TY - JOUR
AU - Bagby,, Jonathan
AB - Abstract Purpose. The implementation of a quality-monitoring program that identifies and corrects problems associated with using a bar-code-assisted medication administration (BCMA) system is described. Summary. In November 2004, the Bar Code Resource Office assembled a work group to develop a quality program to improve machine-readable, bar-coded medications. The project scope involved the development of a pharmacy-based quality program for unit-dose packaging and bar-code labeling to improve the scanning success rate of bar-coded medications at the point-of-care. Data were collected from facility-based BCMA coordinators at each medical center regarding specific reasons for bedside scanning circumvention, as well as successful scan rates in the pharmacy and at the bedside. The pharmacy and bedside scanning data were aggregated and the baseline of successful scans was determined to be 95%. The reported reasons for scanning circumvention were grouped into six categories: bar-code labeling, missing doses, labels not scanning, error messages, mispackaged medications, and mislabeled medications. The work group developed strategies to mitigate problems in each of the areas. As a result of this effort, the Department of Veterans Affairs created a directive that outlined the best practices for unit-dose packaging and labeling, as well as requirements for ongoing data collection and reporting. Conclusion. A quality-monitoring program that identified and provided best-practice recommendations corrected problems associated with using a BCMA system and improved bar-code labeling processes. Codes, Department of Veterans Affairs, Drug administration, Errors, medication, Hospitals, Pharmacy, institutional, hospital, Quality assurance In August 1999, the Department of Veterans Affairs released bar-code-assisted medication administration (BCMA) software to 172 Veterans Affairs (VA) medical centers. Designed as a point-of-care solution to reduce medication errors, BCMA validates the administration of medications by confirming the five rights: the right patient, the right medication, the right dose, and the right route at the right time. A discrepancy in any of the five rights triggers an alert or error message signaling the nurse to further investigate the medication order before administering the medication. A nurse equipped with a computer and a bar-code reader scans the patient’s bar-coded wristband to confirm patient identification. Once confirmed, the patient’s information and medication profile display on the software’s Virtual Due List. Medications to be administered within a facility-defined time frame displays on the computer screen. The nurse scans the bar-coded medication at the point-of-care. Proper use of BCMA point-of-care scanning technology relies on accurate bar-code labeling and decoding of all medications. Poor print quality, inappropriate label placement, and lack of bar codes on labels are examples of issues that can perpetuate scanning circumvention by the nurse administering medications. Bar-code-scanning circumvention bypasses the medication-to-patient safety features of BCMA. Circumvention of BCMA scanning at the point-of-care is reduced when all medications dispensed from pharmacy have accurate human- and machine-readable bar-code labels.1,–3 The ability of a machine (the bar-code scanner) to effectively read (decode the bar code) is defined as a scannable bar code. Because of the complexities involving the use of BCMA, there are circumstances when nurses circumvent the scanning function of BCMA to administer medications. Scanning circumventions (e.g., typing the medication-identifying information by hand, manually entering the medication administration documentation into the record away from the point-of-care system) may be caused by a number of factors including connectivity issues, computer issues, or a lack of machine-readable bar codes on medications. For these reasons, the Bar Code Resource Office (BCRO) of the VA has established two bar-code verification laboratories that diagnose and provide corrective actions for both locally-printed bar codes and manufacturer-supplied bar codes that are sent to them from any VA medical center. The laboratories are equipped with bar-code verifying machines that evaluate bar codes according to American National Standards Institute (ANSI) criteria and assign a grade of A, B, C, D, or F to each bar code—A being the best and F indicating the bar code fails to meet the criteria.4 All verification testing results and corrective actions are communicated back to the reporting facility. In addition, manufacturer-supplied bar codes with verification testing of D or F are communicated to the manufacturer, VA contracting authorities, and the Food and Drug Administration (FDA). Development of a bar-code quality program In November 2004, a work group comprised of representatives from the VA National Center for Patient Safety, Pharmacy Benefits Management-Strategic Health Group, BCRO, and VA staff pharmacists assembled to work on a project to create a bar-code quality program. The project scope involved the development of a pharmacy-based quality program for unit-dose packaging and bar-code labeling to improve the scanning success rate of bar-coded medications at the point-of-care.5 Identifying causes and corrective actions To begin the process, the baseline data provided by the facility-level BCMA coordinators, almost all of whom were nurses, were analyzed for problematic areas that had a negative effect on point-of-care scanning. The work group assembled reasons for scanning circumvention and sorted them into six categories: bar-code labeling, missing doses, labels not scanning, error messages, mispackaged medications, and mislabeled medications. Each of these categories was further divided into the problem and potential cause (Table 1). Once the potential causes were confirmed by the work group, pharmacy-based corrective actions were developed to avoid the identified risks and the following areas were identified as requiring specific attention. Bar-code labeling Procurement practices must ensure that unit-dose medications and i.v. fluids are purchased with scannable manufacturer bar-code labels whenever possible. When packaging bulk medications, the pharmacy must have an automated packager capable of packaging unit-dose medications with a minimum of an ANSI grade-C print-quality bar code. Multiple-dose containers, such as insulin vials, will have the bar code applied on the immediate container by the pharmacy if a machine-readable bar code is not available from the manufacturer. A process must exist to relabel medications already dispensed to patient care areas that do not have bar codes. Missing doses Missing doses can lead to medication errors by omission if the issues related to the missing-dose requests are not resolved promptly. Problems with missing doses caused by new orders can be rectified by ensuring local protocols delineate time frames or turnaround times for the completion, delivery, and administration of stat, now, and routine orders. Facility standardized administration times and cart-checking processes, as well as a standardized location on each nursing unit for the delivery of medications, all help reduce the incidence of missing doses. Where medication carts are used, the cart exchanges occur at least every 24 hours, ensuring that no more than a 24-hour supply of doses is available in the patient care area at one time. Labels not scanning Pharmacy label printers must have the capacity to print high-resolution bar-code labels so the bar code can be correctly decoded. Standardized label placement on small items, such as ampuls, vials, and ointment tubes, will help ensure that the bar code scans at the point-of-care. Implementing a standard bar-code symbology across the medical center for labels printed onsite will help mitigate the risk of a scanner not being able to decode a label because of variations in scanner programming. “Drug not found” software error message The manufacturer’s bar-coded National Drug Code (NDC) numbers or bar codes generated by other dispensing systems must be manually scanned into the synonym field of the pharmacy drug file. Most often, an incorrect or missing synonym in the drug-file-synonym field generates this error message when a bar code is scanned. Pharmacy personnel must scan bar codes into the Veterans Health Information System Technology Architecture (VistA) system as synonyms using a scanner that has the same configuration as scanners used at the point-of-care. Mispackaged medications The pharmacy prepares and packages medications according to the United States Pharmacopoeia (USP), national practice standards, and all applicable federal and state laws and regulations. When there is an automated packager to apply bar codes to unit-dose medications, the pharmacy uses formalized safety processes for packaging medications and replenishment of automated dispensing cabinets to ensure the safety of personnel and to prevent packaging errors. At a minimum, independent double checks are performed to prevent medication errors. Mislabeled medications The pharmacy prints labels with bar codes for pharmacy-prepared or patient-specific medications. All dispensed medications are appropriately and safely labeled using a standardized protocol to include, at a minimum, the drug name, strength, amount, lot number, and expiration date. Specific recommendations Based on the above considerations, detailed recommendations for practice standards have been made in the areas of bar-code labeling, packaging, quality control, and business practices. Bar-code labeling: The pharmacy must have the resources to extemporaneously package or repackage products not available in bar-coded, unit-dose preparations, including oral liquids and solids. The pharmacy must ensure that bar-coded, unit-dose, or ward-stock items, such as i.v. solutions, controlled substances, items available in unitbased cabinets, and items transferred into patient care areas using BCMA from non-BCMA areas (e.g., emergency department, operating room), have appropriate bar-code labels applied. The pharmacy must have an automated packaging system that applies bar codes to unit-dose medications. Bar-code labels must be securely fastened to the immediate container of the drug to ensure an accurate scan-success rate at the point-of-care (avoiding curvature of the bar code). Label placement on small items (e.g., ampuls, vials, ointment tubes) to avoid curvature of the bar code will help ensure accurate scanning at the point-of-care. Bulk or multidose containers (e.g., insulin, topical, inhalers) must have the bar-code label affixed directly to the product, as the outer packaging is often discarded once the product reaches the point-of-care. Packaging resources include the capability to affix small bar-code labels, as may be required to label ampuls and vials (or the capability to affix bar codes to plastic overwrap or tamperevident plastic bags). The pharmacy must have sufficient equipment (e.g., packaging machines, printers, computers) and supplies required to produce ANSI grade-C, target-A resolution bar codes. The pharmacy relabels items from the manufacturer until the manufacturer corrects the bar codes that do not scan. The pharmacy then attempts to identify an alternative source for the product. Packaging: The pharmacy prepares and packages the medications according to USP6 and following the American Society of Health-System Pharmacists Technical Assistance Bulletin on Single-Unit and Unit-Dose Packages of Drugs7 and all other applicable laws and regulations. Formalized safety processes for packaging medications and for replenishing automated dispensing cabinets and automated packaging equipment (internal to the pharmacy) to prevent packaging errors are also used. Double checks or appropriate quality-control measures prevent incorrect medication packaging and repackaging. The pharmacy prints labels with bar codes for pharmacy-prepared, patient-specific medications. Appropriate packaging and labeling log records are maintained in accordance with applicable practice standards and laws. Quality control: Procurement practice provides (for purchase of manufacturers) individually bar-coded, unit-dose medication for institutional patient care where available (including unit-dose liquids, controlled substances, and respiratory therapy medications). Scanning into the VistA-synonym field of the drug file must be accomplished with a bar-code reader that matches the configuration of the BCMA point-of-care scanner. There is an internal quality-control program that ensures that the pharmacy has the capacity to generate high-quality bar-code labels. All medications dispensed are appropriately and safely labeled using a standardized protocol to include, at a minimum, drug name, strength, amount, expiration date, and control number. There is a mechanism in place to ensure that the initials of the pharmacist and technician dispensing the medications are recorded on the medication label before release to the patient care areas. Unit-dose medications remain in the manufacturer’s unit-dose (or immediate container) packaging until the actual drug administration at the point-of-care. Business practices: Pharmacy staff scan manufacturer-provided, bar-coded products into the VistA-synonym field of the drug files upon receipt to assure that the bar code on the product received matches the drug file synonym and the product’s readable label. The manufacturer’s bar-coded NDC numbers (or bar codes generated by other dispensing systems) must be scanned into the VistA-synonym field of the drug file before they are put into active inventory so that nonrecognizable bar codes do not reach the patient’s bedside. Unit-dose medications are purchased with bar codes that scan and decode correctly. Each VA medical center has its own unique business practice associated with the intake and processing of medications, identifying faulty bar codes, and labeling and relabeling of medications. The bar-code-labeling problem-solving matrix (Figure 1) was created to assist facilities with identifying and troubleshooting deficient areas. Development of quality monitors After the problematic areas and best practices to correct deficiencies were identified, six quality monitors were developed. The bar-code labels of controlled substances, manufacturers’ products, and i.v. medications, as well as labels generated by automated packaging machines and the inpatient pharmacy, are monitored for quality by the pharmacy staff and make up the first five monitors. The sixth monitor includes observation of the first five monitors by an end user at the point-of-care. The directive requires that at least 95% of unit-dose medications dispensed from the pharmacy have machine-readable and decodable bar codes at the point-of-care. The rationale for 95% is based on variables that constitute a variance of approximately 5%, such as the user’s influence on the ability of a machine (the bar-code scanner) to effectively read (decode that bar code), the scanner setup and maintenance, the bar-code label print quality, the bar-code label medium, and the environment of use. Best-practice recommendations are intended to promote redundancy and high reliability in high-quality, safe patient care environments. Each facility must establish processes for ensuring that (1) a scanner with the same configuration as the scanners used in the patient care areas is attached to a computer (mobile or fixed) that provides appropriate access to BCMA software within inpatient pharmacy, including the narcotic vault and the i.v. room, (2) metrics are completed based on pre-defined parameters on a quarterly basis, and (3) metric results are shared with a governing body. From the six quality monitors within the directive, the first five monitors are designed to improve pharmacy processes by identifying failed bar codes to be corrected before leaving the pharmacy. The sixth monitor, the end user, validates that the actions taken in the pharmacy have reduced scanning failures at the point-of-care. Establishing baseline data During the development of the quality directive, baseline scanning data were obtained from 19 VA facilities. Two-hundred scans were requested from each facility: 20 scans from each of the pharmacy monitors and 20 from each of the 5 end-user monitors. The total number of scans analyzed was 3900, as some sites provided more data on their scanned products. In the developmental sample, the pharmacy automated packager was the only monitor to exceed the threshold (98%). Scanned manufacturer-prepackaged, unit-dose medications were the least reliable at 87% successful scans. Facility aggregate baseline averages across all six monitors varied from 80% at some facilities to 100% at others. The average across all facilities was 92%. Of the 19 facilities reporting, only 6 facilities (31.5%) reported baseline data above the 95% threshold. Baseline monitor results On February 15, 2006, the Quality Directive for Unit-Dose Packaging and Bar-Code Labeling was distributed to 146 VA medical centers using BCMA. Using the same method, results from 200 bar-code-product scans were requested from the facilities that did not originally report. Of the VA medical centers that used BCMA, 95% (n = 132) reported baseline data and the aggregate success rate of the six monitors was 95% (Table 2). The overall success rate for each monitor was pharmacy-controlled substances, 92%; pharmacy manufacturers’ bar-code label-quality monitor, 91%; pharmacy i.v. quality monitor, 98%; pharmacy-automated unit-dose packaging systems quality-control monitor, 99%; pharmacy-relabeled-drugs quality monitor, 97%; and the end-user monitor, 93%. The numbers (percentages) of facilities achieving threshold in order of monitor success rate are 126 (87%) for automated packaging, 121 (83%) for pharmacy relabeled, 117 (81%) for i.v. label, 83 (57%) for controlled substance, 81 (56%) for end user, and 75 (52%) for manufacturer package. Areas identified to be most problematic include the controlled-substances, manufacturer’s unit-dose, and the end-user monitors. Although comments for corrective action were not required as part of the reporting, 66% (n = 91) of facilities shared their problems and corrective actions. Since the largest number of responses were in the areas of pharmacy-controlled substances, manufacturers’ bar-code label quality, and the end-user monitor, those responses were analyzed to find common areas of concern. The most prevalent area of concern in the pharmacy-controlled substances and the manufacturers’ bar-code label-quality monitors (over 50%) was the lack of the bar-code synonym in the VistA pharmacy drug file. The second area of concern was the inability of point-of-care scanners to read newer bar-code symbologies. These two concerns accounted for approximately 20% of the comments received on the two pharmacy monitors evaluated. The end-user monitor’s most prevalent areas of concern (29% of the comments received) were torn, faded, or curved bar codes and the lack of a bar code on the immediate product for the nurse to scan. Issues with the lack of the bar-code synonym in the VistA pharmacy drug file were also expressed. Although consistent bar-code-quality printing issues were not major areas of concern with the pharmacy monitors, they were observed as a problematic area by the end users. The current scanners’ ability to read a particular symbology accounted for 13–20% of the comments received. Many sites that are aware of their scanners’ inability to read certain bar-code symbologies are implementing local measures to relabel the medications until the scanners can be updated. Three areas that required immediate attention were (1) entering bar-code synonyms in the VistA pharmacy drug database, (2) properly labeling all products for the end user, and (3) upgrading scanners to read newer bar-code symbologies. Monitoring results after the quality program The enterprise success rates for the directive increased each quarter. The overall percentage success rate from 132 facilities showed a statistically significant increase of 4%, from 95% at the February 2006 baseline to 99% in December 2006 (p = 0.05). Of the initial 146 sites queried, 14 sites were discarded because they were unable to provide either preimplementation or postimplementation data. Table 2 depicts the percentage of change for the individual monitors. All monitors showed an increased success rate over the baseline data-collection period. The aggregate remained at 99% through September 2007. Analysis of the initial reporting period showed that only one monitor, the manufacturers’ bar-code monitor, did not meet the 95% compliance threshold. This was, in part, because of the large number of new products that had bar codes added as the result of the FDA mandate to bar code all products used in hospitals. The controlled-substance and the manufacturers’ package monitors were below an acceptable level for the enterprise during the baseline reporting period. These two monitors had a significant negative impact on the success rate of the end-user monitor. Since the fourth quarter of fiscal year 2006, all monitors have been above the 95% compliance threshold. The increases in facilities achieving the 95% threshold compliance mirrored the improvement in monitor success rate. A comparison of the facilities achieving threshold compliance for each monitor is shown in Table 2. The most significant increases occurred within the controlled-substance, manufacturers, and end-user monitors, which had special emphasis placed on them by facilities after the baseline reporting period. Discussion One element of a successful BCMA system is a program within each medical center pharmacy that ensures that machine-readable and correctly decoded bar codes are dispensed to the BCMA point-of-care areas. The VA Quality Directive for Unit-Dose Packaging and Bar Code Labeling prescribes a goal of 95% compliance and provides the tools that pharmacies can use to work toward achieving this goal.5 Diligence has been required by medical center staff to continuously monitor medication labels, correct identified deficiencies, and report metrics quarterly to the BCRO. Some type of monitor is essential in any medical center that is using bar-code technology for administration of medications. The use of the VA Quality Directive for Unit-Dose Packaging and Bar Code Labeling has helped remove some of the barriers that were identified as impeding the appropriate use of BCMA and improved the scan success rate of medications in VA. Conclusion A quality-monitoring program that identified and provided best-practice recommendations corrected problems associated with using a BCMA system and improved bar-code labeling processes. Table 1. Problems and Potential Causes for BCMA Circumvention Related to Labeling or Packaging Issuesa Problem Potential Cause aBCMA = bar-code-assisted medication administration. No bar-code labels on drugs on ward Drug does not come labeled from manufacturer, not enough staff in pharmacy to label, labels fall off in medicine drawer, labels are not placed on immediate drug containers Missing doses New orders, no standardized medication-administration times, no 24-hr cart exchanges Labels do not scan Bar-code print quality, synonym not filled in or not correct in pharmacy drug file, scanning technique, label attachment techniques, no standard symbology, readability of bar code, manufacturer’s unit of use bar code not scanned into synonym field Medication scans but triggers the software error message “Drug not found” Hardware problem (e.g., printer, scanner), scanning technique, synonym not filled in or not correct in pharmacy drug file Mispackaged medications Wrong label placed on drug, automated packager or automation filled incorrectly, automated packager or automation malfunctioning, failure in checking process Mislabeled (medications or patient) I.V. label placed on wrong premixed drug, pharmacy-created bar-code label placed on incorrect package, unit-dose label contains incorrect directions, failure in checking process (quality control) Problem Potential Cause aBCMA = bar-code-assisted medication administration. No bar-code labels on drugs on ward Drug does not come labeled from manufacturer, not enough staff in pharmacy to label, labels fall off in medicine drawer, labels are not placed on immediate drug containers Missing doses New orders, no standardized medication-administration times, no 24-hr cart exchanges Labels do not scan Bar-code print quality, synonym not filled in or not correct in pharmacy drug file, scanning technique, label attachment techniques, no standard symbology, readability of bar code, manufacturer’s unit of use bar code not scanned into synonym field Medication scans but triggers the software error message “Drug not found” Hardware problem (e.g., printer, scanner), scanning technique, synonym not filled in or not correct in pharmacy drug file Mispackaged medications Wrong label placed on drug, automated packager or automation filled incorrectly, automated packager or automation malfunctioning, failure in checking process Mislabeled (medications or patient) I.V. label placed on wrong premixed drug, pharmacy-created bar-code label placed on incorrect package, unit-dose label contains incorrect directions, failure in checking process (quality control) Table 1. Problems and Potential Causes for BCMA Circumvention Related to Labeling or Packaging Issuesa Problem Potential Cause aBCMA = bar-code-assisted medication administration. No bar-code labels on drugs on ward Drug does not come labeled from manufacturer, not enough staff in pharmacy to label, labels fall off in medicine drawer, labels are not placed on immediate drug containers Missing doses New orders, no standardized medication-administration times, no 24-hr cart exchanges Labels do not scan Bar-code print quality, synonym not filled in or not correct in pharmacy drug file, scanning technique, label attachment techniques, no standard symbology, readability of bar code, manufacturer’s unit of use bar code not scanned into synonym field Medication scans but triggers the software error message “Drug not found” Hardware problem (e.g., printer, scanner), scanning technique, synonym not filled in or not correct in pharmacy drug file Mispackaged medications Wrong label placed on drug, automated packager or automation filled incorrectly, automated packager or automation malfunctioning, failure in checking process Mislabeled (medications or patient) I.V. label placed on wrong premixed drug, pharmacy-created bar-code label placed on incorrect package, unit-dose label contains incorrect directions, failure in checking process (quality control) Problem Potential Cause aBCMA = bar-code-assisted medication administration. No bar-code labels on drugs on ward Drug does not come labeled from manufacturer, not enough staff in pharmacy to label, labels fall off in medicine drawer, labels are not placed on immediate drug containers Missing doses New orders, no standardized medication-administration times, no 24-hr cart exchanges Labels do not scan Bar-code print quality, synonym not filled in or not correct in pharmacy drug file, scanning technique, label attachment techniques, no standard symbology, readability of bar code, manufacturer’s unit of use bar code not scanned into synonym field Medication scans but triggers the software error message “Drug not found” Hardware problem (e.g., printer, scanner), scanning technique, synonym not filled in or not correct in pharmacy drug file Mispackaged medications Wrong label placed on drug, automated packager or automation filled incorrectly, automated packager or automation malfunctioning, failure in checking process Mislabeled (medications or patient) I.V. label placed on wrong premixed drug, pharmacy-created bar-code label placed on incorrect package, unit-dose label contains incorrect directions, failure in checking process (quality control) Table 2. Comparison of Successful Scan Rate and Compliance Goal Before and After Quality Program % Successful Scan Facilities Achieving 95% Compliance (n= 132) Monitor Baseline 4th Quarter FY07a Increase No. (%)Baseline No. (%) 4th Quarter FY07 % Increase aFY07 = fiscal year 2007. Pharmacy-controlled substance 92 99 7 83 (57) 111 (77) 20 Manufacturer’s bar-code monitor 91 97 6 75 (51) 111 (72) 21 I.V. labeling 98 100 2 117 (80) 125 (87) 7 Automated unit-dose packaging monitor 99 100 1 126 (86) 129 (88) 2 Pharmacy-relabeled monitor 97 100 3 121 (83) 130 (90) 7 End-user quality monitor 93 98 5 81 (56) 116 (80) 24 Overall 95 99 4 112 (77) 134 (92) 15 % Successful Scan Facilities Achieving 95% Compliance (n= 132) Monitor Baseline 4th Quarter FY07a Increase No. (%)Baseline No. (%) 4th Quarter FY07 % Increase aFY07 = fiscal year 2007. Pharmacy-controlled substance 92 99 7 83 (57) 111 (77) 20 Manufacturer’s bar-code monitor 91 97 6 75 (51) 111 (72) 21 I.V. labeling 98 100 2 117 (80) 125 (87) 7 Automated unit-dose packaging monitor 99 100 1 126 (86) 129 (88) 2 Pharmacy-relabeled monitor 97 100 3 121 (83) 130 (90) 7 End-user quality monitor 93 98 5 81 (56) 116 (80) 24 Overall 95 99 4 112 (77) 134 (92) 15 Table 2. Comparison of Successful Scan Rate and Compliance Goal Before and After Quality Program % Successful Scan Facilities Achieving 95% Compliance (n= 132) Monitor Baseline 4th Quarter FY07a Increase No. (%)Baseline No. (%) 4th Quarter FY07 % Increase aFY07 = fiscal year 2007. Pharmacy-controlled substance 92 99 7 83 (57) 111 (77) 20 Manufacturer’s bar-code monitor 91 97 6 75 (51) 111 (72) 21 I.V. labeling 98 100 2 117 (80) 125 (87) 7 Automated unit-dose packaging monitor 99 100 1 126 (86) 129 (88) 2 Pharmacy-relabeled monitor 97 100 3 121 (83) 130 (90) 7 End-user quality monitor 93 98 5 81 (56) 116 (80) 24 Overall 95 99 4 112 (77) 134 (92) 15 % Successful Scan Facilities Achieving 95% Compliance (n= 132) Monitor Baseline 4th Quarter FY07a Increase No. (%)Baseline No. (%) 4th Quarter FY07 % Increase aFY07 = fiscal year 2007. Pharmacy-controlled substance 92 99 7 83 (57) 111 (77) 20 Manufacturer’s bar-code monitor 91 97 6 75 (51) 111 (72) 21 I.V. labeling 98 100 2 117 (80) 125 (87) 7 Automated unit-dose packaging monitor 99 100 1 126 (86) 129 (88) 2 Pharmacy-relabeled monitor 97 100 3 121 (83) 130 (90) 7 End-user quality monitor 93 98 5 81 (56) 116 (80) 24 Overall 95 99 4 112 (77) 134 (92) 15 Figure 1. Open in new tabDownload slide Bar-code-labeling problem-solving matrix.a BCRO = Bar Code Resource Office, FDA = Food and Drug Administration, VA = Veterans Affairs, BCMA = bar-code-assisted medication administration. Figure 1. Open in new tabDownload slide Bar-code-labeling problem-solving matrix.a BCRO = Bar Code Resource Office, FDA = Food and Drug Administration, VA = Veterans Affairs, BCMA = bar-code-assisted medication administration. References 1 American Society of Hospital Pharmacists. Technical assistance bulletin on single unit and unit dose packages of drugs. Am J Hosp Pharm . 1985 ; 42 : 378 –9. PubMed 2 Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999 . 3 Mills PD, Neily J, Mims E et al. Improving the bar-coded medication administration system at the Department of Veterans Affairs. Am J Health-Syst Pharm . 2006 ; 63 : 1442 –7. Crossref Search ADS PubMed 4 American National Standards Institute. ANSI x3.182: bar code quality guideline. Washington, DC; 1999 . 5 Department of Veterans Affairs. VHA directive 2006-008. Quality directive for unit-dose packaging and bar code labeling. www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1380 (accessed 2008 Feb 11). 6 The United States Pharmacopeia and The National Formulary, 28th rev. Rockville, MD; 2005 . 7 Webber R. Handbook of storing and securing medications. Bethesda, MD: American Society of Health-System Pharmacists; 2006 . Author notes The authors have declared no potential conflicts of interest. Copyright © 2009, American Society of Health-System Pharmacists, Inc. All rights reserved.
TI - Quality-monitoring program for bar-code-assisted medication administration
JF - American Journal of Health-System Pharmacy
DO - 10.2146/ajhp080172
DA - 2009-06-15
UR - https://www.deepdyve.com/lp/oxford-university-press/quality-monitoring-program-for-bar-code-assisted-medication-YciDkqOJ3Q
SP - 1125
VL - 66
IS - 12
DP - DeepDyve
ER -