Medication errors: Hospitals slow to meet barcode standard, big on CPOE
Only 30 percent of 1,859 measured hospitals fully meet the Leapfrog Group patient safety standard for use of bar code medication administration technology, but a significant 74 percent fully meet the group’s patient safety standard for use of computerized physician order entry systems to minimize medication errors, according to a new study from the Leapfrog Group.
On the barcode side, another 35 percent made substantial progress toward the standard by fulfilling three of the four requirements, and an additional 26 percent made some progress, meeting two of the standard’s four criteria. Nine percent met one or none of the criteria.
The four criteria of the Leapfrog BCMA standard include:
- Implement a BCMA system linked to an electronic medication administration record (eMAR) in 100 percent of the hospital’s medical and/or surgical units and intensive care units.
- Scan both patient and medication barcodes in 95 percent of bedside medication administrations in BCMA-equipped units.
- Hospital’s BCMA system includes all seven decision support elements identified as best practices by the Leapfrog BCMA Expert Panel, including wrong patient, wrong medication, wrong dose, wrong time, vital sign check, patient-specific allergy check and second nurse check.
- Hospital has implemented all five best practice processes and structures to prevent workarounds, including a formal committee to review BCMA use, back-up systems for BCMA hardware failures, a help desk to respond to BCMA issues, observation of users using the BCMA system, and engaging nursing leadership.
On the CPOE side, the percentage of hospitals fully meeting Leapfrog’s standard for CPOE systems has risen steadily over the past five years. In 2016, 74 percent of hospitals fully met Leapfrog’s CPOE standard. This represents an increase of 10 percent over the prior year and more than double the percentage of hospitals meeting the standard in 2012.
The two criteria of the Leapfrog CPOE standard include:
- Order at least 75 percent of inpatient medication orders through a CPOE system that includes decision support software and is linked to key hospital information systems to reduce prescribing errors.
- For adult and general hospitals (standard excludes pediatric facilities), demonstrate that the system alerts physicians to at least 50 percent of common, serious prescribing errors by participating in Leapfrog’s CPOE Evaluation Tool.
When nurses use a BCMA system as directed, the error rate in administering medications is reduced by up to 93 percent, according to a VA study cited by Leapfrog.
CPOE systems have been highly effective at reducing the rate of serious medication errors, decreasing error rates by 55 percent -- from 10.7 to 4.9 per 1,000 patient days, according to the Journal of the American Medical Association. Rates of serious medication errors declined by 88% in a follow-up study by the same group, according to a Qual Safe Health Care study.