Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment

• Main Authors: David Burger, Jackie Ho
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-09-01
• Series: BMJ Open Quality
• Online Access: https://bmjopenquality.bmj.com/content/9/3/e000987.full

Introduction In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration.Objective To improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%).Methods Implementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders.Results Following a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750–239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855–80 928 per year).Conclusion Adopting John Kotter’s model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.