Post-Rollout, BCMA Vigilance Urged
Publication: Pharmacy Practice News
Author: Fran Lowry
Date Published: July 26, 2011
Implementing a bar code medication administration (BCMA) system is labor-intensive, but the real work starts after the technology rollout, Jerry Fahrni, PharmD, currently product manager at Talyst, in Bellevue, Wash., said at the 2011 unSummit for Bedside Barcoding meeting.
“Like most people in health care, we implemented our BCMA system and then we forgot about it,” said Dr. Fahrni, a veteran of BCMA in his former post as IT pharmacy specialist at Kaweah Delta Medical Center, in Visalia, Calif. “I don’t think most people realize that it takes just as much work following implementation to optimize it, standardize it, and keep everything up and running smoothly.”
Dr. Fahrni gave some suggestions for steps that stakeholders can take post-implementation to make sure their new BCMA system they have worked so hard to establish functions, so that it doesn’t start to “crumble before their eyes.”
First, Develop the Right Team
“Everybody develops a team before BCMA implementation, but I think people fail to develop a team post implementation that will come back and make sure the system is working properly,” Dr. Fahrni said. The team should be interdisciplinary and involve pharmacists and nurses from all areas of the hospital.
“We had nurses coming from the emergency department, from rehab, from our mental health department, our intensive care unit, our obstetrics department, and they all had something to bring to the table,” Dr. Fahrni said.
The role of the nurse as the end user of the technology should not be underestimated, he emphasized. “I can’t tell you the number of times I’ve sat down at meetings and saw nothing but administration, directors, sitting across the table from me. As great as that is, it doesn’t really help the process because they tend to be disconnected from what’s going on at the bedside, so it’s important that you get the bedside nurse in, free them up, give them the time to come in and sit down and talk with you.”
The second thing that needs to be done is to go through all reports and data that are being generated by the new system on a regular basis. All too often, these data are ignored. Once a procedure is in place for reviewing the data, hold people accountable for the information that is brought to the fore and meet on a regular basis to discuss what is going on. “This keeps everyone on top of any problems that might be developing so that you can act on them right away,” Dr. Fahrni said.
Next on the list is troubleshooting. Sometimes the problem can be with the hardware that is not functioning properly, the software, the product or the user. “The biggest problem we had was that some of the bar codes were difficult to scan. People would continue to scan problematic bar codes until they got it instead of telling me. If you can’t scan the med in three attempts, then the bar code is no good and you need to figure out another way to handle that bar code.”
Create a Culture of Safety
Even when hardware and software are running well, the human element can have a negative impact, especially when people have a poor attitude about bar coding. “When someone speaks negative thoughts, that can be contagious,” Dr. Fahrni said. “Working toward making all members of the health care team accountable for the success of BCMA is key. Change the culture of your organization, if necessary; you want to foster a culture that really believes in the value of safety.”
He added that there should be zero tolerance for people who willfully disregard the BCMA system. “If it’s an honest mistake, you accept it as honest and move on. But don’t let a just culture be an excuse to ignore bad behavior. If somebody willfully disregards your system, they’re putting themselves, the hospital and the patient at risk.”
Chris Urbanski, RPh, MS, director, pharmacy informatics and medication integration at Clarian Health Partners in Indianapolis, agrees that much work remains to be done once BCMA is implemented. “We tend to underestimate the resources needed to support systems like this once they are live,” he told Pharmacy Practice News. “They tend to work extremely well for us in the test lab as well as during a pilot implementation, but once the implementation is widespread, there are lots of potential failure points. The end users cannot always interrupt their job of direct patient care to call the help desk to report a problem.”
Mr. Urbanski said that his center has had to redeploy resources several times to nursing units for direct observation and discussions with staff to understand the issues that arise after they implemented BCMA. He also agreed that reviewing reports on a regular basis is important. “It is very helpful to look at these reports to look for trends that might suggest the system is not working as intended.” However, Mr. Urbanski cautioned that reports can be misleading. “Scanning compliance numbers might look appropriate but need to be validated to be sure users are not working around the system,” he said.
In addition, Mr. Urbanski suggested that the nursing leadership should be charged with regular review of data for their respective areas “so follow-up can be sure and swift.”
Source: Pharmacy Practice News
