Integration of a Commercial Barcode-Assisted Medication Dispensing System in a Teaching Hospital

Abstract

Objectives A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process.

Methods We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study.

Results There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget).

Conclusion This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.

Keywords

electronic data processing - medication systems - medication errors - hospital information systems - integrated information systems - specific types - clinical information systems - pharmacy

• References

• 1 Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother 2013; 47 (02) 237-256
• 2 Berdot S, Gillaizeau F, Caruba T, Prognon P, Durieux P, Sabatier B. Drug administration errors in hospital inpatients: a systematic review. PLoS One 2013; 8 (06) e68856
• 3 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
• 4 Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf 2013; 36 (11) 1045-1067
• 5 Beso A, Franklin BD, Barber N. The frequency and potential causes of dispensing errors in a hospital pharmacy. Pharm World Sci 2005; 27 (03) 182-190
• 6 Cina JL, Gandhi TK, Churchill W. , et al. How many hospital pharmacy medication dispensing errors go undetected?. Jt Comm J Qual Patient Saf 2006; 32 (02) 73-80
• 7 Allan EL, Barker KN. Fundamentals of medication error research. Am J Hosp Pharm 1990; 47 (03) 555-571
• 8 Hicks RW, Cousins DD, Williams RL. Selected medication-error data from USP's MEDMARX program for 2002. Am J Health Syst Pharm 2004; 61 (10) 993-1000
• 9 Agence Française de Sécurité Sanitaire des produits de Santé (ANSM). Le Guichet Erreurs Médicamenteuses: Bilan d'activité de l'année 2009; 2010
• 10 Fox BI, Pedersen CA, Gumpper KF. ASHP national survey on informatics: assessment of the adoption and use of pharmacy informatics in U.S. hospitals-2013. Am J Health Syst Pharm 2015; 72 (08) 636-655
• 11 T H, Heelon M, Siano B. , et al. Medication safety improves after implementation of positive patient identification. Appl Clin Inform 2010; 1 (03) 213-220
• 12 Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2002. Am J Health Syst Pharm 2003; 60 (01) 52-68
• 13 Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing-2016. Am J Health Syst Pharm 2017; 74 (17) 1336-1352
• 14 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 (06) 426-434
• 15 Barker KN, McConnell WE. The problems of detecting medication errors in hospitals. Am J Hosp Pharm 1962; 19: 361-369
• 16 Flynn EA, Barker KN, Pepper GA, Bates DW, Mikeal RL. Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. Am J Health Syst Pharm 2002; 59 (05) 436-446
• 17 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378-382
• 18 Allan BL. Calculating medication error rates. Am J Hosp Pharm 1987; 44 (05) 1044-1046
• 19 ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm 1993; 50 (02) 305-314
• 20 Siska MH, Tribble DA. Opportunities and challenges related to technology in supporting optimal pharmacy practice models in hospitals and health systems. Am J Health Syst Pharm 2011; 68 (12) 1116-1126
• 21 Phast - Information de santé standardisée (CIO - PN13 - MIO). Available at: http://www.phast.fr/about-phast-2/ . Accessed July 19, 2019
• 22 Samaranayake NR, Cheung STD, Cheng K, Lai K, Chui WCM, Cheung BMY. Implementing a bar-code assisted medication administration system: effects on the dispensing process and user perceptions. Int J Med Inform 2014; 83 (06) 450-458
• 23 Koppel R, Metlay JP, Cohen A. , et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-1203
• 24 Using Resources with Services and Service-oriented Architecture. Available at: https://www.hl7.org/fhir/services.html . Accessed July 19, 2019
• 25 Saleem JJ, Russ AL, Sanderson P, Johnson TR, Zhang J, Sittig DF. Current challenges and opportunities for better integration of human factors research with development of clinical information systems. Yearb Med Inform 2009; 48-58
• 26 Zachariah M, Phansalkar S, Seidling HM. , et al. Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems--I-MeDeSA. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i62-i72
• 27 Phansalkar S, Edworthy J, Hellier E. , et al. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. J Am Med Inform Assoc 2010; 17 (05) 493-501
• 28 Klein K, Stolk P. Challenges and opportunities for the traceability of (biological) medicinal products. Drug Saf 2018; 41 (10) 911-918
• 29 Nanji KC, Cina J, Patel N, Churchill W, Gandhi TK, Poon EG. Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: a case study. J Am Med Inform Assoc 2009; 16 (05) 645-650
• 30 Koppel R, Wetterneck T, Telles JL, Karsh BT. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008; 15 (04) 408-423
• 31 Van der Veen W, van den Bemt PMLA, Wouters H. , et al. Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. J Am Med Inform Assoc 2018; 25 (04) 385-392
• 32 Wang J, Liang H, Kang H, Gong Y. Understanding health information technology induced medication safety events by two conceptual frameworks. Appl Clin Inform 2019; 10 (01) 158-167
• 33 Holden RJ, Brown RL, Scanlon MC, Karsh B-T. Pharmacy workers' perceptions and acceptance of bar-coded medication technology in a pediatric hospital. Res Social Adm Pharm 2012; 8 (06) 509-522
• 34 Boussadi A, Bousquet C, Sabatier B, Caruba T, Durieux P, Degoulet P. A business rules design framework for a pharmaceutical validation and alert system. Methods Inf Med 2011; 50 (01) 36-50
• 35 Boehm B, Abts C, Brown A. , et al. Software Cost Estimation with COCOMO II. Upper Saddle River, NJ: Pearson Education (US); 2009