Running head: PROPOSAL FOR BARCODING FOR MEDICATION

Proposal for Barcoding for Medication Administration

Susan Cody, Terresa Roulhac, Harleen Kaur
National University
System Management and Planning
HTM 660
Susan Leonard
May 16, 2015

PROPOSAL FOR BARCODING FOR MEDICATION

Proposal for Barcoding for Medication Administration
Susan Cody
Executive Summary
This proposal presents a plan for acquiring and implementing a barcoding system at
Community Memorial Hospital. This project is very important to this healthcare system,
as it will assure a decrease in costly medication errors, streamline workflows for various
departments in the HC entities, and decrease costs in the long run of the program.
Included in this proposal are the necessities that are key to the project: an efficient, welloiled team, functionality of the barcoding system, and budget issues, goals, and
constraints of the system.
Project Summary
As operational expenses continue to increase and stricter regulatory standards
have come into place, automated data collection has become a necessity in the healthcare
industry. ("Barcoding.com," n.d.) Community Memorial Hospital (CMH) also has a
vested interest in protecting and ensuring patient safety, as well as increasing
productivity, and reducing medication errors. A system that can identify the correct
patient, the correct supplies, medications, procedures is critical to CMH, its patients, and
its employees.
Statement of Need
Barcoding is a system that can be utilized on any computer equipment,
and facilitates the hospital admission process. It is also used for tracking and identifying
patients, managing inventory, and administering medication. Medical personnel can
easily access patient information by scanning the patient's wristband. Point-of-care

PROPOSAL FOR BARCODING FOR MEDICATION

(POC) technology can cut costs, enhance efficiency, and prevent harmful medication
errors. Scanners can also be used to ensure that lab functions, prescriptions and even
food trays are associated with the correct patient.
Barcoding offers a number of hardware and software solutions to automate the
inventory process in the pharmacy, and provides efficacy in management, maintenance,
and distribution of medical supplies and materials. When medications are
being administered, barcoding can verify the patient information as well medication and
dosage information to avoid errors.
Because patient safety is a goal of this healthcare facility, and Community
Memorial Hospital has already instituted a Pyxys system, this proposal will be
specifically addressing barcoding in the medication administration process to prevent
medication errors. The National Coordinating Council for Medication Error Reporting
and Prevention (NCCMERP) defines a medication error as "...any preventable event that
may cause or lead to inappropriate medication use or patient harm while the medication is
in the control of the healthcare professional, patient, or consumer". (Cummings, Ratko, &
Matuszewski, 2005) Research has shown that errors that occur earlier in the medication
process are more readily detected, while very few errors are caught in the administration
phase. (Cummings et al., 2005) For this reason, error reduction strategies have received
significant attention. Scanning patients at POC has become a very effective tool in
prevention of medication errors by ensuring the "5 rights": the right patient, the right
drug, the right dose, the right route and the right time. (Brusco, 2012)
Barcoding has become the go-to technology in assurance of accuracy in the
delivery and recording of medication administration. This proposal includes a plan to

PROPOSAL FOR BARCODING FOR MEDICATION

distribute handheld scanners, barcoding printers, and other hardware and the software
required to achieve a comprehensive system to assure that the 5 rights are being met. The
Pharmacy will be able to ascertain the medication levels in the Pyxis units, track
medication delivery to patients, monitor administration levels, as well as medication
allergies and interactions. (Cummings et al., 2005) The nurse will be able to scan the
barcodes of the patient and the medication, in addition to charting the medication on the
eMAR. Quick Response (QR) code, or 2-D technology, allow other departments such as
Radiology, Laboratory, Admitting, Materials Management to easily be rolled in as
CMHs budgetary and data expansion plans are developed.

PROPOSAL FOR BARCODING FOR MEDICATION

Project Goals
The goals for this proposal are to improve patient safety, streamline the current
workflow, reduce costs over the long term, and to develop improvement cycles for future
implementation of ancillary departments. Metrics to determine the value of these goals
are:
1. Fewer errors in the medical records. Crosschecks are imbedded in the
programming to alert users to possible errors in documentation, and to when
medications are due to be delivered.
2. Improved access to data is enhanced via documentation that is available to all
authorized healthcare personnel.
3. Patient and provider satisfaction is increased due to availability of information
to both interested parties.
4. There is diversity in a single investment. Changing to the barcoding program
will allow integration of EHR, laboratory, radiology, referral systems, dietary,

PROPOSAL FOR BARCODING FOR MEDICATION

etc., thereby reducing costs and improving service and productivity as CMH
plans to integrate other departments.
The scope of this proposal covers barcoding for medication administration, and, at this
time, does not address barcoding for the departments of Materials Management,
Laboratory, Radiology, or Admissions.
Constraints
Some constraints to the system, however, will be budgeting, choice of hardware
and software, and training for all employees. Time management is critical to the success
of the plan. It will also be important to establish a steering committee that is well-versed
in the technology, and in the current hospital systems, to create a smooth transition in the
planning of the project. The depth, breadth, and efficiency of cooperation between nurses,
pharmacists and information technologists are pivotal to the success of the plan. In
addition, selection of the appropriate vendor and software that is compatible with our
needs and our existing Pyxys functionality must be considered. CMH must be prepared to
provide the support necessary at go-live and for a time thereafter to ensure the successful
adaptation of the new system by hospital staff. Logistics will determine where equipment
will be placed in proximity to the patient and the nursing personnel, availability of space,
proper utilization of resources, etc.
Terresa Roulhac
Timeline
Project will begin on July 1, 2015 pending approval, and be completed by
December 1, 2015. Installation of the barcoding system to CMHs inpatient pharmacy
will take place July 5, 2015 and continue until 01 August 2015.

PROPOSAL FOR BARCODING FOR MEDICATION

01 August 2015 15 August 2015-Vendors will be brought to CMH for five
workshops. In order to cut down on the amount of disruption of workflow, the workshops
will be spread out among the three main shifts. Vendor workshops will have a Monday
and Wednesday training at 0700 a.m., Tuesday and Thursday training at 1530 p.m. and a
Friday workshop at 1730. The workshops will be held in the main conference room at
CMH, and each workshop will last approximately two hours.
15 August 2015 30 August 2015-Training for all end users will begin. There will
be a total of 10 available workshops for all end users, and times and dates will be set to
mimic the day and times of the vendor workshops to guarantee that everyone has the
opportunity to learn the new systems prior to the go live date.
01 September 2015 01 October 2015-Testing begins on the test barcode system.
During this time system hardware will be examined for accuracy and workflow
discrepancies. Common infrastructure metrics that will be closely examined will be how
often the barcoding system has unscheduled downtime, the speed it takes the system to
recover from downtime, and any other issues that affect applications within the system.
(Wager, Lee & Glaser, 2013, p. 428-429)
01 October 2015 01 November 2015-Staff surveys via email will be sent out
and collected for review for the steering committee. Completion of the rollout to entire
hospital will be done by 01 December 2015.
01 November 2015 -- Barcoding system goes live
01 November 2015 01 December 2015-Steering committee meeting to evaluate
the new bar code system, Patient surveys sent out via email and text.

PROPOSAL FOR BARCODING FOR MEDICATION

Costs & Risks
There are three elements for consideration of cost for any barcode system. The
origin source for the barcode can either have the ability to produce preprinted labels or
print them on an as needed basis. Also, the system must contain a reader that includes
input devices so that he barcode can be scanned as well as convert symbols to ASCII text.
(Barcoding Sales and Inventory, n.d.) ASCII stands for the American Standard Code for
Information interchange and is the most common format for text files in computers and
on the internet. (What is ASCII (American Standard Code for Information Interchange)?
Definition from WhatIs.com, n.d.) The third element for consideration is the computer
system that will process the barcode information. The system chosen will have either
single-user, multi-user, or have a network system. (Barcoding Sales and Inventory, n.d.)
Understanding the risks associated with new projects is important. Barcode
systems are fragile and often overlooked, but barcodes are the link to help systems run
properly. The technologies, both hard and soft, must work together. If a barcode fails,
tracking becomes difficult, and the potential risk for errors increases. Barcodes track a
number of items. For example, barcodes help verify the manufacture and expiration dates
of pharmaceuticals as well ensuring that right patient is receiving the right dose at the
right time. Another risk associated with barcoding is the failure to recognize barcode
quality and the implementation of the minimum requirements as a part of the policy and
procedure manual. By not qualifying the barcode quality, organizations are putting
themselves at risk for future increase in costs and unnecessary problems in the future.
Testing of barcode equipment can be obtained easily to help determine and control risks

PROPOSAL FOR BARCODING FOR MEDICATION

related to barcode systems. No organization can afford to overlook the potential financial
and safety risks. (Nachtrieb, 2013)
Other risks include challenges of introducing the system to the organization.
Strategies must include quality improvement and addressing barriers to ensure training is
sufficient; vendors are involved in the first phase of implementation and available
throughout the process. Also it is important to understand any limitations and to keep
communication channels open and clear. (Wager, Lee & Glaser, 2013, p. 156)
Below is the proposed budget plan for the barcoding system. The budget includes
fifteen workshop and training sessions. Refreshments and handout expenses are included.
The equipment includes 175 Intermec SD20B Healthcare 2D Imagers. These imagers are
chosen because the product is ideal for a number of healthcare applications and for their
ease of capturing data. (SG20 Healthcare 2D imager, n.d.) Also, four stand-alone
computer systems will be dedicated to the new barcode system. The Intermec Labelshop
Ultra Barcode with two licensures and the Zebra HC 100 Barcode printer are also
included in the budget proposal. The Zebra HC 100 was designed to print patient ID
wristbands at a cost effective price. This particular printer is a thermal printer with
cartridges that anyone will be able to load and unload. The thermal printer enables CMH
to print wristbands on demand and cuts down staff performing multiple steps of loading
special trays, printing labels, applying the label to bands, and laminating the band prior to
placing the wristband on the patient. (Zebra HC100 Wristband printer, n.d.)

PROPOSAL FOR BARCODING FOR MEDICATION

BarcodingProjectBudgetProposal
Training
Handouts
Refreshments
Vendor Training

10$*10workshops
200$*10workshops
500$*5workshops

$100.00
$2,000.00
$2,500.00

Equipment
Barcode readers
Computer System
Barcode Software
Barcode Printer

395$*175readers
4general station
273$* 2Licensure
540$* 25printers

$69,125.00
$6,000.00
$546.00
$13,500.00

Miscellaneous
Version Updates
for q 33months
Software maintenance yearlyprice
Hardware maintenance yearlyalloted

GrandTotal

$500.00
$10,000.00
$20,187.80

$124,458.80

Other items included in the budget are software version updates that will take
place every 33 months. Software maintenance and hardware maintenance will have a
combined yearly allotment of $30,187.80. All items such as blank printable wristbands
and ink for the printers are included in the hardware maintenance.
The committee understands that initially the cost of implementation is large, but
the return of investment will prove that the barcoding system is a much-needed
investment. In order to determine a positive return of investment the committee will take
a look at patient satisfaction surveys as well as surveys from CMH staff. Ideally the

PROPOSAL FOR BARCODING FOR MEDICATION

reduction of medication errors and a functional closed loop of healthcare services will be
determining factors for the return on investments.
Benefits & Opportunities
Barcoding systems help reduce the number of times a patients is interrupted while
receiving medications. A BCMA can reduce deviations from regular sequences.
Barcoding systems help streamline routines and allow for healthcare providers to
anticipate activities and find inaccurate actions. The potential of barcoding in a healthcare
system can increase productivity; improve patient safety and the quality of care. Along
with a more streamline process is the reduction of labor costs, fast and reliable data
collection, improved supervision, and better decision making for management. Many
studies have shown that errors happen at many stages in the medication process. These
errors often occur at the ordering stage, dispensing stage, administering stage and even
when medications are only being monitored. Barcoding systems are highly effective in
decreasing medication errors at all stages of medication administration process. Studies
have shown a 40%+ reduction in medical errors was linked to organizations that
implemented barcoding systems. (Wager, Lee, & Glaser, 2013, pp. 154 -155)
Generating positive public relations with the local community by improving
patient satisfaction and improving nursing staff job satisfaction are opportunities that can
be gained with the implementation of a BCMA. A case study done at Beloit Memorial
Hospital in Beloit, Wisconsin showed that job satisfaction increased because of the
implementation of a barcoding system. The nursing staff felt the organization was
dedicated to improving quality of care with the investment of new technology that would
improve patient safety. Briefings were conducted in the early stages of implementation,

PROPOSAL FOR BARCODING FOR MEDICATION

and patients were briefed about the new BCMA system. The staff at Beloit Memorial
reported patient and families were happy for the briefing. Local media were contacted
and the exposure increased relationships between the local community and the hospital.
(Work, 2005)
Alternative Impact
The costs associated with new technologies are usually the determining factors of
choosing one product over another. The alternatives to the barcoding system include the
UHF RFID and the RTLS. The RFID is a radio frequency identification system that has
two components, readers and tags. The reader emits radio waves and has one or more
antennas that also obtain signals from RFID tags. Patients with pacemakers, implantable
cardioverter defibrillators are not ideal candidates for RFID because of the potential
interference. (U.S. Food and Drug Administration, n.d.) One concern of an RFID scanner
is that there is no way to control who can read the tag and that can lead to serious privacy
issues. Also, another security issue is that RFID information can be read from a distance
and these scanners may not be able to function in a heavy use environment causing the
system to not function properly. (Evans, n.d.)
Real Time Location Systems (RTLS) is the other alternative to the barcoding
system. RTLS provide tracking and management of medical equipment, patients and staff
in real time. RTLS help healthcare organizations capture workflow efficiencies, lower
costs, and improve quality care. The systems components include badges and different
types of tags as well as different types of platforms to send and share information. (Intro
To Real Time Locating Systems (RTLS), n.d.) There are three main considerations
associated with RTLS in Healthcare.

PROPOSAL FOR BARCODING FOR MEDICATION

The first consideration for RTLS is whether or not there are accurate room and
sub-room locations for the technology. Also, the ability for the system to operate with
other mission-critical systems is important. Software is the second consideration of RTLS
systems. RTLS is progressing beyond locating assets and expanding further into
managing patient flow, beds, rooms, staff, and other departmental activities and
workflows. (Critical Considerations for RTLS in Healthcare, n.d.) Other considerations
for RTLS are that tags and readers cost more than barcoding systems, and RTLS systems
must be custom developed to customize the needs of the organization. (RTLS Solution
Comparison, n.d.)
The last consideration for RTLS is the combination of technology and people to
guarantee highest productivity and reduce redundancies and busy work. (Critical
Considerations for RTLS in Healthcare, n.d)
Although both the UHF RFID and RTLs provide many of the same features that
the barcode system does, the costs associated with the alternatives do not align with the
goals and objectives of CMH. Figure 1 gives a breakdown on the cost of each product,
visibility frequency, and the ideal environment that each product has.
Harleen Kaur
Why CMH needs Barcoding?
Medication management is a complex process, which involves numerous steps,
including: prescribing, transcribing, dispensing, and administration. Medication data was
extracted directly from the SaaS database used at the CMH and exported in Microsoft
Access 2000 format. A quantitative analysis will be performed to examine where in the
medication process the error occurred (prescribing, transcribing, dispensing,

PROPOSAL FOR BARCODING FOR MEDICATION

administering, monitoring), and the disciplines involved (physicians, pharmacists,
nurses). An analysis of medication errors revealed that around 38% of errors in our
system occurred around the medication administration phase.
A large sum of money is lost because of the medication errors at the CMH. The
records revealed the occurrence rate of 650 adverse drug events per year. Last year, more
than 2 million dollars were spent on the medication error issue. The analysis of the issue
showed nursing was the number one discipline involved in the error process. Further
analysis showed that these errors could be avoided if intercepted during the medication
administration process. Therefore, bringing the Barcoding medication administration
(BCMA) technology to the CHM is critically important. The introduction of BCMA
fulfills the AIM of CMH of expanding the efficiency of the healthcare operations.
Project fit
The BCMA technology can help CMH to expand the domains in forming more
integrated healthcare delivery system. The functionalities (physicians, nurses, and
pharmacists) involved in the drug administration process can interact efficiently with this
technology. Drug administering is greatly influenced by the efficiency of the
communication, coordination and cooperation (C3) between the functionalities. (Duffy,
2009) Before implementation of BCMA, a work analysis will be conducted to obtain an
understanding of the work processes between nurses, physicians, and pharmacists.
With Barcoding, the dispensing and administration errors will significantly
decrease. There is growing body of evidence demonstrating a 54-87% reduction in errors
using BCMA. (Agrawal, 2009) With this project we will get closer to our organizations
goal of forming a safer environment for patients by having a more integrated delivery

PROPOSAL FOR BARCODING FOR MEDICATION

system. We will also have increased revenue by losing less money on the adverse drug
administration issue, which we are facing right now.
Pilot testing
The introduction of the new technology can be intimidating for the stakeholders
involved in the process. To reduce the unexpected outcomes and concerns regarding the
new introduction of BCMA, a pilot implementation will be conducted on a smaller unit.
This implementation will be carried out for three weeks on ten beds before it is rolled out
to the whole hospital. During this time, special attention will be paid to glitches faced by
the staff using the technology, and proper steps would be put in place to ensure that full
technical support is available. After the staff is satisfied with the new workflow, the
technology will be expanded to other units of CMH.
Implementation Process
The implementation process will be carried out in five phases. Phase one will be
planning where a multidisciplinary steering committee will be formed with heads from
the pharmacy, IT, nursing, and admitting departments. They will meet biweekly for the
duration of the project to provide strategic direction, make key decisions, and resolve
project issues. Phase II will consist of design and quality assurance. During this phase the
planning activities and system specifications will be gathered and the BCMA software
application will be configured. Phase three will be about training. A 10-hour training
session will be provided to unit staff before units go-live. It will be focused on new
technology adoption, including ample practice time using the new scanners on
medications and wristbands. Phase four will be going live with BCMA. New technology
will be implemented in all inpatient units and seven other specialties associated with

PROPOSAL FOR BARCODING FOR MEDICATION

CMH. To help stakeholders with the new onset, on-site go-live support will be provided
for at least one week on each unit for 24 hours/day. Phase five will be post
implementation monitoring. Case studies have shown that this is an integral part of the
implementation process. During this phase, evaluations about the Barcoding will be
carried out, and new issues like wrong drug, wrong patient, or wrong form used will be
cited. (Agrawal & Glasser, 2009)
Workflow
With BCMA technology, CMH will we be required to follow a new workflow.
When administering the medicine to patients, nurses will be required to scan both the
patient identification bracelet and the medication being administered at the point-of-care.
This workflow would include issues such as charting in patients rooms, downtime
procedures, and procedures for ensuring the Five Rights. (Agrawal & Glasser, 2009)
With time there might be a need to modify additional policies concerning how and when
scanners should and should not be used.
BCMA will be a big step towards forming a complete, closed-loop medication
management system. With this loop, we would be able to offer a safe administration of
medications to patients. As explained by Fruzsina, one of the directors at LMC, The
closed-loop system requires four things: an active medication order; an electronically
identified provider (nurse); a bar-coded drug; and an electronically identified patient.
(Pataky, 2014) In this system, clinicians will be able to receive and review orders online,
and the relevant information will be documented seamlessly.

PROPOSAL FOR BARCODING FOR MEDICATION

Addressing the Constraints

Special measure will be taken to ensure that all the constraints are addressed and fully
resolved. To address the issues regarding the safety and processing of this technology,
prospective hazard analysis will be used. During this analysis, the risk factors of the
system, devices and the process will be monitored. Predictions will be made for all the
possible ways in which failure can occur, and areas where improvement can occur will be
closely evaluated. A rating system will be formed to identify and rank the hazards on
seriousness levels. This table shows some of the expected constraints and resolutions.

PROPOSAL FOR BARCODING FOR MEDICATION

To address the issue of BCMA network failure, special procedures will be developed. An
online help-desk system will be established to ensure timely communication between
nursing, pharmacy, IT, and the project management team. The issues such as unscannable
medications, hardware failure, or system enhancement requests will be addressed and
resolved timely. (Agarwal & Glasser, 2009)

PROPOSAL FOR BARCODING FOR MEDICATION

References
Susan Cody
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Cummings, J., Ratko, T., & Matuszewski, K. (2005, September/October). Barcoding to
enhance patient safety [Article]. Patient Safety & Quality Healthcare. Retrieved
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barcoding_adv.html
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PROPOSAL FOR BARCODING FOR MEDICATION

Evans, K. (n.d.) What Does RFID Stand For? Retrieved from:
http://science.opposingviews.com/rfid-stand-for-18664.html
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Community Hospital. Retrieved from: http://psqh.com/mayjun05/casestudy.html

PROPOSAL FOR BARCODING FOR MEDICATION

Zebra HC100 Wristband Printer. (n.d.). Retrieved from:
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Harleen Kaur
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Appendix
Figure 1.

The Costs of the Alternative sytems would have a negative impact due to the increase in cost that
CMH would gain.