Table 1.
General description of the process of medication administration pre- and post-BCMA at Hospital 1.a
| Pre-BCMA | Post-BCMA | |
|---|---|---|
| 1) Pre-administration | Medications are ordered using computerized provider order entry (CPOE) and transcribed into pharmacy information system (IS) by pharmacist. Paper medication administration record (MAR) is printed from pharmacy IS once per day and updated by nurses with labels generated by pharmacy. | Medications are ordered using computerized provider order entry (CPOE) and and transcribed into pharmacy information system (IS) by pharmacist. This updates or creates the nurses’ electronic MAR (eMAR). eMAR is updated by pharmacy throughout the day. |
| 2) Identifying self/logging in | n/a | Nurse scans bar code on badge or logs in manually to identify self in system and access patient profile. |
| 3) Matching medication to MAR | Upon retrieving a medication, nurse compares the medication to what is printed in the MAR. Medications can also be checked to the order in CPOE. | Upon retrieving a medication, nurse is required to scan medication bar code using scanning device (nurse can also manually select medication) to ensure it is the right medication for the selected patient. Medications can also be checked to the order in CPOE. |
| 4) Checking patient identification (ID) | Nurse checks patient ID by visually inspecting or by asking patient/patient family for identifying information. | Nurse required to scan bar code on patient’s ID bracelet (nurse can also manually select patient). |
| 5) Administering medication | Nurse administers medication or leaves it with patient/family. | Nurse administers medication or leaves it with patient/family. |
| 6) Documenting medication administration | Nurse initials scheduled time slot on MAR. If medication unscheduled or administration time differs from schedule, nurse writes time of administration. | Nurse clicks “Submit” in BCMA, adds any notes, and provides mandatory explanation for late or missed medications. |
| 7) Monitoring patient condition | Nurse monitors patient condition/reactions post- administration. | Nurse monitors patient condition/reactions post-administration. |
BCMA = Bar coded medication administration
a
Ordering of steps is based on a common linear progression of events. Steps can be added, skipped, and carried out in various sequences.