Each Member of BCMA Team Should Be a Key Player in Patient Safety

Louisville, Ky.—The most important factor in implementing a successful bar code medication administration (BCMA) program is ensuring that all players in the process feel that they are accountable to one another.

Moreover, that sense of shared responsibility can’t only be present in the rank-and-file staff tasked with implementing BCMA. “It has to be present all the way up to the top at the executive level,” said Karla M. Miller, PharmD, BCPP, director of pharmacy at the Hospital Corporation of America (HCA), in Nashville, Tenn.

For BCMA to work, a multidisciplinary team that works well together is essential, Dr. Miller said at the 2011 unSummit for Bedside Barcoding meeting. All members must feel a sense of responsibility not only for the successes but also the failures in improving patient safety in their hospitals, she stressed.

A lack of accountability can have a very negative impact on the work the team is trying to do, and also on the morale of team members.

“Often you have resentment among team members for various reasons. Some have different work ethics, or different ways of approaching things, or just different standards of performance,” Dr. Miller noted. “Also, when you have a team without accountability, you just get average work and you begin to accept that mediocrity.”

Teams that lack accountability miss deadlines and place undue pressure on those team members who are willing to work hard to implement patient safety, she added.

Barriers to Success

After BCMA was instituted in the HCA consortium of hospitals, Dr. Miller and her colleagues began to ask questions to find some of the barriers that were preventing the program from developing and moving forward. They found that team members were blaming each other, rather than taking responsibility for the success of the project as a whole.

“Some told us it was pharmacy’s fault, some blamed the biomed people, some blamed the information technology staff. There were a lot of excuses, and it was a prime example of people not being held accountable and just finger pointing,” she said.

But the multidisciplinary team began to work more cohesively after potential problems were identified. Also, specific responsibilities for each team member were elucidated. As these measures evolved and were adopted, team members began to feel comfortable with one another.

“They felt comfortable questioning each other’s approach. They weren’t afraid of being wrong. Respect was established and everyone was held to the same standards. We made it possible for poor performers to feel pressure to improve, but in a respectful way,” Dr. Miller said.

Steps To Creating More Accountability

Jon Lakamp, PharmD, vice president of pharmacy at Sisters of Mercy Health System, in St. Louis, and a co-presenter at the unSummit session, detailed more thoroughly how accountability can be established. He listed responsibilities for some of the key players on the BCMA team. As members became more accountable for their actions, compliance with bar-code scanning rose. At Sisters of Mercy hospitals, compliance was less than 90% when BCMA was first instituted. Two years later, it was 95% and continues to rise, he said.

The first key player is the top executive. “The executive leader’s role involves setting expectations,” Dr. Lakamp said. “It’s all about assuring that the automation is sound and actually works, and communicating those expectations to the clinicians who are involved in direct patient care as well as to the staff who oversee the delivery of that care.”

Next on the team is the medication safety leader, who can be a pharmacist, nurse or someone in charge of quality.

“The medication safety leader’s role is all about defining best practices, outlining the exact process that is to be followed based on the safest methodologies documented in the literature, knowing what medications require independent double-checking, how to document that this checking has been done,” Dr. Lakamp said. “It’s establishing all policies and procedures behind utilizing the technology and putting the patient in the center of the process.”

The middle manager has several important responsibilities. Perhaps the most important is being able to recognize and respond to health care staff who may be knowingly or unknowingly putting patients at risk. “If there are at-risk behaviors, the middle manager has to be able to appropriately respond. He or she may have to do some coaching or counseling and be prepared to take action in cases of reckless behavior, consistent with a ‘just culture,’” Dr. Lakamp said.

The pharmacy department needs to confirm that all medications are available on a unit-dose basis, that the bar codes work and that verification processes are in place.

Information technology needs to ensure that all equipment is running properly and reliably. “Some of the key roles for IT include making sure that back-end support systems are in place, that dictionaries are built, that bar codes are flowing into the right systems, and making sure that all systems are updated on a regular basis,” he said.

Last but definitely not least is the patient. “We need to empower patients so that they feel free to speak up if they see something that doesn’t look quite right to them,” Dr. Lakamp said. “When we started a campaign to get our patients to hold our staff accountable, that was probably one of the most powerful tools that we had. When the patient asked the nurse why she wasn’t scanning a medication when the last three nurses did so, that was more impactful than having the nurse’s supervisor do the counseling, so setting the stage for having our patients hold us accountable definitely is a very key tool.”

In an interview with Pharmacy Practice News, Dr. Lakamp emphasized that setting up a culture in which accountability is recognized as a key component is essential for success. “Make sure you’ve got the right systems in place, the right tools in place, and set the stage for the right path to follow, from the beginning. Make sure everyone on the team has performance goals and that they all feel accountable for implementing safe patient care.”

Setting the Stage

Laura M. Lee, RN, special assistant to the deputy director for clinical care at the National Institutes of Health (NIH) Clinical Center in Bethesda, Md., agrees that accountability is important. “Setting the stage for assuring accountability starts at the leadership level of the organization,” she said.

Ms. Lee is responsible for ensuring that patients participating in one of the more than 1,400 clinical research protocols at the NIH Clinical Center receive not only the highest-quality, but also the safest care. She also is responsible for designing and operationalizing the organization’s patient safety activities, coordinating the clinical center’s clinical quality and performance measurement activities, directing the patient perception survey process and ensuring compliance with accrediting organizations.

“A first step toward creating a culture of accountability is to articulate clearly the strategic importance of an initiative such as bar coding,” Ms. Lee told Pharmacy Practice News. “Equally important is assuring that the organization provides appropriate support, such as staffing, equipment and supplies and training, to those staff members who are responsible for implementing and maintaining these types of complex, critical patient safety initiatives.”

From Pharmacy Practice News , JULY 2011, VOLUME: 38