Bcma

night owl · Oct 19, 2002

There are times when a pt needs a new ID band because it doesn't scan anymore. When we tried to make a new ID band, the machine that prints them out wasn't working properly. It wasn't loaded properly, or for some reason when the ID band was printed out, the bar code wasn't printed properly therefore showing that little sign "Pt not listed" or whatever it says when you scan it. After scanning and scanning, and scanning and scanning and it just wouldn't scan, you more or less have to type in his SS#. I don't know if it was the printers' error, or the ink cartridge was messed up or whatnot, but it just wouldn't scan...happened on the weekend, and we couldn't spend all morning trying to figure out what was wrong with the ID band machine. No one knew how to fix it and had to give the man his meds. The system isn't error proof...yet, so things of this sort are bound to happen. What else were we to do?

And yes, DelGR, someone needs to address the fact that when we are passing those meds, that's all we should be doing and nothing else.

I got nervous there for a minute about that drop down menu for the prn effectiveness saying to myself, "WOE! I don't remember seeing that am I really missing something here???" Ours are entered as text also. I guess they're all the same right? I work nights and a prn pain med effectiveness is often entered as, "Pt sleeping at this time." Do you have to go back and enter a level of pain # in the BCMA or in the CPRS? "Pt sleeping at this time" is or is not an acceptable effectiveness response? Was never told about it. I suppose if JCAHO wanted to know it had better be somewhere right? and they are focusing alot I hear on pain meds and their effectiveness.

FTell001 · Oct 20, 2002

I had a pt on q1hr eye drops...and was using the BCMA...

ok...soooooooo..I scan the pt's arm band...scan the eye drops..THEN have to change the doseage to reflect TWICE the amt because it was for BOTH eyes...put all that into the computer...and..then I got to put the drops in the eyes!

Can you say "AGGRAVATING"????????? and..calculate the time that took!

Oh..forgot to say..I had to first SIGN in..or LOG in to the computer.

DelGR · Oct 27, 2002

Night Owl, wasn't there another ward you could have had the armband printed to? At our facility there is no excuse for the nurses not to use the system as intended. :nono:Our facility has gone straight to disciplinary action if a med error happens because the nurse circumvented the system. Of course, they try to first ascertain if the mistake happened due to the system, process or something other than the nurse not using the correct steps of scanning the pt's armband then the medication.

night owl · Nov 8, 2002

I recently transfered to another unit and this unit has the ID bands right in the residents med bin! Pharmacy comes to change the bins and no one says a thing about it. I have yet to see any unit that does it totally the right way. Another unit has a set of ID bands on a key ring for each district, another has the ID bands taped on piece of card board according to room number for each district and I've seen nurses come in at 0600, sit at the nurses station and scan all the meds on the Due List for 0600 then give them all out with their 0900 med pass so they don't have to go around twice! Also seen nurses scan all the meds for 0600 first, then go around and pass them all out. I could never figure out how nurses that were pulled to my old unit finished their meds before the nurses who work there. It would take them one hour to give the meds and two hours later, I'd still be scanning and passing meds. As I am pulled to different units, I now see the ways they try to beat the system and yet nothing is being said, so obviously it's being tolerated...Why then was all this money spent for this system to make medication errors become obsolete???? The whole purpose of this system is defeated when they go about using it the wrong way. I just wonder if they really know about the "cheating ways" and if they do, do they really care? Makes you wonder.

FTell001 · Nov 8, 2002

All the nurses...and I mean ALL of them do it the same way as Night Owl mentioned....and thats how they get their meds passed...BUT..if caught..there will be consequences! Yes..it defeats the whole purpose of the BCMA ...but then again.....try getting your meds passed on time by doing it the correct way!

OH..and administatration denies that this method takes soooooo much of our time. They said "well..we haven't had any complaints from the nurses"...

Little to "They" know that the nurses figured out immediately that passing meds the "correct" way was just NOT going to work on a busy floor!

or..ELSE..they are clearing themselves of any liability by understatffing and then initiating this method of preventing med errors..to put it on the nurses shoulders!

night owl · Nov 11, 2002

Went to BCMA version 2 class the other night at 0300! I like the idea that you can highlight all the meds when someone goes on pass instead of entering them "held" for EACH med and then entering the comment "on pass" for EACH med. Saves some time. When our residents go on pass, they have at least 10 meds at 0600 that I give out. Pheeeew! I also like the idea that the applied nitropatch will continue to display on the VDL until it is marked as "removed." How many patches I find in the morning that weren't removed! And then you can edit a medication status from "given" to "not given" from the BCMA and Oh, the new allergy display screen that shows in three different areas. An "M" will now appear if a missing dose has been submitted. The med will still display on the missed medication report.

They still need to come up with a way to have the meds show that were held for labwork like when a chem-7 is done you would hold insulin, glyburide etc. I go home and the only way the day people know the pt's insulin, ect. was held due to lab work is if I verbally tell them. The 0600 meds need to show again at 0900 in the VDL's so they can be given. I know some of these meds aren't given because they just don't show up again and the nurse forgets to give them... especially if they aren't showing up. They have enough to give and then try to remember to give the meds that were held earlier. Maybe BCMA version 3 will have this feature. Can't they just come up with one button you push and they're all given just like that??? It would be so much easier that's for sure...maybe BCMA version 10!

For those of us who use the system the way it was designed I applaud us. It is tedious to say the least, but at least the patient is protected from med errors and I am protecting my license...to me, that's all that counts. But for those of you who cheat and try to do it an easier way, you're bound to make a med error...Beware, you just may get caught...

DelGR · Nov 20, 2002

You guys should be talking to your Bar Code committee and tell them you're not getting support to use the system correctly. I know it is difficulty but you must be persistent and not let them brush you off. I know I am not really a pushy person, but when push comes to shove, I speak up. I will not let someone else dictate how I do my job unless they fully understand the difficulties they place on me when they introduce something new and untested and tell me I have no choice.

I was orginally placed on the BCMA committee by my nurse manager. I spoke up during any national conference calls pre-BCMA and continue to speak up either through the e-mails from the national Nursing BCMA committee or locally in our facilities committee.

You all should be communicating to the nurse on the BCMA committees at your facility and let them know of difficulties.

BCMA was not a local or VISN decision, it was a VHA mandate per Kizer when he was in office. It wasn't especially thought out fully when it was first put into being. It continues to be tweaked. It needs the voices of the users explaining to the techies, managers, pharmacists and others-- what is working and what is not --- and that is US, the nurses that need to tell them. This IS one area that Nurses could really step up to the plate and have more of a voice. You need to speak up if the hours of med passes are not working for the majority of your patients. If you don't have enough nurses you need to let the nurse manager flex someones schedule. Pharmacy can move some meds that do not need to be given at 9AM to a less busy time. I know I spoke up and told the committee--"if you think the nurses are taking those big bulky med carts out to give one or two prns, you are all crazy; it isn't happening." Our chief of pharmacy got on the internet and found a stand with a stable base that held the laptop with a small drawer/shelf and basket for carrying small amounts of meds and IVs. Plus, as I said in an earlier post, our facility has gotten tougher with medication errors resulting from circumventing the system. Nurses are punished right away. So, I find it is easier to speak up when there is a difficulty and be persistent in trying to get it resolved than be punished. Call your Patient Safety officer or Risk manager for some Organizational Performance Improvement backup.

Sorry this is soooooooo long; But I just had to speak up.

esselmulen · Mar 4, 2003

Originally posted 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 !

You're right on that one Chiron. Once again, the chair polishers have shafted us working nurses, they jump on any old band wagon that comes down from on high, never questioning their bosses for fear of falling out of favor and the only nurses that test this garbage are a bunch of prima donas who work in the education departments at our medical centers and need to justify their jobs. Nobody ever asks us working stiffs about nothing. And then there are the new nurses and the agency nurses who constantly ask we older nurses how to do everything because the bcma class they got was full of baloney and they didn't learn anything anyway.

esselmulen · Mar 4, 2003

Originally posted by rnmom3x
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.

rnmom3x, maybe being in VA and close to the seat of power you have all of the right equipment and it's all in working order, but up here on the Great Lakes, we're lucky if we get patients with ID cards from the atr, let alone arm bands, and the printer on our ward works about 50% of the time so it's a crap-shoot whether you can scan a vet or not.

Pompom · Feb 11, 2010

I have worked at 2 different VA's and unfortunately both use this system. It is a pain and time consuming. I believe it came about to satisfy JACHO. We love when the computer crashes and we use our contingency paper back up system . Despite our complaining, nothing will change it is what we are forced to use. It pays the bills, what else is there to say.