Pediatric Informatics: Computer Applications in Child Health (Health ...

364 C. Garger et al.
28.6 Case Studies
28.6.1 The VA Bar Code Medication Administration System
The US Department of Veterans Affairs (VA) Bar Code Medication Administration
(BCMA) system is an integral part of the Veterans Health Information Systems
and Technology Architecture (VistA), 43 the VA’s comprehensive electronic record
system, used by all VA inpatient facilities, outpatient clinics, nursing homes, and
long-term care facilities across the US.
VistA’s Computerized Patient Record System’s (CPRS) graphical user interface
(GUI) supports provider order entry (CPOE), including real-time communication
of clinical reminders, access to problem-allergy-medication lists, laboratory, radiology,
and pathology data. It also provides access to clinical notes, consultations,
discharge summaries; and other functions (Fig. 28.1).
The VA developed a bar code medication administration system (BCMA) in
1995. In the BCMA, patients wear bar-coded wristbands and unit-dose medications
are bar-coded in the pharmacy before delivery to a patient’s medication drawer.
The BCMA shares data with the CPRS through the VistA database, using wireless
laptop computers mounted on wheeled medication carts. During medication
rounds, nurses scan patients’ wristbands with a bar code reader connected to the
laptop to access up-to-date medication order data in BCMA (entered into CPRS by
physicians and verified by pharmacists in the VistA database). When a nurse scans
Fig. 28.1 CPRS screen listing medications for a fictitious patient. Tabs at the bottom of the screen
show other CPRS functions