Hospitals falling short on implementing bar code medication administration

Ever noticed the steps nurses have to go through when they administer medications in the hospital? Scanning, typing, asking the patient for name and birthday – these steps protect patient health and hospitals from liability. Despite how useful these steps are for reducing medication errors, the Leapfrog Group found that not all hospitals are using them effectively.

Only 30 percent of hospitals are meeting standards

In the 2017 report on medication safety, Castlight Health analyzed hospital use of bar code medication administration (BCMA) and computer physician order entry (CPOE) systems. Although Leapfrog’s standard standards include implementation of a BCMA to cover 100 percent of a hospital’s intensive care and medical/surgical units, along with several important processes, only 30 percent of hospitals met all four of Leapfrog’s criteria.

BCMA systems

A BCMA system requires the administering nurse to scan a bar code on the patient’s wristband and then scan the bar code on the medication. This ensures that the “Five Rights of Medication Administration” are met: right patient, drug, dose, time, and route. The Leapfrog Group developed the first industry standard for BCMA adoption and included measurement elements in its 2016 hospital survey. One of Leapfrog’s standards requires scanning both bar codes for 95 percent of bedside administration in units with BCMA systems.

Findings

Although 97.8 reporting hospitals have a BCMA system in at least one inpatient unit connected to their electronic medication administration record, only 30 percent of the hospitals fully met the standard. A remaining 35 percent fulfilled three out of the four, and 26 percent met two of the criteria.

The most commonly unmet requirement was integration of Leapfrog’s seven decision support elements. These support elements are ensuring that the patient, medication, dose, and time are correct as well as checking for vital signs, performing a patient-specific allergy check, and having a second nurse perform a check. Out of these elements, the vital sign check was the most frequently lacking at 80 percent. Hospitals also failed to adhere to Leapfrog’s best practice processes and workaround prevention, which require (1) formal BCMA use committee; (2) back-up systems for hardware failure; (3) a help desk; (4) observation of BCMA users; and (5) engaging nursing leadership.

Reporting issues

In addition to the BCMA elements in the hospital survey, Leapfrog’s CPOE Evaluation Tool allows hospitals to download simulated data and input patient and medication combinations into their systems. Hospitals then track the alerts generated by the system and are scored based on correct alerts. Leapfrog noted that although more hospitals have been meeting the CPOE standards, an additional 26 percent of reporting hospitals failed to meet these standards. Only 22 percent of hospitals that reported CPOE and BCMA data fully met all standards. Leapfrog noted that some hospitals are not reporting their data at all, and noted that this can cause a serious gap in understanding hospital medication safety because Leapfrog is the only organization that publicly reports this data.

Leapfrog names the ABCs of hospital-acquired conditions

Since the 2012 establishment of the Leapfrog Group’s Hospital Safety Grade health care rating system, patient safety has improved across the country, including a 21 percent reduction in hospital-acquired conditions (HACs). However, significant patient safety problems persist. For example, over 1000 people are estimated to die each day from preventable errors—the third leading cause of death in the country.

Rating

The Leapfrog Hospital Safety Grade is the only national health care rating focused on errors, accidents, and infections. The program has assigned letter grades—A, B, C, D, F—to general acute-care hospitals in the U.S. since 2012 based upon national performance measures from CMS, the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the American Hospital Association’s Annual Survey and Health Information Technology Supplement.

Improvement

A significant area of improvement is the 21 percent reduction in HACs between 2010 and 2015. The positive stride is attributable, in part, to Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) provisions designed to reduce HACs (see By any measure, national effort to increase health care safety succeeded, Health Law Daily, December 13, 2016). However, the HAC progress is not without its caveats. Estimates of hospital related patient harms put the number of hospital deaths related to preventable errors at over 400,000 per year.

The Leapfrog Group identified other areas of progress, regarding the reduction of medication errors through increased adoption and functionality of computerized physician order entry systems, as well the development of public and private partnerships to reduce HACs.

Grades 

Five years into the Leapfrog Hospital Safety Grade scoring, 63 out of over 2,600 hospitals have achieved an “A” in every national scoring update. In the most recent rating of 2,369 hospitals, 823 earned an “A,” 706 earned a “B,” 933 earned a “C,” 167 earned a “D” and 10 earned an “F”. The five states with the highest percentage of “A” hospitals were Maine, Hawaii, Oregon, Wisconsin and Idaho.