Objectives: Barcode-assisted medication administration (BCMA) is technology with demonstrated benefit in reducing medication administration errors in hospitalized patients; however, it is not routinely used in emergency departments (EDs). EDs may benefit from BCMA, because ED medication administration is complex and error-prone.Methods: A na€ ıve observational study was conducted at an academic medical center implementing BCMA in the ED. The rate of medication administration errors was measured before and after implementing an integrated electronic medical record (EMR) with BCMA capacity. Errors were classified as wrong drug, wrong dose, wrong route of administration, or a medication administration with no physician order. The error type, severity of error, and medications associated with errors were also quantified.Results: A total of 1,978 medication administrations were observed (996 pre-BCMA and 982 post-BCMA). The baseline medication administration error rate was 6.3%, with wrong dose errors representing 66.7% of observed errors. BCMA was associated with a reduction in the medication administration error rate to 1.2%, a relative rate reduction of 80.7% (p < 0.0001). Wrong dose errors decreased by 90.4% (p < 0.0001), and medication administrations with no physician order decreased by 72.4% (p = 0.057). Most errors discovered were of minor severity. Antihistamine medications were associated with the highest error rate.Conclusions: Implementing BCMA in the ED was associated with significant reductions in the medication administration error rate and specifically wrong dose errors. The results of this study suggest a benefit of BCMA on reducing medication administration errors in the ED.ACADEMIC EMERGENCY MEDICINE 2013; 20:801-806 © 2013 by the Society for Academic Emergency Medicine M edication errors are a frequent and costly problem for hospitalized patients, and medication administration errors account for onethird of all medication errors. 1,2 Since the publication of the Institute of Medicine report To Err Is Human, health systems have adopted technology and information systems to improve the medication use process and reduce errors. 3 Barcode-assisted medication administration (BCMA) systems reduce medication administration errors by 40% to 70% in hospitalized patients. [4][5][6][7][8] While progress has been made to use technology to reduce medication errors for hospitalized patients, studies evaluating technology and medication safety in the emergency department (ED) are limited. Specifically there is no literature describing the effect of BCMA on medication administration errors in the ED. A survey of the 2010 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits, found that 28.1% of EDs did not have any information system, while only 38.9% had completely electronic medical records (EMRs).
Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to evaluate the cost avoidance associated with emergency medicine pharmacist (EMP) presence in the emergency department (ED) using a novel cost avoidance framework. Summary This single-center, retrospective, observational study examined EMP interventions from November 1, 2021, through March 31, 2022. EMPs prospectively selected up to 10 shifts in which to log interventions during the study period. Interventions were categorized into 25 cost avoidance categories, 10 of which incorporated recently proposed probability variables. All categories were organized into 4 broad cost avoidance domains, including resource utilization, individualization of patient care, adverse drug event prevention, and hands-on care. During the study period, 894 interventions were logged, which accounted for $143,132 in cost avoidance (lower probability value of $124,186, upper probability value of $168,858), with a median cost avoidance per shift of $1,671 (interquartile range, $1,025 to $2,451). On the basis of 240 shifts, the estimated annual total cost avoidance per pharmacist was extrapolated to be $401,040. Conclusion While the mean cost avoidance of $161.10 per intervention observed in our study was less than that in prior cost avoidance studies due to the conservative and potentially more realistic estimates used, implementation of this cost avoidance framework still showed substantial cost avoidance associated with EMP presence in the ED.
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