Describe a specific situation where you observed a strategy to enhance patient safety?
In the Hospital Institution where I am currently working, we are utilizing KBMA or Knowledge Based Medication Administration feature of Electronic Medical Record for medication administration. Prior to administering medications the nurse scans the barcode of medication then scans the barcode in the patient's identifier. This process allows the system to cross reference medication prepared by the nurse versus the ordered medication in the system. This ensures the accuracy of rights of medication administration (Right Patient, Drug, Dose, Route, and Right Time). This is important especially in administration of High Alert Medication (HAM) which may cause harm to patients when given inappropriately. The system will prompt the user not to administer the medication should the order of the medication be suspended or discontinued by the ordering physician.
Important features KBMA includes co-signature (required) when administering HAM, timely administration, and documentation of site of administration. This is a concrete mechanism in double checking the medication (stock dose and preparation versus ordered dose in the system) to be given to patients. Co-signature will be accomplished by the nurse who double checked the medications. In terms of timing, the KBMA system only allows administration of medication as ordered. The nurse will be prompted by the system should he/she attempt to administer medications earlier or later than the prescribed timing/frequency/interval. Before completing the administration, the system will confirm the location/ route of medication administration. Other features of KBMA include but are not limited to patient education, and tolerance to medication.
This critical element in providing medical care is aligned to meet the standard of Joint Commision International International Patient Safety Goal no.1 (Identify patient correctly) and no.3 (Improve the safety of medications including IPSG no. 3.01: look alike/sounds alike, and IPSG no. 3.02: concentrated electrolytes) (JCI, 2024).
What was the outcome?
KBMA utilization results in accurate administration of medication. In some instances, KBMA stopped me from administering medications that have been suspended or discontinued during or after medication preparation.
What evidence-based practices supported your action?
Currently, there are no Clinical Practice Guidelines that provide support in the use of KBMA but, the Joint Commision International requires healthcare organizations to develop systems and implement processes that will ensure effective and safe medication management (JCI, 2024). A systematic review of the impact of Bar Code Medication Administration Technology on patients safety shows that the utilization of such system results in reduction of errors in terms of medication, administration, dosing, route, and timing (Shah et al., 2016).
If faced with the same situation again, how would you further improve patient safety?
KBMA is part of our EMR thus, it is a standard and routine practice in our institution. Situations like system downtime would hamper this process. In connection, our business continuity plan is in place and ready to operate at any given time when needed. It includes but is not limited to separate manual cross-checking of orders by 2 RNs and involving a witness during drug administration.
References
JCI. (2024). Joint Commision International Standards for Hospitals Including Standards for Academic Medical Center Hospitals (8th Edition ed.). Joint Commision International.
Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar Code Medication Administration Technology: A Systematic Review of Impact on Patient Safety When Used with Computerized Prescriber Order Entry and Automated
