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More Opinion and still lack of science on BCMA

01/21/2009

This is getting downright weird.  I am starting to feel like Henry Fonda in 12 Angry Men, calling for real proof of decrease med errors rather than jumping on the BCMA bandwagon. 

New Report on Lessons from AHRQ-Funded Barcode Medication Administration Projects

The AHRQ National Resource Center for Health Information Technology has released a new report that summarizes key findings from grantees who have examined how applications such as barcode medication administration can improve the quality, safety, efficiency, and effectiveness of health care. The report focuses on lessons learned, challenges, and opportunities associated with introducing these applications into real-world clinical settings so that others who wish to implement and use barcode medication administration and electronic medication administration record technologies can learn from the experiences of these AHRQ projects. Select to access the report.

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Would like to hear reactions to the just released report.

My spin: It is my view that the statement below from the report does NOT support BCMA.

“Research has demonstrated successful reductions in the rate of medication administration and dispensing errors after the implementation of barcoding systems,8-16”

Reference 8 and 9 are on the dispensing process that are elegant and very convincing for the dispensing process not BCMA.

Reference 10-16 are not research studies showing reduction in errors but opinion pieces. They assume that BCMA will decrease errors and give commentary from that perspective. None of the references are research to show decrease medication errors. Something as important as this needs science not opinion.

8. Poon EG, Cina JL Churchill W, Patel N, et al. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Ann Intern Med 2006 Sep 19;145(6):426-34.

9. Poon EG, Cina JL, Churchill WW, et al. Effect of bar-code technology on the incidence of medication dispensing errors and potential adverse drug events in a hospital pharmacy. AMIA Annu Symp Proc 2005:1085.

10. Patterson ES, Rogers ML, Render ML. Fifteen best practice recommendations for bar-code medication administration in the veterans health administration. Jt Comm J Qual Saf 2004 Jul;30(7):355-65.

11. Wright AA, Katz IT. Bar coding for patient safety. N Engl J Med 2005;353:329-31.

12. Patchett JA. Bar coding: A practical approach to improving medication safety. ASHP Advantage; North Shore LIJ; Hospira; 2004:1-11.

13. Department of Health and Human Services: Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 2004;69(38):201-601.

14. Department of Health and Human Services: Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 2004;69(38):201-601.

15. The Joint Commission. http://www.jointcommission.org/. Accessed August 30, 2008.

16. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.

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One Comment leave one →
  1. Barry Keil, PharmD permalink
    01/21/2009 11:48 pm

    I not only agree with John Poikonen, but also question, assuming that BCMA does someday prove to be effective in reducing errors, how a small community hospital, with limited resources and multiple information systems, is supposed to make Bar Coding medications at bedside work? I have no way to equate a manufacturer’s bar code on the unit dose package with the NDC-identified product in the Pharmacy Information system, since there is no standardization of bar code information, and few, if any, bar code imprints match the 11-digit standard NDC numbers supplied by First DataBank and other database vendors.

    Tremendous resources have been utilized by the VA Hospital system to monitor bar codes…to the point that the VA has an entire department, their BCRO, to maintain that task to ensure that the bar codes on manufacturers’ products are readable and can be maintained in the VA IT system. A small, community hospital does not have those resources, yet we use the same number, or more, formulary items as the VA, with perhaps a greater variety of vendors.

    Bar codes should identify the drug, regardless of the manufacturer…not the NDC number (plus whatever additional information the manufacturer has arbitrarily decided to include). Additional modalities can be utilized to provide NDC numbers for billing purposes, but the NDC bar code, as it exists today, is not the panacea that BCMA advocates want us to believe it is.

    Until such time as the Government (i.e., FDA) can develop and dictate a standard that all manufacturers and IT providers can utilize, the time and cost to implement a Bar Code Medication Administration system can not be wasted in the face of opinion rather than scientific study. Why can’t we apply “Evidence-based Medicine” to BCMA?

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