Integration is key

Tina M. Suess, RN, manager for medication safety integration, at Lancaster General Hospital in Lancaster, Pa., encourages hospitals to move toward an integrated BCMA platform allowing clinical decision support to be "aligned" and streamlined across all areas of the medication use process.

For example, if the provider overrode an allergy alert during CPOE and the pharmacist overrides it during order verification, why should the nurse need to see an allergy alert at the point of administration?

Suess said it's important to have ownership of the data.

"BCMA systems provide a plethora of information to allow hospitals to improve the medication use process, said Suess. "Hospitals need to define 'who' will own the data and oversee the process for improvements."

She added that many hospitals make the mistake of "decentralizing" the data.

"Although this is better than not looking at the data at all … it doesn't allow a big picture look," Suess said.

Suess offers the following tips to health systems considering BCMA:

• Optimize the relationship between pharmacy and nursing. Nurses use the BCMA technology… but the software is often owned by pharmacy. I would suggest a nurse … who works in the pharmacy as the operational owner to drive adoption and practice and process changes.
• Make sure someone is "looking" at all technology and that alerts are firing at the appropriate "technology" spot in the medication use process
• Go true unit-dose and eliminate manipulation of the dose by the nurse at the bedside.  The BCMA system can fire an alert if the nurse scans a 10 mg tablet … for the 5 mg dose.  The nurse can "tell" the computer that they broke the tablet … butif the nurse fails to actually break the tablet, the result is a wrong dose error.
• Ensure that pharmacy adopts a "quarantine" environment that ensures product is "mapped" into the system before being dispensed.
• Monitor the human interface with technology. Use direct observation to actually observe how end users are using the technology. Very valuable approach to identifying needed system improvements and to find out "workarounds"
• Invest in the necessary infrastructure for success. Don't introduce an environment in which the BCMA cannot be used. Invest in wireless infrastructure, appropriate number of electrical outlets to charge the workstation on wheels and purchasing enough devices to meet the patient care demands
• Create an environment that allows for timely resolution of identified problems.

Finally, industry insiders note that BCMA is a large undertaking that requires significant pharmacy and nursing resources.

However, according to the Cleveland Clinic's Chalmers, "Given the fact that the administration phase of the medication use cycle is the stage where errors are the most likely to reach the patient, it seems logical that we devote the time and resources here to protect our patients."