March / April 2012
The Next Stage for BCMA
On February 23, 2012, CMS took the next step toward meaningful use of electronic health records (EHRs) by proposing Stage 2 criteria. In 2 years, CMS has provoked dramatic change in the EHR landscape, stimulating nearly 2,000 hospitals and more than 41,000 doctors to invest in IT with $3.1 billion in Stage 1 payments.
The proposed Stage 2 rule spans the healthcare continuum, but one objective, in particular, presents a significant opportunity to address a top source of patient harm. The criterion calls for 10% of medication orders to be tracked in electronic medication administration records (eMAR) that “automatically documents the administration of medication into certified EHR technology” using “assistive technology” (for example radio frequency identification [RFID] or electronically readable tagging such as barcoding.)
Since the mid-1990s, hospitals have been pairing barcoding with eMAR to achieve multiple goals including improved patient safety. Scanning facilitates compliance with The Joint Commission’s (TJC) National Patient Safety Goal for positive patient identification. More advanced systems support bedside verification of the correct medication, dose, and time of administration. Yet, one of the greatest benefits of barcode medication administration (BCMA) is real-time automated capture of accurate administration data.
Because the medication-use process is cyclical, delays and inaccuracies in documentation may impact prescriber therapy decisions. For example, a dose of warfarin is administered to a patient, but the nurse is interrupted before she can document the administration on the MAR. Meanwhile, the physician decides to increase warfarin dose based on recent lab results. Unaware of the dose already given, the physician orders the new higher total daily dose. If not caught by pharmacy or nursing, the new order may result in duplicate dosing and associated toxicities. With BCMA, administering is documenting. As the caregiver scans her badge, the patient wristband and the medication, the information is automatically, accurately, legibly captured and time-stamped. Both the physician and the reviewing pharmacist see the already administered dose and proceed with a smaller “booster” dose for the remainder of the day.
The inclusion of this objective was based on the experience of organizations such as Hospital Corporation of America and Brigham and Women’s Hospital, which have adopted and studied the impact of barcoding on dispensing and administration. Public statements of support from advocates including the Institute for Safe Medication Practices, the American Society of Health-System Pharmacists, TJC and the University HealthSystems Consortium no doubt influenced the inclusion as well. Yet, possibly the most compelling support for eMAR with assistive technology is the rapidly expanding base of hospitals already using this technology.
The TerraPharma Project estimates that approximately 46% of U.S. hospitals are using BCMA. While the early adopters were primarily academic medical centers and health systems, the next class to implement is composed of smaller facilities. Given the deadlines and limited resources of these providers, careful consideration must be given to the potential for unintended consequences if hospitals rush to achieve the objective with inadequate planning.
The most difficult component of a BCMA implementation is shepherding the change management process required to safely modify long-established workflow. For hospitals that target the minimum 10% threshold by piloting BMCA in isolated areas, the ramifications of operating BCMA on some units and non-scanning systems on others will be immediately evident. Those that fast-track a house-wide implementation and then rely on a few superusers to achieve the threshold, will fail to improve safety and possibly even create new sources of harm. BCMA implementation takes planning, collaboration, diligence, and time.
Hospitals have until fiscal year 2014 to meet Stage 2 criteria. There is time for most hospitals to implement BCMA properly. Fortunately, today’s adopters benefit from forums for peer-to-peer education which share BCMA best practices. The annual unSUMMIT for Bedside Barcoding in May 2012 unites multidisciplinary teams from hospitals in all stages of BCMA use.
Don’t Miss the Opportunity to Comment
CMS is accepting comments on the proposed rule until May 7, 2012. Please share specific safety benefits that your institution has realized with BCMA. To submit electronic comments go to http://www.regulations.gov/#!submitComment;D=CMS-2012-0022-0001 and complete the short form.
Medical Center Hospital in Odessa, Texas, worked with McKesson’s Clinical Consulting Services, an offering that optimizes clinical product performance through process redesign, standardization, and change management, to enhance clinical documentation by improving compliance with documentation standards, decreasing the variability of care, reducing medication errors, and accelerating return on investment. The hospital also utilizes McKesson’s comprehensive suite of clinical solutions.