Quality Improvement 2012: Using 2D Barcodes to Enhance Bedside Medication Delivery
Project Goal: Improve the rate of scanning medications at the bedside from 88% to 99.5%.
Time Frame: 2008 – 2011.
Project Summary: One strategy to reduce medication administration errors is bar-coded medication administration (BCMA). BCMA technology involves placing a unique identifier (barcode) on each unit-dose of medication and a unique identifier (name) on the patient’s armband so that each can be read by an optical scanner. The nurse can safely administer the medication if there is a match between the drugs the nurse has to give the patient, the drugs ordered (as listed on the patient’s profile) and the patient’s identification. Medication identification is confirmed with a barcode scan of the medication. Patient identification is confirmed with a barcode scan of the patient’s wristband. If the two scans do not match, there is an alert that cautions the nurse not to give the medication until the discrepancy can be cleared up. Research has demonstrated at 42% relative reduction in medical tin administration errors using this type of system.
Unfortunately, the current linear barcode standards generally adopted in most healthcare applications are not fail-safe and encourage users to create ways to work around the process that increase, rather than decrease, the opportunity for error. A Linear barcode curves around the patient’s wrist and is therefore difficult to scan. Among others, it required the nurse to free up one hand in order to stretch out the linear barcode and scan it, or required that the patient be awakened during sleep to properly scan the wristband. In either case, this was a disruption to the flow of the medication administration process and created opportunity for error. To address this, the team instituted an innovative 2D data matrix barcode that was easier to scan because it is smaller than a linear barcode and can be replicated multiple times around the base of the patient’s wristband. Once implemented, the nurses no longer needed to free up both hands in order to stretch out the length of the wristband, nor did they need to disturb the patient.
As a result of this and other key interventions employed during the improvement phase of the project, SVMC’s medication scan rate increased from 88.4% to 97.7% over 36 months since BCMA went live in 2008. Not only are these rates higher than any other scan rates noted in the literature, but they have also been sustained over time.
Contact: Avis Hayden, PhD.
Patient Safety & Quality
Note: This project was featured as a full-length article entitled Design for Reliability:
Barcoded Medication Administration published in the Journal for Patient Safety & Quality Healthcare July/August 2011