New BCMA study

This BCMA study (link and abstract below) is very well done.  Unfortunately, it does not advance the notion that BCMA decreases medication errors, IMHO.  Here is my assessment, what is yours?

The key issue that goes unanswered here is the value of BCMA over an electronic MAR (eMAR).

The errors that may decrease with the use of an eMAR without BCMA needs to be considered when extolling the virtues of BCMA.  BCMA over the use of an eMAR is still of questionable value, from the results of this study.  The cost in time, materials and implementation of eMAR to BCMA is huge.  The benefit according to this study is negligible.

The pre-study was with paper MARs.  Then an eMAR with BCMA capabilities was implemented.  One of the largest benefits noted was a decrease in omitted dose errors.  I would suggest that using an eMAR alone would help with omitted doses. BCMA does nothing to prevent these types of errors.  An eMAR with the use of scheduling, work lists and reminders would presumably help decrease omitted dose errors. The study conclusions would be invalid if omitted dose errors where excluded in the targeted preventable ADEs calculation.   Therefore I conclude that the benefit of BCMA over eMAR in this study is zero.

 Effectiveness of a Barcode Medication Administration System in Reducing Preventable Adverse Drug Events in a Neonatal Intensive Care Unit: A Prospective Cohort Study.

 Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine; University of Iowa, the University of Iowa Hospitals and Clinics; University of Iowa Children's Hospital Iowa City, IA.

 OBJECTIVE: Patients are at risk of harm from medication errors. Barcode medication administration (BCMA) systems are recommended to mitigate preventable adverse drug events (ADEs). Our hypothesis was that a BCMA system would reduce preventable ADEs by 45% in a neonatal intensive care unit.

 STUDY DESIGN: We conducted a prospective, observational, cohort study of a BCMA system intervention in a neonatal intensive care unit. Participants were admitted neonates during 50 weeks. Medication errors and potential or preventable ADEs were detected by a daily structured audit of each subject's medical record, with assignment of an event as a preventable ADE made by blinded assessors. The generalized estimating equation method was used in modeling the targeted, preventable ADE rate with covariates.

 RESULTS: A total of 92 398 medication doses were administered to 958 subjects. The generalized estimating equation method yielded a relative risk of preventable ADE when the system was implemented of 0.53 (95% confidence limits 0.29 to 0.91, P = .04), adjusted for log(10)doses of medication/subject/day, a significant predictive covariate (P < .001), as well as for birth weight, sex, Caucasian race, birth cohort number, and nursing hours/subject/day.

 CONCLUSION: The BCMA system reduced the risk of targeted, preventable ADEs by 47%, controlling for the number of medication doses/subject/day, an important risk exposure.

 PMID: 18823912 [PubMed - as supplied by publisher]