Bcma

  1. I would like some input from all of you BCMA users out there. DO you like it? Is it worth it? Pros and cons about it.

    I've been using it for about a year now in our VA Nursing Home Care Unit that houses 60 residents on one unit. I think that it's wonderful if you use it on smaller units. To give out 0600 meds, you have to start at 0430 just to be done with the med pass by 0700. It seems that every med given needs to have some sort of comment ie bp, pulse, missing med, if pt refused med, why? All kinds of things to add on and make it more time consuming to take away from pt care. Then if the computer is down you have to use the back up summary computer and run all of the med sheets off and sign them! It's gets to be very time consuming after awhile but maybe that's just me. I'd like to hear from others and their opinions...
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  2. 33 Comments

  3. by   gymcobb
    I didn't know that hideous program was national. Yes, you're right. It is very cumbersome and I don't waste time commenting on things. It takes too much time. For example, when I give a SQ shot it's always in the same area - if you'd believe the computer. I draw the shot up and then ask the patient where he'd like his shot. I'm not a mind reader. I have no way of knowing where he'd like it when I'm drawing it up. Then the pain scale seems to be of little value too. It's too cumbersome to chart in it, nobody does because they've got too much else to do, so you never get a full picture of the pain-relieving abilities of the medication.

    And how about those smart-asses who say that their pain is always a "10"?

    The intention behind BCMA - to have an all-electronic medical record - is good. But it wasn't ready for deployment. We have so many agency personnel on our floor. They have no idea how to make the thing work. Then it takes a good hour - if they're computer literate - to teach them to make the thing work so that they can do IMs, IVs, POs and edit the medication log. I'm told that the next version will be much better. We'll see.
  4. by   night owl
    I was beginning to think that the only VA who used them was the one I work at! I'm glad to hear that someone else also thinks it's a pain. The next version??? Any idea when that'll be? Do you know what else annoys me? I don't know how fast yours scan, but the one I use takes 10 full seconds from the time you scan it until the time it goes *ding* and says "G" for given. Count them...10 seconds. May not sound like alot, but if you're giving out over 100 pills it adds up. Interesting though I found that by 7am it starts to scan much faster. If they can have DSL, fast internet hook up, why on earth can't they have fast BCMA scanning? Beats me....Typical government, bass-ackwards! If you get this new version before I do, let me know all about it. I sure hope it's better!

    Oh, and those people who are always having "10" pain? I always want to say, " I don't think you quite understand the pain scale...If I took two bricks and placed your testicles between them then slammed the bricks together, that will equate to #10 pain...Now again I ask you, What # pain are you having???...I thought so." It's like comparing apples to a baseball
    Last edit by night owl on Dec 12, '01
  5. by   rnmom3x
    I went to St. Louis in 1999 for the national training for BCMA and I must admit I was skeptical at first about the program. I had the opportunity at our facility to assist with /or train other staff in the use of BCMA. I administer meds when I work 0500-1330 to approximately 25 pts. with an average of 8 different meds. I love the system and I will admit there are some "bugs & kinks", but that is with anything that is new.
    BCMA was designed to be a patient safety mechanism. I have not found it to be more time consuming, but then that is an indiviualized component.
  6. by   night owl
    It becomes very individualized when one pt has 15 different things you have to enter a comment for (ie) bp's, tx's, liquid meds, and when one med asks for 5mgs say for fosinopril and they send it in 10mg packets so now you have to go back and enter a comment that you gave only 5 mgs. Then you have to enter what his bp was. Why can't pharmacy send the med in a 5mg packet with barcode instead of 10mg? That way we wouldn't have to go back and enter the comment. It becomes very time consuming especially when there's alot of pts that have those kind of comments required. Between a pt with many different entries after much scanning and the slowness of the computers, it does take way too long. We start at 0430 for 5am-6am meds and are lucky to get done by 0715, just in time for report. That one pt can take up to 20 minutes to pour the pills scan them and enter all of the comments. I hope they come out with a better and quicker method. There are times that I must help the CNA with her residents because it's just too much for her by herself and we aren't getting any younger, so that takes away from BCMA time, but to me that's worth my time. I'm not saying the BCMA isn't worth my time, but it does take away from caring for my residents. All the bit**ing in the world isn't going to change it...As I already know.... I for got to mention about when the meds are missing and now you have to go to the Doc-u-Med cabinent DOWNSTAIRS and not just one time, maybe two and three times in one med pass because the med wasn't in the drawer...waaaaaay too much time consuming. By the time you print the order, get the key, run downstairs, hope the med is in there, retrieve the med run back up, put the key away and begin where you left off. It's a great system...when everything runs smoothly, but it NEVER does. It's great for the Pt, but for the nurse??? I need a doctor by the time I'm done with it...:stone
    Last edit by night owl on Apr 13, '02
  7. by   rnmom3x
    Perhaps it would be beneficial if the pharmacy at your facility would do what the pharmacy at my facility does. You gave the example of Fosinopril 5mg as the prescribed dosage and stated that 10mg is what is supplied;if the order states 5mg and 10mg is what is supplied when the med is scanned it does not require the nurse to go back in and enter a comment. For in the section
    titled active medication it gives the name of the drug and the dosage supplied and the section titled dosage gives the amount of the dosage that the provider ordered. Even though the bar code and the medicine is for the higher dose it doesn't require the nurse to enter a comment if the above mentioned sections are as I mentioned. Try this and I guarantee that it will save you some aggravation and headache.
  8. by   night owl
    Thank you for that little piece of information. I will pass it on to my coworkers.
  9. by   ArenRN
    It is a national mandate for all VAs to implement BCMA. We have been using it for the past 3 yrs. Everyone hates it as it is very time consuming. I can understand using it if the nurses duty was only to pass meds. We have lost too many nurses to other hospitals because of BCMA. It is too stressful having to take hours just to pass meds. It is almost impossible to take care of 6-8 pts in a medical floor and then spend hours just passing their meds.
    It is totally ridiculous using it in ICU, since we have no time to enter the meds at the time a patient is going down the tubes. After giving IV pushes, hanging drips, etc during an emergency situation, then we have to actually go and enter the correct time and this must be done manually, which takes too much time.
    It only works for nurses that only passes meds.
  10. by   night owl
    All I know is that after three hours of passing meds to 30 residents on some days, of which the majority receive 5-10 meds at a time, my legs are shot, my hips are shot and I can hardly walk out of the place! Then there are the treatments which you have to enter also! I'd like to choke the person who invented this system...the problem is, she's already dead! The nerve of some people!
  11. by   micro
    one day for my paycheck i will work for the VA.......does that make me a bad person.......that that is a goal...............

    micro needs input.......and/or micro and out
  12. by   Chiron
    I am a VA RN and have been using the BCMA on a med/surg unit, my opinion is that it is not for the convenience of the Nurse or the Patients but for the Administration to keep better records.

    It is just one more added step in medication Administration, as if Nurses needed just one more little thing to do.

    The scanner usually doesn't work and wastes time rescanning, not to mention the eye strain from staring at those timy little lap top screens for hours.

    At least it looks funky and high tech !
  13. by   DelGR
    We are beta testing Version 2. It does have some nicer features with the IVP/IVPB and the Continuous IV fluid tabs. In the status column, you will now have a M show up when you put in a missed medication request. You will be able to highlight several meds or all of them to place them on hold and the same for patients on pass. If you accidently mark a med as given, you will be able to undo that and mark it as held or refused or whatever without having to go to the Vista screen to edit your entry. You will be able to print from the BCMA screen. If you facility decides to, you will be able to do a stat med entry that will generate a VA alert to the pharmacy and the MD that gave the stat order. We have left that button disabled at this time. We do use BCMA in our 10 bed ICU. It can work in ICUs with the more stable meds; but, not during an emergency at all. Way too many steps to input the order and then scan it and deliver it to the patient. Any one else using BCMA in their ICU? What do you do if you are floated and have not learned how to use the BCMA?
    I believe that part of the problem is that each VA has different equipment, IRM and Pharmacy capabilities. Not all have 24 hour Pharmacy or good Administrative backing for this new way of administering medications. Not all VAs gave this much thought or money. It seems like they thought it would be a neat piece of equipment with minimal needs. Far from that, you need the nursing, pharmacy, IRM, administration and facility support to work together to keep this functioning properly.
    This system should have been tested more thoroughly before it was implemented and put into patient care areas.
    One thing I really like about it is that the MD has to input the order into the computer. At our facility, we are strongly discouraged to accept verbal orders and input orders into the computer.
    When I float, I don't have to worry about going back into the chart to check if the med sheet is current. It's all there. It use to take me about 40 minutes to check all my patient's orders against their med sheets before gathering up the meds and passing them. To me it is a time saver and safer for the patients. I like it for the most part.
    One of the things I think all VA facilities need to do, is rethink how nursing is done at the ward level. They need to get out of the Team nurse or Primary nurse mode. Someone needs to say that when a nurse is passing meds ----that is all he/she should be doing at that time. It should have been that way a long time ago so that there wouldn't have been as many errors made that prompted someone to come up with this way of passing meds. Even now we let ourselves get distracted because we need to pass the meds, feed the patients, answer the phone, direct the NAs, assist with ADLs, consult with the MDs, Rehab, on and on and on, etc.
    What are you all doing about patients that are on Airborne isolation?
    What about those that don't leave the armbands on? Or, those that are too agitated to let you get close with the scanner?
    Last edit by DelGR on Jul 9, '02
  14. by   rnmom3x
    You are correct when you said thst each VA has different equipment, IRM and pharmacy capabilities.
    The floor that I work on at the nurse manager has appointed two main people to administer meds, one being me and the other is an LPN on the evening tour. The con of having designated people passing meds is that when one is on leave or rotated to another tour, the nurses that will be administering meds will "act" like they don't have a clue as to how to pass meds or operate the system.
    One idea for the patients that are in Airborne Isolation is to have 2 ID bands(1 on the pt. & the other either on the isolation cart or in a plastic bag outside the entry to the room, provided it doesn't violate confidentiality ), scan the id band and then proceed to scan the meds of course, this is done outside the pt. room.
    For those pt's. who won't leave the ID bands on (notice I said ID bands not armbands), for the band can be placed around the pt's. ankle if need be. This can also work for those who are too agitated to let you get too close with the scanner. If you conti nue to have problems with one not letting you scan the ID band, you can always manually enter the meds after you have finished your med pass. I keep paper handy so that I can jot down the time that I gave the meds so that when I manually enter the meds I am able to enter the time also.
    You were also correct when you stated that nursing, IRM, pharmacy, admin.and facility support to keep this functioning properly. When we went to the training in St. Louis in 1999, we were told that this was a pharmacy package and that it required teamwork. Well, the pharmacist that went to the training from the facility I work made a comment when we returned to the facility that this was a nursing program. That stirred me up and I replied that this was a pharmacy package and it required teamwork. Thankfully, the IRM individual that went to the training also backed me up.
    Our facility is in the process of training personnel in Version 2.

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