Barcode Medication Administration: Lessons Learned From an Intensive Care Unit Implementation

摘要

An electronic barcode medication administration system was successfully implemented in the acute care and long-term care sections of a 118- bed Veterans Administration hospital beginning in February 2000. Known as Barcode Administration (BCMA), the software was designed to improve medication administration accuracy and to generate online patient medication records. The application was created by the Eastern Kansas Health Care System and the Colmery-O- 'Neil VA Medical Center, and was modified to meet the general requirements of all U.S. Veterans Health Administration (VHA) medical centers. The nationally implemented Barcode Medication Administration software enables users to document electronically the administration of medications at the bedside, or where other points of care are involved. Barcode technology and real-time network connectivity are used to improve the accuracy of medication administration. The barcode software implementation proved problematic in the 10-bed intensive care unit (ICU) for a number of reasons, including the lack of functionality related to the documentation of intravenous fluid administration and the need for immediate software access for urgent medication documentation. The ICU staff stopped using the BCMA software in November of 2000, eight months after the initial implementation. Department of Veterans Affairs' programmers made additional enhancements to the software and the BCMA program was re- implemented in November of 2002. Staff and management confidence in the enhanced software remained weak following the re-implementation, so a system of dual documentation of medications prescribed for patients following open-heart surgery. This complex patient population was selected purposely because delays in critical medication administration can produce life-threatening results. Solutions identified in the treatment of such priority patients would lead to improved care for all ICU patients.