Bcma

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! and S.O.L....

Micro,

We would love to have you!!!:kiss

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!

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!

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)

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.

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!

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?

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.

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

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

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.

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.