Barcode Medication Administration (BCMA): A Quality Improvement Initiative in the Ambulatory Care Setting

Barcode medication administration (BCMA), a standard workflow in the acute care environment, is rarely used in the ambulatory care setting where medications and vaccines are frequently administered. The goal of BCMA is to align with principles and behaviors of causing no harm by providing a safe, consistent workflow to mitigate medication errors. As noted by Seibert (2014), the most common method of identifying medication administration errors is through voluntary reporting. An online portal for adverse event reporting was utilized throughout the project. To prepare for the pilot, multidisciplinary site visits were conducted to assess the quantity of scanners needed, current inventory of hardware, subsequent configuration, and team member training. BCMA project launched at 5 pilot practices (3 family medicine, 1 internal medicine, and 1 pediatric) to provide an additional layer of patient safety. The pilot reinforced verifying the five rights of medication administration: right patient (identified verbally with two identifiers), right medication, right dose, right time, and right route. Post go-live surveys were sent at 30-day and 60-day intervals to assess team members’ adaptiveness of the BCMA workflow, and site visits were conducted to provide support and education. Monthly adverse event reports were analyzed to trend medication administration related errors. Additionally, a BCMA Microsoft Power BI dashboard was utilized to review scanning rates and details, including scanning compliance and near misses. The scanning compliance goal was 95%, and after 8 months the pilot practices demonstrated a 94.3% compliance. BCMA utilization demonstrated a 40% decrease in self-reported medication administration errors during Q1 and Q2 2023, versus errors which occurred in the same period in 2022. Data collection is ongoing and continues to be analyzed by the project team. Epic development requests have been submitted to further improve Epic’s functionality with BCMA in the ambulatory care setting. After 6 months of BCMA, the results were favorable, and the decision was made to expand BCMA to 2 additional pediatric practices for fall 2023. Furthermore, BCMA is planned to expand throughout primary care practices in 2024. BCMA implementation has successfully decreased medication administration events. Team member survey results indicate there was overall satisfaction with BCMA.