Barcode scanning in ED?

[Emergent, RN]

The larger hospital where I work has had bedside med scanning for many years, but not in the ED. I'd been told that the fast paced environment of the ED is not compatible.

I also work in a tiny ED that's attached to a tiny hospital. They are just starting bedside scanning in the inpatient area. Instead of handheld scanners the nurses will have take COWs into the room to administer meds. I was surprised to hear that the ED will be next.

The whole idea sounds even more inconvenient that the usual"improvements". This tiny ED already is less than streamlined, partially due to lack of resources innate to a small place, and also from a bargain basement computer charting system, sometimes working with clinic docs, and a feast or famine patient load, etc.

How many EDs out there are scanning meds?

[NurseOnAMotorcycle, ASN, RN]

I just moved to a hospital that does this. It's actually not nearly as bad as it sounds even though I had my misgivings going into it. During code situations there's a separate screen that you just mark what you gave and it is all automatically put in as verbal orders by the MD. They have these made up specifically for the ER and the fact that we do a lot of codes. The different floors and departments have their own set ups as well depending on their acuity etc.

[Lev, MSN, RN, NP]

We have computers in every room and also there are cows floating around. Each nurse has a mobile which scans as well - but these tend to be very slow and drain the battery very quickly. Our scanning compliance is somewhere in the 85% range, but if you have a critical patient there is no time to wait for the mobile to load up. We tend to scan afterward if there is time on the computer in the room. The mobile does not let us change the time to when the med was actually given.

In code situations we use paper documentation. If the patient makes it, we put the orders in the computer and sign them off.

[NickiLaughs, ADN, BSN, RN]

We do it. It's annoying. I override far more than I should when the computers are broken in my area instead of search for a working one. There's never enough and they should keep them running if they want me to do my job the right way.

[EDnurseNY]

We scan our meds at the ED I work at. It's really not as bad as it sounds, the only time it's a pain in the a-- is when we have admitted patients and you have to do a 20-med med pass and all the rest of your patients are more critical. Then again, it'd be annoying even without scanning, scanning is the easy part.

I also feel a lot safer with med scanning. Of course I check everything before giving, but I like having a safety net that's not distracted by other patients or a loud environment or anything else. Or if a nurse is covering for me (on break), I'll have peace of mind the right dose, med, etc. is being given.

We also have a computer with a scanner in each room and they usually work.

[brewski09]

A previous ED I was in made the transition and now it bugs me that my current one doesn't scan (yet). I'll likely end up a superuser since so many are resistant. Scanning meds cuts down on potential errors. Also, there should still be an emergency override function to not scan for "codes" and all manner of ED shenanigans that we see.

I would be very surprised if the hospital didn't use a mobile device or have a computer in every room since the documentation is so critical. You're ED should have the same computer standards as any other critical care area where they are expecting bedside charting and Med administration with barcode scanning (see what the ICU does and that should be the standard of care/equipment you should be afforded in the ED too).

[pluckyduck, MSN, NP]

We scan, but in EPIC during our code/trauma narrators we have led administration set as verbal orders given by a person in the code to bypass. Scanning cuts down a lot on med errors and we have computers in every room. I may not always scan things like Tylenol or ibuprofen but I always scan my narcotics, heparin, insulin, high risk drugs, etc.

[akulahawkRN, ADN, RN, EMT-P]

I work in a small ED that recently started scanning meds. By and large the system works generally well. There are meds that will NOT scan properly. For instance if I have an order for a saline bolus, the system may recognize the bag correctly but if the order is for a maintenance drip of NS, it may not recognize that same bag for that order. For the most part, the system does work the way it's supposed to and it has helped prevent errors. The barcode scanning system won't prevent instances where the physician orders a certain med that's not available locally but is available in the entire chain. The CPOE system doesn't "know" what's local and what isn't.

The transition for me was very easy. For others, not so much, but they're getting there.

[canoehead, BSN, RN]

We only scan for glucoscans. Our hospital printer doesn't make wristbands that will scan, so we just keep a patient sticker in our pocket or in the room. Totally defeats the system.

[akulahawkRN, ADN, RN, EMT-P]

We only scan for glucoscans. Our hospital printer doesn't make wristbands that will scan, so we just keep a patient sticker in our pocket or in the room. Totally defeats the system.

Our system won't accept 2D barcodes so we can't use a patient sticker. Our wristbands have 2D and 3D barcodes printed on them and the system will only accept the 3D barcode. This, I can only assume, is to ensure that we're scanning an actual patient wristband and not defeating the system by scanning a patient sticker as the stickers only have a 2D barcode on them. Probably the most irritating thing about our barcode scanners is that they're not wireless and sometimes people (trying to keep things looking good) tuck the cord away so the cord becomes way too short to do any good.