Background: Novant Health is dedicated to making the patient experience remarkable and shaping the future of healthcare. You see evidence of this every day in the work we’re doing to transform our care models and improve quality and safety for our patients. There is also significant work going on across the system to identify best practices and create one Novant Health. Novant Health Medical Group consists of 530 outpatient physician office locations across three states on the east coast. We serve 4.7 million clinic appointments annually.

Problem statement: Medication events were the second most frequently reported safety event type for Novant Health Medical Group (NHMG). Many of these events occurred with the administration of vaccines. Leader rounding among clinics indicated wide variation for how medications, including but not limited to vaccines, are administered.

Having a consistent vaccine and medication administration process brings multiple benefits to patients and team members:

Since standardizing the vaccine administration process in 2016, NHMG has seen a 36% decrease in vaccine errors in 2017.

In 2017, the NHMG “first do no harm” steering committee endorsed a medication barcode scanning pilot project for 6 pediatric and family medicine clinics.

This 6-week pilot has demonstrated a zero rate of patient facing errors, improved efficiency (20-second improvement PER medication), and high team member satisfaction with the technology.

Following this successful pilot, medication barcode scanning for all clinics that administer medications, was endorsed by our first do no harm and clinic operations leadership.

The system-wide ambulatory roll out of bar code scanning technology was completed in October 2018 and has demonstrated the following outcomes:

Previously, we did not have a consistent way to know when we “almost” gave the wrong vaccine due to the burden of manual error reporting in ERL.

We now have data demonstrating our near miss rate is 3.1% for NHMG. This extrapolates into 54,500 errors that are NOT reaching our patients.

There were 63 clinics that started this cadence of roll out, and we have used that group to learn how to increase compliance and will roll out compliance reporting to all clinics in 2019.

We have demonstrated a compliance in scanning all medications and vaccines in this initial group of 63, from 57% compliance to 92% compliance.

Our pre- and post-survey indicate strong support of the technology by both clinical team members and providers.

The automation of entering NDC number, lot number, and expiration dates in the electronic medical record saves and average of 20 seconds per vaccine documentation.

The implementation of bar code scanning technology across a complex, multidisciplinary medical group was not without challenges, including cost, buy-in, education, and communication, but ultimately has been well received as a tool in the standard of care for NHMG patients.

Nikki Nissen MN, RN

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