Improve Patient Safety with Barcode Medication Administration (BCMA)

One of the most practical ways to reduce medication errors within a hospital is to implement a system called barcode medication administration (BCMA). BCMA is an inventory control system that is designed to make sure that patients are receiving the correct medications by electronically validating and documenting during the administration of medication¹.

The Patient Safety Network defines a medication error as “an error (of commission or omission) at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually receives the medication².” The pharmacy’s role typically occurs within the center of this pathway, after the clinician orders the medication and before the nurse administers the medication. However, pharmacy’s responsibility does not end after the medication order is checked and verified. We are responsible for providing the medication and ensuring that the medication can be administered appropriately to the patient. This is at the core of the “Five Rights” of safe medication administration:

1. The right patient
2. The right medication
3. At the right time
4. At the right dose
5. By the right route

BCMA plays an important role in preventing medication errors during the administration to the patient. As the name states, this system is dependent on barcodes. When admitted to a hospital, each patient is given an ID bracelet with an individual barcode that corresponds to the patient’s identification. Each drug in the hospital is also labeled with a unique barcode that corresponds to drug-specific information, such as a drug name, dose, and dosage form. 

Before the barcode administration occurs, medication therapy begins with a prescriber ordering a medication for a patient. The hospital pharmacy will receive the medication order through a computerized prescriber order entry (CPOE) system where a pharmacist can check and verify the medication order. After being verified by the pharmacist, the medication order becomes active and is listed within the patient’s medication profile. A nurse may then administer the medication at the proper time indicated within the medication order.

As a nurse or clinician is administering the medication, BCMA will be utilized to make sure the correct patient is receiving the correct medication. The nurse or clinician will use a handheld device that is electronically connected to a barcode point-of-care (BPOC) system, such as an electronic medication administration record (eMAR) system, to scan the barcode on the patient’s ID bracelet as well as the barcode on the medication. The BPOC system will compare the medication being administered with the medication that was ordered for the patient. If the BPOC system cannot match the medication being administered to the medication ordered within the patient’s profile it will visually alert the nurse or clinician with a warning indicating that the wrong medication is about to be administered to the patient. The BCMA system may give the nurse or clinician the option to override the alert, which would likely require the documentation of a reason by the user. It is always good practice to contact the pharmacy when a medication cannot be scanned properly within the BCMA system.

According to a study in the June 2016 issue of Hospital Pharmacy, the reported medication error rate decreased by 20% after the implementation of both BCMA and eMAR technologies, plus the use of BCMA correlated with a significant decrease in the harm caused to patients³. A separate study in a May 2010 issue of the New England Journal of Medicine found that the use of BCMA and an eMAR within the hospital studied was associated with a 41% reduction in non-timing administration errors and a 51% reduction in potential adverse drug events from these errors⁴.

BCMA technology, when combined with CPOE and eMAR systems, has shown to improve medication delivery within hospitals. Unfortunately, it is not possible to completely prevent medication errors, but barcode medication administration has been shown to reduce medication errors, increase patient safety, and ultimately improve patient care.

1. https://searchhealthit.techtarget.com/definition/Bar-Coded-Medication-Administration
2. https://psnet.ahrq.gov/primers/primer/23/Medication-Errors-and-Adverse-Drug-Events
3. https://www.ncbi.nlm.nih.gov/pubmed/27354749
4. https://www.nejm.org/doi/full/10.1056/NEJMsa0907115

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