Bcma

rnmom3x · Jul 9, 2002

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.

night owl · Jul 14, 2002

When we were orienting two new nurses last year on our LTC unit each six months apart and they were "let go" to use the BCMA on their own, they each ended up giving a resident the wrong meds. Why? b/c someone had placed the wrong ID bands on the residents. It's funny how it only happened to the new nurses (six months apart mind you) Obviously they weren't sure of the identity of the residents faces with their names. My husband said, "Sounds like a set-up to me." One nurse quit that evening the other is still with us. It only goes to show you that the ID bands are useless unless you actually know the patients. I could see where Agency nurses would have a big problem using the BCMA and probably wouldn't! But who would put a new ID band on someone without checking to make sure it's the right band for the right person??? Brain dead, or a set-up? SOOOO, I was thinking, after you scan the band and the question pops up, "Is this the correct patient?" wouldn't it be a good idea to have a photo ID (like the picture on their locator card) next to that question so that mistakes like this could be avoided? Luckily, no allergic reactions occured to either resident. But worst case senario,...sentinal event! :crying2: and S.O.L....

night owl · Jul 14, 2002

Micro,

We would love to have you!!!:kiss

DelGR · Jul 15, 2002

Night Owl, Were the two misidentified patients able to tell others their names? Didn't the nurses ask them their names? I thought that this was still practiced? I know I've always asked the patient their name even with the BCMA because I was afraid of just such a thing happening........what a shame for the patients and the nurses.

I like the picture on the screen thing.

I was visiting one of our nurses that works in informantic (sp?) and he showed me a new version of the CPRS chart. We will be able to view xrays, CT scans, videos of echos, etc and 12 lead EKGs. Why not put the patient's image on the e-chart too. What a good idea!

night owl · Jul 19, 2002

The two residents were not able to tell the two nurses their names and obviously they didn't ask anyone else to identify them.

The new version sounds alittle better than the first...I think these terrorists should blow these med carts up! you're right though DelGR, they should be able to put their pic on 'puter!

mariabruja · Aug 16, 2002

How fabulous to find this discussion. We have been working with BCMA here for a while on a geriatric/ltc ward. Wondering what you use as a comment when meds are given early (5-10 minutes before the 1 hour window) and the prn effectiveness if pts are sleeping. Often bypassing the armbands by entering the SSN manually. (bad habit, I know)

DelGR · Aug 18, 2002

Is there a reason that the patient is getting the meds 5-10 minutes early? If it is that frequent, maybe you should have your ward administration times changed (especially if it is multiple patients). That is what one of our long term care wards did when they continued to have a lot of early/late variances.

You can always add to the drop down list of reasons in the BCMA for PRN effectiveness, such as, "patient sleeping". Our Chief of Pharmacy, who is the chair of our BCMA, will add reasonable request when enough nurses let her know that it is an ongoing need for something added to the list to choose from. For that matter, you can have the list expanded for the Hold reasons too. We found that one of the reasons might be "no site available" had to be added when the IV, NG tube and PO route wasn't availble.

If you bypass the arm band and enter the SSN instead and are caught, you may be facing disciplinary action against you if you don't have a good reason to use SSN instead of scanning. We have had some nurses caught with list of bar codes, a key ring with trimmed down patient arm bands on it, a list of the patient's SSN under the laptop. Not a good practice.

BCMA was set up for patient safety not to ease the med pass routine for the nurses.

Brownms46 · Aug 18, 2002

Originally posted by night owl
The two residents were not able to tell the two nurses their names and obviously they didn't ask anyone else to identify them.
The new version sounds alittle better than the first...I think these terrorists should blow these med carts up! you're right though DelGR, they should be able to put their pic on 'puter!

I worked with the BCMA system while on contract at a VA hospital! HATED IT ! And I'm totally glad I won't have to deal with it again! I prefer using the pyxis system!

mariabruja · Aug 18, 2002

Tell me about the drop down menu for prn effectiveness. All our comments are entered as text. Is this something that can be added to the system?

DelGR · Aug 19, 2002

I misspoke. The menu I meant to say was the hold menu. You're right that the PRN is a text message. Sorry for the misunderstanding on my part.

Why wouldn't "pt.sleeping" be just as good as a pain level or saying pain med is effective or not effective? You can always ask the patient later when he wakes and put his repsonse in a regular chart note. At least you attempted to chart the patient's response to the pain medication or any other prn for that matter.

DelGR · Aug 19, 2002

http://www.msnbc.com/news/795131.asp

An article about one of our VAs and the use of Bar Codes for Medication Administration.

rnmom3x · Aug 28, 2002

I agree with DeIGR about the pharmacy being able to add to the pick list for prn effectiveness. Also, why are you circumventing the system by entering the SSN instead of scanning the ID band ? To be honest, there is no justifiable reason for manually entering the SSN.