Patient safety is at risk when the nurse fails to follow the five rights of medication administration. Barcode medication administration (BCMA) has been proven to decrease medication administration errors by taking advantage of real-time administration documentation in the electronic health record (EHR). BCMA is a key safety process in the tertiary care setting that is closely measured and trended to safeguard medication administration. After years of meeting organization goal, compliance in the pediatric intensive care unit (PICU) decreased, causing nurse leaders to ask “why?”

Effective BCMA implementation requires a multidisciplinary approach with nursing, pharmacy, and information services department (ISD) to identify barriers and workflow issues. Physical aspects of barcode scanning, the scanners and labels, along with a hands-on approach to education are crucial. Nurse informaticists are key in bridging the gap to resolve issues and barriers and promote collaboration.

Data was recorded using a database management system that generated report from the EHR. A statistical process control chart (SPC) was used to plot monthly compliance using the total number of scanned medications divided by the total medications administered. January 2022 to July 2022 acted as the pre-intervention period. A mean was calculated using this time frame with baseline barcode scanning compliance at 90.8%. Aim goal was set to improve average monthly compliance in the PICU from 90.8% to 95% by August 2023. Subsequent monthly data points after the baseline time period were evaluated for statistical significance using SPC rules for shifts in the mean.

Interventions eliminated the shortage of workstation on wheels and unreliable scanners. Mobile EHR was utilized. Workflow analyses were completed to optimize the mobile EHR to improve functionality. In addition, mobile device setting updates were completed to eliminate frustration from end users when using the mobile application. Lastly, hands-on training was performed.
Next, the lack of ease and flexibility of the BCMA report was identified. The report included pages of PDF report that were difficult for nursing managers to trend and troubleshoot in real time. Nurses reported medications not scanning despite multiple attempts and reporting to pharmacy. Interactive dashboards were created to replace manual reports. The dashboards empowered nurse managers, nurses, pharmacy, and nursing informaticists to identify BCMA issues. The dashboards are user friendly, easy to trend, and comprehend. Managers are able to quickly see which users are not scanning while pharmacy can identify medications not scanning. Nurse informaticists utilize the dashboards to optimize medication administration documentation and workflows.

Scanning compliance in the PICU was 95.5% in August 2023. This is significant for a unit that administers thousands of critical and high-risk medications to pediatric patients. An improvement in average monthly barcode scanning compliance was demonstrated by a sustained centerline increase on the SPC chart. The success of this project is not the end, as interventions are being spread outside of PICU to sustain positive results towards patient safety. With interventions completed at a system level, collateral benefits increased scanning compliance not only in the PICU but in all inpatient areas, emergency, and respiratory therapy department.

Sheila Daniels MSN, RN, CCRN, NI-BC

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