Ashley J Dalton
8.5 IMPLEMEnTATIOn STRATEGIES
Many different healthcare groups have recommendations for implementing BCMA and tips for using it. Of particular note are the American Society of Health-Systems Pharmacists Foundation and the Institute for Safe Medication Practices (ISMP).14,15 Common themes
emerge from these recommendations. In order to conduct a successful implementation of BCMA, an organization must create a multidisciplinary BCMA team, conduct a for- mal readiness assessment for the entire organization, and begin a shift in culture toward patient safety and awareness.
8.5.1 Creating a BCMA Team
BCMA spans many disciplines. In order to have a successful implementation, an orga- nization is advised to include all of the vested parties in planning. Although the level of participation may vary, each representative may have a function that will need to incorpo- rate BCMA. The total size of the team should be relatively small (6–10 people). This group should be considered the project lead team and each team member may have assignments
requiring him or her to form action groups outside the project lead team in order to achieve the goals. The following disciplines are suggested for inclusion on a BCMA implementa- tion team; however, each institution should create a team specific for its need that takes into account all of the projected users and their work areas.
Because of the tremendous change to daily work flow that BCMA presents to nursing, a nurse is a logical selection as a task force chair and project leader. It is imperative that nurs- ing provide strong leadership and commitment to the implementation of BCMA. When nurses are satisfied with their point-of-care technology, they may be less likely to develop work-arounds. If the end user does not back the product, it will not be successful.
Another natural fit for a BCMA project lead and cochair on the BCMA task force is a pharmacist. BCMA affects all parts of pharmaceutical management and the pharmacy has to be ready to incorporate bar coding into each aspect flawlessly. Pharmacy is the backbone that supports BCMA. Nursing success and ease of system use are partially dependent on the pharmacy. If all medications do not have a readable bar code, the primary functionality of a BCMA system is lost.
An informatics leader is another natural selection to sit on the project leadership team. Financial and technical support for both the hardware and software of BCMA is essential.
Ancillary members of the project team may include people from departments such as hospital quality improvement, respiratory therapy, nursing education, medicine, purchas- ing, and materials management. Depending on the services they offer and their configura- tion, some institutions might choose not to implement BCMA in departments that care for a mix of inpatients and outpatients, such as radiology or a postanesthesia care unit. Personnel from these areas may then not need to be part of the team.
8.5.2 Conduct a Formal Readiness Assessment
The purpose of a readiness assessment is to examine the organization for assets and work flows essential to BCMA and determine at what state of readiness each currently functions. Items may be categorized as fully ready, partially ready, or not ready. The concept behind the assessment is to take each item that is fully ready and develop a plan to maintain the current status. Items that are only partially ready or not ready will need a plan to move to a fully ready state.
The ISMP has developed a readiness assessment that encompasses nine essential ele- ments of BCMA.15 The assessment presents each element as a detailed checklist. Some of
the items on each checklist are listed as prerequisites, and others are listed as facilitators. Prerequisites are items that must be in place prior to BCMA implementation; facilitators are not required, but would most likely make implementation easier. See Table 8.1 for a listing of the nine essential elements of BCMA.
8.5.3 Begin a Culture Shift toward Patient Safety and Awareness
A workforce culture can be defined by the shared basic assumptions about an organiza- tion’s values, beliefs, and behaviors that have been taught to personnel.16 The Agency for
Healthcare Research and Quality (AHRQ) defines patient safety as freedom from acci- dental or preventable injuries caused by healthcare.17 Therefore, a culture of patient safety
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can be defined as shared values, beliefs, and behaviors that place a priority on prevent- ing healthcare-related injuries. A culture of patient safety is paramount for the successful implementation of BCMA. Users of technology that promote patient safety may be more inclined to use the technology properly if the organization culture is striving for excellence in patient safety.
To define and measure a culture of patient safety more clearly, the AHRQ began devel- oping patient safety culture surveys in 2004. The survey elicits information from 12 areas considered essential in a culture of patient safety17:
communication openness •
feedback and communication about error •
frequency of events reported •
handoffs and transitions •
management support for patient safety •
nonpunitive response to error •
organizational learning •
continuous improvement •
overall perceptions of patient safety •
staffing, supervisor expectations, and actions promoting patient safety •
TABLE 8.1 ISMP Elements BCMA Implementation Success
ISMP nine elements related to successful
BCMA implementation Example
Drug labeling, packaging, and nomenclature Determine the most frequently used medications requiring a bar code
Drug standardization, storage, and distribution Ensure that all patient care areas are using unit dose medications
Environmental factors Ensure information systems are secure with access control Patient information All patient wristbands have a bar code that includes a
unique patient identifier
Drug information The BCMA system is able to provide maximum dosage alerts for high-alert drugs, such as chemotherapy Communication of drug orders and other drug
information Standardized medication administration times have been implemented Staff competency and education A formal training and competency program has been
established
Patient education Educational resources have been dedicated to helping patients understand BCMA and what it means for their care
Quality processes and risk management A business case has been developed for BCMA and agreed upon by senior organizational leaders
teamwork across units and •
teamwork within units. •
Organizations can use the data reported by the AHRQ to benchmark themselves against others and learn where improvements are needed within themselves to optimize a culture of patient safety.
Organization-wide understanding and awareness of medication errors can facilitate a culture that anticipates and demands implementation of error-preventing technologies. Institutions proactively participating in healthcare culture assessments, such as the survey conducted by the AHRQ, have the knowledge to begin developing an action plan for improve- ment and facilitating implementation of patient safety technologies such as BCMA.
8.6 SuMMARy
Thousands of deaths or injuries occur every year as a result of medication errors. Some of these errors can be attributed to errors in the medication administration process. BCMA is a rapidly emerging technology that can reduce errors in this process. The implementa- tion of BCMA has a large impact on the work flow of both nurses and pharmacists. Each step in medication management should be explored for the impact imposed by BCMA. Implementation is best facilitated by creating a multidisciplinary team to lead the project, conducting an organization-wide readiness assessment, and fostering a culture of patient safety and awareness.
REFEREnCES
1. Institute of Medicine. To err is human: Building a safer health system. Washington, D.C.: National Academy Press, 1999.
2. Bates, D. W., Cullen, D. J., Laird, N. et al. Incidence of adverse drug events and potential adverse drug events: Implications for prevention. JAMA 1995. 274:29–34.
3. Paoletti, R. D., Suess, T. M., Lesko, M. G., et al. Using bar-code technology and medication observation methodology for safer medication administration. American Journal of Health-
System Pharmacy 2007. 64:536–543.
4. Cummings, J., Bush, P., Smith, D., et al. Bar-coding medication administration overview and con- sensus recommendations. American Journal of Health-System Pharmacy 2005. 62:2626–2629. 5. Pedersen, C. A., Schneider, P. I., and Scheckelhoff, D. J. ASHP National Survey of Pharmacy
Practice in Hospital Settings: Dispensing and Administration—2008. American Journal of
Health-System Pharmacy 2009. 66:926–946.
6. Pedersen, C. A., Schneider, P. I., and Scheckelhoff, D. J. ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration—2002. American Journal of
Health-System Pharmacy 2003. 60:52–68.
7. Department of Health and Human Services Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 69 (38): February 26, 2004.
8. Department of Health and Human Services Food and Drug Administration. FDA issues bar code regulation fact sheet. February 25, 2004 (Available at http://www.fda.gov/oc/initiatives/ barcode-sadr/fs-barcode.html [accessed April 13, 2009]).
9. Institute of Safe Medication Practices. ISMP survey shows drug companies providing fewer unit-dosed packaged medications. Medication safety alert. March 6, 2002.
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10. VanOnzenoo, H., VandePlas, A., Kessels, A., et al. Factors influencing bar-code verification by nurses during medication administration at a Dutch hospital. American Journal of Health-
System Pharmacy 2008. 65:644–648.
11. Galvin, L., McBeth, S., Hasdorff, C., et al. Medication bar coding: To scan or not to scan?
Computers, Informatics, Nursing 2007. 25(2):86–92.
12. Poon, E., Keohane, C., Featherstone, E., et al. Impact of bar code medication administration technology on how nurses spend their time on clinical care. Journal of Nursing Administration 2008. 38(12):541–549.
13. Sakowski, J., Newman, J., and Dozier, K. Severity of medication administration errors detected by a bar-code medication administration system. American Journal of Health-System Pharmacy 2008. 65:1661–1666.
14. ASHP Foundation. Implementing a bar coded-medication safety program—Pharmacist’s tool kit. (Available online: http://www.ashpfoundation.org/MainMenuCategories/Education/ SpecialPrograms/ImplemetingaBarCodedMedSafetyProgram.aspx [accessed April 13, 2009]). 15. Institute of Safe Medication Practices. Pathways for medication safety: Assessing bedside bar
code readiness. (Available online: http://www.ismp.org/selfassessments/PathwaySection3.pdf [accessed August 23, 2008]).
16. ISMP Medication Safety Alert! If safety is your yardstick, measuring culture from the top down must be a priority. March 22, 2007.
17. Hospital Survey on Patient Safety Culture: 2008 Comparative database report. AHRQ publica- tion no. 08-0039, March 2008. Agency for Healthcare Research and Quality, Rockville, MD. (http://www.ahrq.gov/qual/hospsurvey08/ [accessed August 25, 2008]).
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9
C h a p t e rPharmacy Informatics
as a Career
Armen I. Simonian
9.1 InTRODuCTIOn
Pharmacy informatics is a relatively new specialty within the practice of pharmacy, creating an exciting career path for the pharmacist who has a passion for computers and ideas for leveraging information technology to support pharmacy activities. This specialty might be well suited to pharmacists who like to tinker with computers, manage a Web site, build a personal computer from components, or program for fun or who are intrigued by the possi- bility of incorporating these hobbies into their professional practice. One of the most fulfill- ing job benefits is the satisfaction of knowing that advancing the best and most efficient use of information, aided by deployment of the latest computer technologies, will increase the effectiveness of pharmacy personnel and ultimately improve patient care for a large number of patients. This chapter discusses ways to build a curriculum vitae and job description and to define the typical activities a pharmacist performs in this new specialty practice.