Factsheet: Bar Code Medication Administration

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Page | 1 Factsheet: Bar Code Medication Administration

Last Revision: 04/01/2021

Measure Background

Medication errors often have tragic consequences for

patients. Many serious medication errors result in

preventable adverse drug events (ADEs), approximately

20% of which are life-threatening.

1,2

According to the

Institute of Medicine’s report, To Err is Human,

medication errors alone contribute to 7,000 deaths

annually.

Despite clinicians’ best efforts, over 40% of

serious and life-threatening ADEs are preventable.

Medication errors also result in tremendous financial

costs. ADEs add more than $7.5 billion per year

nationwide in hospital costs alone.

Furthermore, this

figure excludes other important costs of medication

errors, such as malpractice insurance premiums and

losses in worker productivity.

Errors resulting in preventable ADEs occur during the

stages of ordering, administration, transcription, and

dispensing. Over 30% of these errors are committed at

the point of administration.

What is Bar Code Medication

Administration?

Bar code medication administration (BCMA) systems are

electronic scanning systems that intercept medication

errors at the point of administration. When

administering medications with BCMA, a nurse scans a

bar code on the patient’s wristband to confirm that the

patient is the right patient. The nurse then scans a bar

code on the medicine to verify that it is the right

medication at the right dose, given at the right time by

the right route. These are known as the “Five Rights of

Medication Administration.”

BCMA is typically used in conjunction with electronic

medication administration record (eMAR) systems. An

eMAR serves as the communication interphase that

automatically documents the administration of

medication into certified Electronic Health Record (EHR)

technology. By linking BCMA with the eMAR,

information on medication administration is captured in

a much timelier manner than a manual documentation

process can accomplish.

BCMA systems also can be used for pharmacy stocking

and retrieval processes to help avoid medication

dispensing errors. BCMA implementation in the

pharmacy has been shown to significantly reduce

dispensing errors.

Leapfrog’s current focus is on BCMA

use at the bedside, with possible future expansion into

the pharmacy.

Effectiveness of BCMA in Reducing

Errors

BCMA implementation can be remarkably effective in

reducing medication administration errors. A study of

BCMA-eMAR implementation in an academic medical

center demonstrated a 41.1% relative reduction in

nontiming errors in medication administration, resulting

in a 50.8% relative reduction in potential ADEs due to

such errors.

BCMA implementation in the ED has also

shown a relative reduction of 80.7% in medication

administration errors.

BCMA has also demonstrated financial benefits. While

BCMA implementation costs approximately $2,000 per

harmful medication error averted, this is less expensive

than the estimated $3,100 -$7,400 cost of a harmful

error.

The Leapfrog BCMA Standard

With the guidance of a national panel of experts in

BCMA use, The Leapfrog Group developed a standard

for hospital adoption of BCMA. Leapfrog’s standard

focuses on four components of BCMA implementation:

• The extent of a hospital’s BCMA implementation

throughout the hospital with a focus on medical

and/or surgical units (adult and pediatric),

intensive care units (adult, pediatric, and

neonatal), and labor and delivery units.

• A hospital’s compliance with both patient and

medication scans at the bedside prior to

administering medications.

• The types of decision support that the hospital’s

BCMA system offers.

• A hospital’s structures to monitor and reduce

workarounds.

Hospitals fully meeting the Leapfrog standard:

• Have implemented BCMA systems in 100% of

their medical and/or surgical units (adult and

pediatric), intensive care units (adult, pediatric,

and neonatal), and labor and delivery units.

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Factsheet: Bar Code Medication Administration

• Have both patient and medication scans in 95% of

the bedside medication administrations in units

that have implemented BCMA

• Have a BCMA system that includes all five

elements of decision support that have been

identified as best-practice by the Leapfrog BCMA

Expert Panel.

• Have implemented at least six of the eight best-

practice processes and structures to prevent

workarounds.

Challenges to BCMA Implementation

While most hospitals reporting to the Leapfrog Hospital

Survey indicate that they have implemented BCMA

system in at least one inpatient unit, some hospitals

have not adopted BCMA or are not using it in all units.

What are the challenges?

• BCMA adoption requires significant efforts to

redefine caregiver responsibilities and workflows,

which must all be communicated to staff through

trainings and demonstrations.

• Cultural obstacles may inhibit BCMA

implementation. For example, some nurses resist

utilizing BCMA as it introduces additional steps

into their already-hectic care schedules.

• The cost of implementing and operating BCMA is

one major hurdle for some hospitals. A study by

Sakowski and Ketchel estimated the cost of

implementing and operating BCMA including

electronic pharmacy management and drug

repackaging over five years to be $35,600 to

$54,600 per BCMA-enabled bed.

As such, a 100-

bed hospital can spend over $3 million in BCMA

implementation over the initial five years.

Why Purchasers Need to Get

Involved

Given these challenges, hospitals may need

encouragement from purchasers to maximize the

efficiency of their BCMA systems. While BCMA systems

may require significant investments, they help avoid

even more significant costs due to medication errors.

More importantly, BCMA systems can significantly

reduce the risk of adverse drug events that can cause

significant harm or even death to employees.

References

1. Bates DW, Teich JM, Lee J, et al. The impact of computerized

physician order entry on medication error prevention. J

Am Med Inform Assoc. 1999;6(4):313-321.

2. Bates DW, Leape LL, Cullen DJ,et al. Effect of computerized

physician order entry and a team intervention on

prevention of serious medication errors. JAMA.

1998;280(15):1311-1316.

3. Kohn LT, Corrigan JM, Donaldson MS. To err is human:

Building a safer health system. committee on health care

in america. institute of medicine. . 1999.

4. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug

events and potential adverse drug events: Implications

for prevention. JAMA. 1995;274(1):29-34.

5. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug

events in hospitalized patients. JAMA. 1997;277(4):307-

311.

6. Poon EG, Cina JL, Churchill W, et al. Medication dispensing

errors and potential adverse drug events before and

after implementing bar code technology in the

pharmacy. Ann Intern Med. 2006;145(6):426-434.

7. Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code

technology on the safety of medication administration. N

Engl J Med. 2010;362(18):1698-1707.

8. Bonkowski J, Carnes C, Melucci J, et al. Effect of barcode‐

assisted medication administration on emergency

department medication errors. Acad Emerg Med.

2013;20(8):801-806.

9. Sakowski JA, Ketchel A. The cost of implementing inpatient

bar code medication administration. Am J Manag Care.

2013;19(2):e38-45.

10. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national

survey of pharmacy practice in hospital settings:

Monitoring and patient education–2012. Am J Health

Syst Pharm. 2013;70(9):787-803.

11. Gooder V. Nurses’ perceptions of a (BCMA) bar-coded

medication administration system: A case-control study.

Online Journal of Nursing Informatics (OJNI). 2011;15(2).

For a comprehensive list of references please review

the Bar Code Medication Administration Bibliography,

available here:

https://ratings.leapfroggroup.org/measure/hospital

/safe-medication-administration