medication (controlled substance (CS) only and medications in general), and by tour of duty. Each unit have different challenges in different tours and with CS.
Results
Purpose
Discussion
Scan of all Medications
Total scanning
attempts (WB+M scan)
Wristband (WB)
Correctly
Scanned
WB by- pass Keyed entry
WB by-pass unable to scan
Medications (M) Correctly
M by-pass keyed Entry
M by-pass unable to scan
M by- pass manual entry
Oct FY1 18
# of events
Percentage
75,675
329,075
73,066
96.55%
2,022
2.67%
587
0.78%
325320
98.86%
1,018
0.81%
2735
0.83% 2 0%
Nov FY1 18
74,291
324,334
70,792
95.29%
2,607
3.51%
892
1.20%
320,434
98.8%
1,185
0.37%
2,715
0.84%
Dec FY1 18
76,891
340,012
72,616
94.44%
3,119
4.06%
1,156
1.5%
335,408
98.65%
1,163
0.34%
3,441
1.01%
Average attempts per month
75,619
331,140
72,158
95.43%
2,583
3.41%
878
1.16%
327,054
98.97%
1,122
0.54%
2,963.7
0.49%
0.67
Scan of all Medications
N=Total Attempts (WB+M scan)
Wristband (WB) Scan
WB by pass Keyed entry
WB By Pass unable to scan
Medication Scan (M)
Medication By pass keyed Entry
M By pass unable to scan
M By pass manual entry
Pre-PDAS
Sep’13 FY4 13
# of events
Percentage
61,661
242,441
59,870
97.1%
1,296
2.1%
495
0.8%
237,706
98.0%
1,212
0.5%
3,523
1.5% 0%
Post-PDSA
Dec’14 FY1 15
Level of Improvement
64,462
261,437
63,072
97.8%
+ 0.7%
947
- 0.6%
443
0.7%
- 0.1%
258,200
98.8%
+ 0.8%
971
0.4%
2,266
- 0.7% =
Ave. attempts
FY1 18
# events
75,619
331,140
72,158
95.43%
2,583
3.41%
878
1.16%
327,054
98.97%
1,122
0.54%
2,963.7
0.49%
0.67
Acknowledgements
Scanning Failures
Compliance for Wristband Scanning
# of units <92.5%
# of units
>/=92.5 <96.5%
>/=96.5%
Oct FY1 18
Nov FY1 18
Dec FY1 18
3/22 (4N,5NPCU, ARC I)
4/22 (4N,5NPCU, ARC I, SCI-F)
5/22 (4N,5NPCU, ARC I, MICU,
SCI-F)
4/22
6/22
15/22
12/22
11/22
Compliance for
Medication Scanning
# of units <97.5%
# of units >/=97.5<98.5%
# of units >/=98.5
Nov FY 18
Dec FY 18
1/22 (MICU)
4/22 (4N, 5NPCU, MICU, SICU)
7/22
17/22
14/22
Dr. Candace Burns, PhD., ARNP, FAAOHN. Director Dual Degree Program AGPCNP/ Occupational Health Nursing. Deputy Director USF Sunshine Education & Research Center (SERC) who served as USF Faculty Supervisor.
Courtney Ullrich, PharmD, BCPS. Inpatient Pharmacy Supervisor, who served as JAHVH preceptor.
Myriam Onyebueke, DNP AGPC, who served as mentor JAHVH.
Erika Reynolds, MS, RN-BC. Clinical Informatics Nurse, JAHVH.
Katerina Smith, MPH, Program Specialist, Data Acquisition and Analytics Services (DAAS), JAHVH.
Kelley Wood, MSN, RN. Clinical Nurse Educator – Acute Care, JAHVH.
Kathleen Manley, ARNP. Clinical Nurse Educator - Acute Care, JAHVH.
Melinda Casey MSN, DNP© for her friendship and moral support.
PATIENT SAFETY …
…IS OUR MISSION
Background
Safe medication administration is key to prevent medical errors, and It is a mandatory requirement for initial and renewal licensing (Florida Department of Health 2018).
BCMA reduces medical error during medication administration but compliance remains an issue.
Bedside medication administration is a nursing task, PDSA implementation should be a Nursing driven project.
Problem Significance: 34% of medical errors during medication administration (Voshall, et al., 2013); 400,000 preventable drug-related injuries per year (Wisor, 2016). Devastating human and financial loss (Macias et al., 2018).
Methods
Data Collection: Review of BCMA records include rates and percentages of scanning errors. Pharmacy Supervisor was the facility preceptor. Support for data analysis was provided by the Departments of Analytics (DAAS), Nursing Informatics, and Compliance. Data was entered in protected electronic database.
Data analysis: Descriptive statistics and data graphs used. Four variables were analyzed. Data stored at the JAVAH S-Drive (protected database).
Methods: Plan-do-study-act (PDSA) cycle to assess need for implementation in the in-patient hospital wards.
Total # CS scanning failures
Range of failures by units
Overall Improvement (percentage)
Pre-Implementation
Dec 2013 FY1 14
325
1-71 per unit
n/a
Post-Implementation
Aug 2014 FY4 2014 74
0-14 per unit
77.2%
Dec 2017
FY1 2018
141
0-25 per unit