February 2, 2024

Ambulatory Barcode Medication Administration Implementation team effort improves safety for all

“This effort is the result of enormous teamwork and results in added safety for medication administration for all patients from newborn to geriatric. It’s a real win for all the patients we serve.”

Elevate Team Award winners - Ambulatory Barcode Medication Administration Implementation Team

More than 400,000 immunizations and nearly 2 million medications are administered each year at Vanderbilt Health’s ambulatory clinics. So, when work began more than three years ago to implement a new barcode medication administration (BCMA) program at these clinics, the effort was understandably massive.

The BCMA process involves using a barcode scanner to scan a patient’s armband to verify their identity. Then, a barcode on the medication is scanned before its administration.

“Barcode scanning for medications is a national standard for inpatient care but is considered innovative in the ambulatory setting,” said principal nursing informatics specialist Krystle Suszter, MSN, RN, who served as the team leader. “Implementation of BCMA in our outpatient clinics improves patient safety and identification, reduces medication errors and improves medication charge capture. Also, because the system provides a double-check for safety, it has allowed our medical assistants to expand their practice to administer certain medications.”

Supported by the Ambulatory Nursing Informatics team, the complex undertaking involved identifying the arm-banding and barcode-scanning workflows that best suited each clinic, ordering and installing new equipment, training clinic staff, and using metrics to track and continually improve BCMA compliance.

Additionally, Vanderbilt Nursing Informatics pioneered a novel support format combining on-site, at-the-elbow support with virtual Teams chat lines and video calls to ensure all clinics, no matter how distant from the main campus, received excellent support during BCMA launches.

BCMA has been successfully implemented in approximately 250 ambulatory clinic sites that represent all adult and pediatric outpatient clinics. Because of this work, the multidisciplinary Ambulatory Barcode Medication Administration Implementation Team was honored with an Elevate Team Award during the January VUMC Leadership Assembly.

An analytics report is generated for managers to track their clinic’s success, and many of the Vanderbilt Health Patient Care Centers are achieving greater than 95% BCMA compliance. For clinics needing additional support, Nursing Informatics provides indepth troubleshooting to identify barriers to success.

“We are grateful to every individual who contributed to the success of this effort,” said Vice President and chief nursing officer for Adult Ambulatory Nursing Michele Hasselblad, DNP, RN, NE-BC. “While the implementation was supported by the Ambulatory Nursing Informatics team, this work would not have been successful without collaboration with our Pharmacy colleagues, the Ambulatory Health IT analyst team, the eStar Training Team, the Pediatric Outpatient Support Team, Vanderbilt Operational Services and NTT Data Services.

“Additionally, each implementation required a significant time and effort commitment from our ambulatory leaders and clinical teams, Vanderbilt Nursing Informatics Committee eStar representatives, and patient service specialists.”

The use of BCMA saves an average of 17 seconds per medication or immunization administration by automatically pulling in some medication information into Epic. This results in a 31% reduction in steps associated with medication administration, which equates to substantial time savings for nurses and medical assistants.

“This effort is the result of enormous teamwork and results in added safety for medication administration for all patients from newborn to geriatric,” said Gretchen McCullough, MSN, RN, NEA-BC, chief nursing officer of Monroe Carell Jr. Children’s Hospital at Vanderbilt. “It’s a real win for all the patients we serve.”

Members of the team have presented the work at national conferences, including the American Nursing Informatics Association Conference, Epic Expert Group Meetings Conference, Summer Institute of Nursing Informatics, and the American Academy of Ambulatory Care Nursing Conference. As the BCMA work in Vanderbilt Health’s ambulatory clinics has favorably impacted patient care and clinical practice, other ambulatory practices around the country have been asking the team how they did it so they can follow suit.

“You know you’ve done something right when colleagues at other health systems are taking notes,” said Shawn Coomer, MBA, MSN, RN, Nursing Informatics services manager. “That should always be a goal — making positive practice changes that not only improve patient care and clinical operations here but that also drive improvements for patients and clinicians everywhere. The work of this team has succeeded in promoting Vanderbilt as an innovative medical center, focused on safety and quality for their patients and staff.”

Watch the Ambulatory Barcode Medication Administration Implementation team video from Leadership Assembly here.

If you are a VUMC employee, you can nominate a colleague for an Elevate Credo Award, Five Pillar Leader Award, or Team Award. Visit the Elevate website to fill out a nomination form. Employees demonstrate credo behaviors when: they make those they serve the highest priority; respect privacy and confidentiality; communicate effectively; conduct themselves professionally; have a sense of ownership; and are committed to their colleagues. Elevate award nominations are accepted year-round. If a nomination is received after the cut off for an award selection period, the nomination will be considered for the next period. VUMC VOICE will post stories on each of the award winners in the weeks following their announcement.