The following is a response to numerous comments from my post on the press release of 100% error reduction, that is in this blog as well. I felt it responsible to post his response here as well.
Thanks to everyone who submitted comments and opinions on the Nursing News article published on Nursezone.com. As a member of the Section Advisory Group on Automation for the ASHP Section on Pharmacy Informatics and Technology, I certainly understand the premise of your opinions and comments. I feel strongly that the Listserv should not be used by vendors to promote or defend a product or company. With that in mind, let me attempt to at least clarify some of the points that have been mentioned so that Listserv participants have complete and accurate information.
First, most IntelliDOT customers like to do a before-and-after study surrounding the implementation of our BCMA product. Sample size is typically about 250 pre-implementation transactions and 250 post-implementation transactions. We advise them to follow the David Bates study methodology. As stated in the article, only serious errors (does not include dose timing errors or dose omissions for something like a vitamin) were counted which accounts for the small number of pre-BCMA errors. I suspect like users of other BCMA vendors our customers have seen some very positive results.
Furthermore, the individual hospital studies were done by these hospitals to meet their internal needs, and it was not originally our intent to publish a compilation of these studies. However, users of our system encouraged us to do so, so the summary results were made available at our website. We have no intent to pass this article off for more than what it is which is very clearly described by the author. Ron categorized it as “additional information”, which is a good description of its intent. Also, the info from the various hospitals that submitted data was collected at or around their date of BCMA implementation, so it was not in any way selectively collected by the company over the four year period. That said, we are going to review the wording in the posted article to make sure the intent is clearly stated.
In reference to the sample size, I agree the sample size is limited although it does far exceed the sample size in the Barker-Bates study which is the largest multi-facility study to date (50 med administrations each in 36 hospitals). An observation study with a much larger sample size done by an independent clinical group (ASHP or other) is a good idea. Such a study that includes all BCMA vendors with results comparatively and categorically analyzed would be most valuable to pharmacists and nurses planning to implement a BCMA system. We welcome such research and would be happy to participate in and support it.
Reference was also made on the Listserv to “a very small bar code” that IntelliDOT uses, specifically saying it may be a potential competitive advantage. In fact, IntelliDOT’s BCMA system reads all standard manufacturer bar codes as well as those applied by pharmacy packaging systems….just as I suspect other BCMA systems do. The “small bar code” is probably a reference to the proprietary “DOT” symbology that IntelliDOT uses as a way for nurses to document observations and comments during administration without having to type them. The DOT is not a symbol that is interchangeable with a bar code and has not been applied to medication, patients, or name badges when using IntelliDOT’s BCMA system. Therefore, the benefit of the DOT lies in its application, not in how it competes with bar codes.
In one of the listserv messages, the question is raised of how a system can insure that a patient wrist band - and not some other bar code - is scanned. Simply stated, the bar code on the wrist band must be unique and not easily reproduced when using a BCMA system in the hospital. It cannot be the same as the patient bar code that prints on hospital forms or labels. There are ways to make the wrist band bar code unique and difficult to reproduce. Access to the reprinting of patient wrist bands also needs to be limited, controlled and tracked. In my opinion, proper management of bar coded patient wrist bands is an inherent part of a successful BCMA system, and our customers have been successful in doing it.
Finally, a posted comment suggests that having the observer intervene to prevent a serious error from occurring may account for the 100% reduction in serious errors. In fact, while observation of med passes was taking place, the RNs doing the observing did intervene if a serious error was about to be made. This was obviously in the patient’s best interest. However, these interventions only occurred during the pre-implementation phase, although the study plan also included such intervention in the post-implementation phase if it were needed to prevent a serious error. In either case, the near error would be tabulated as an error, not at as accurate administration. At no time was an intervention used to avoid an error when using the BCMA system to pump up the success rate of using the BCMA system.
I plan to attend the ASHP meeting in Orlando and would be happy to further discuss this article and any ideas for future studies. I can also be reached on my cell number below.
Happy Thanksgiving to all!
Thanks again,
Paul Seelinger, RPh
Sr. Director of Clinical Operations
IntelliDOT Corporation
The Bedside Patient Safety Experts
13520 Evening Creek Drive North, Suite 400
San Diego, CA 92128
Cell: 310-961-0630
Fax: 866-212-9947
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