Raising the Safety Bar: Using BCMA for Outpatient Antineoplastic Administration

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Raising the Safety Bar Using BCMA for Outpatient
Antineoplastic Administration

• Pam Pickett RN, BSN, MSHSA, BC
• White River Junction, Vermont VAMC

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• Antineoplastic medication administration high
  risk
• Most antineoplastic agents administered in
  outpatient setting
• BCMA software is inpatient only

3

• tipping point medication error and 11 near
  misses were catalyst for practice change
• Medication Error parenteral antineoplastic
  agent hung on wrong patient. No harm to patient
• - Contributing factors included increased
  workload, complex protocols with multiple
  medications and delivery / storage processes.
• - Near miss review problematic areas included
  ordering (paper vs electronic), timeliness of
  ordering process and delivery of medications.

4

• Multidisciplinary team chartered by Associate
  Director for Nursing and Patient Care Services
• Flow chart current process
• Opportunities for improvement
• Ordering process combination of paper and
  electronic orders
• Dispensing Handwritten orders entered into
  pharmacy software by pharmacy technician
  representing an additional handoff
• Delivery common area
• Administration manual

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Development of New Process

• Evidence based studies reviewed indicated that
  with a manual system, most errors occur at the
  ordering step and administration step.
• Use of electronic provider order entry and BCMA
  may decrease the likelihood of medication errors
  at those common points
• Multiple cycles of refinement

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New Process

• Patient is checked into clinic appointment
• Patient is admitted to a ward Same Day Chemo
• Provider enters orders into CPRS using inpatient
  quick orders
• Meds administered using BCMA
• Admission is deleted

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Lessons learned

• Clinic check in / admission must be timely
• Timely pharmacy verification of premeds is
  essential
• Process for consecutive days of chemo was needed
  and was developed

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Lessons learned (cont)

• Correct progress note location essential for
  billing / workload
• Number of patients not accurate representation
  of workload with complex protocols
• Use of just in time training and cognitive
  aids necessary

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Outcomes

• Use of BCMA no medication errors or near misses
  reported since new process implemented. 685
  patient visits since Oct 2006
• Reduction of cycle time
• Replicable process without variation

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Outcomes

• Risk mitigated with provider order entry
• Quick order set development and deployment
• Spreading the change
• expansion to include non-antineoplastic agents
  April 2007
• Pilot in ED May 2007