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(NQF) has revised its list of practices that have proven effective in reducing adverse events – Pharmacy Informatics perspective

03/13/2009

The National Quality Forum (NQF) has revised its list of practices that have proven effective in reducing adverse events.  This is a very impressive list of practices.  It also revealing what is not on the list.

From a pure pharmacy informatics perspective the following practices are good to see.  CPOE and Pharmacy leadership are, of course, welcome additions to this list.  Using technology to enhance medication reconciliation and antimicrobial stewardship will go a long way to enhancing care as well and need a full court press by pharmacy and informatic departments.

Bar Code Medication Administration (BCMA) is not on the list.  This is not a big surprise.  I have settled into a role and view of a counter balance to most of my pharmacy colleagues.  There is a wide effort to implement BCMA to decrease adverse events without much evidence that it does anything.   Spouting a negative view on this practice is not comfortable nor one that I believe will last forever.  I fully believe that this practice will eventually be proven effective.  At this time it clearly is not.  Given this list of these proven practices, spending time and effort on BCMA if all of these practices are not fully exploted, may even be harmful.  We all have limited resources and time taken away from proven practices to ones of dubious value needs to be evaluated.

What say you?

John Poikonen
john@poikonen.NET
http://twitter.com/poikonen
Blog = http://pharmacyinformatics.wordpress.com/

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One Comment leave one →
  1. Dennis Tribble permalink
    03/13/2009 2:52 pm

    I think we have to admit that current BCMA implementations are at best problematic. Koppel et al documented a panoply of implementation problems from things as gross as COWs that wouldn’t fit through the doors of rooms, to user interfaces that required a nurse to complete the next chapter of her life story to document medication administration to upwards of 40% of doses failing to scan for a variety of reasons all of which are embarrasing to recite.

    It is clear that BCMA system rely on the notion that commercial packages reach the bedside, which we know is not true especially in hospitals. Some of our most public and egregious medication errors involved cases where the label was correct; the dose it was on was wrong. It is also clear that the pharmaceutical industry responded to the FDA mandate for bar codes on all packaging to contain the NDC by simply no longer making unit-dose medications (doses that WOULD be labeled with a commercial bar code all the way to the bedside).

    It is clear that the NDC is not appropriate as a clinical marker for BCMA purposes. It changes too often, it is too poorly controlled, and too often reused to be reliable as a marker for BCMA.

    Finally, as recently noted in a blog by Neuenschwander, health care providers still don’t believe they make mistakes so BCMA, like a lot of other safety initiatives, become additional tasks layered on top of an already-burdened caregiver workforce, performed begrudgingly and often incorrectly. Those who do use it correctly seem to have all experienced some kind of epiphany; often associated with an error or a near-miss.

    So it should be no surprise that the evidence for BCMA is spotty at best.

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