Poster - #2022UCDH-44 - Keywords: BCMA Barcode Medication Administration Data Quality Interventional Radiology Nurse Analytics Patient Safety

An Examination of Bar Code Medication Administration: A Focus on Data Quality

Ashley Johnson, BSN, RN, CCRN & Rosemary Kombo, BSN, RN
Department of Radiology, UC Davis Health

ABSTRACT:
Background The days of hand calculations and deciphering reels of data are a relic of the past. Health informatics has changed the face of data collection. Academic journals, treatment algorithms, and quality initiatives are driven by hi-tech data mining and analysis. Hospitals use this data to improve patient outcomes. Purpose The National Institute of Health estimates at least 1.5 million people are affected by medication errors each year. One of the efforts to improve medication errors has been instituting Bar Code Medication Administration (BCMA). BCMA creates checks and balances by requiring a medication scan, a user scan, and a patient scan. However, it is necessary to evaluate how the data is collected and if it truly reflects its intended measure for each hospital unit. Methods The data was gathered from U.C. Davis Health, Department of Radiology from January 1, 2021, to December 31, 2021, via internal reports compiled in Tableau. The first set of data was gathered for the unit named HOSP IR. The second set of data was gathered for each individual nurse (IR RN) that is assigned to HOSP IR. A comparison of the data was performed. If the data was being collected correctly then the medication scan rate and the patient scan rate should be the same for both sets of data. However, if the rates are different a further delve into the data collection methods is warranted. Results When the data was analyzed by department, HOSP IR had 91.3% of all patients scanned and 90.8% of all medications scanned with a total of 1,667 administration events. When the data was analyzed by aggregating the data from each IR RN assigned to the Interventional Radiology department there were 97.4% patients scanned and 96.9% of all medications scanned with 9,445 total administration events. There are more than five times more administration events when the data is collected by individual nurses than when data is collected for the HOSP IR department. The overall inaccuracy for BCMA compliance for interventional radiology RNs is greater than 6% for both medication scans and patient scans. Discussion The difference in the reported versus the actual data is significant when comparing the two methods for gathering the data. When the data by nurse is evaluated, IR nurses have data attributed to several other units (where IR nurses do not float). Furthermore, pharmacists and nurses from other units also appeared on the HOSP IR administration events. In the case of pharmacists, they never administer medications in the HOSP IR unit. All administrations by pharmacists were chemotherapeutic agents administered in HOSP IR by oncology providers. The most likely cause of incorrect data collection would be the patient location as indicated in EPIC, but this theory must be explored more in depth. Conclusion and Implications The human element is necessary to make informatics technology operational. BCMA has emerged as a validated tool to help facilitate safer patient care. However, before analyzing unit data from this tool, care must be made to ensure the accuracy of the data. There are three important implications for BCMA from this review. First, reviewing the accuracy of data mining validates quality improvement measures. Second, data from ancillary areas warrant closer examination as these areas are likely to have different data collection needs than traditional units. And finally, despite the inaccurate data, there is still work to be done in the HOSP IR department to meet hospital benchmarks for BCMA. Inaccurate data can lead to an overuse of resources or implementing unnecessary measures. Collaborative efforts with quality and safety, operational analytics, and the information technologists are necessary to fix the current data collections methods for BCMA to reflect accurate results.