Living through going to barcode scanning

melizerd, ASN, RN · Jan 11, 2015

I've used both Cerner and Epic. Epic is pretty intuitive for me. I'm not sure what kind of hiccups to expect during a transition but once it's all through it should be fairly easy.

Scan patient, ask DOB/name, scan medication (I explain as I scan each one) and then give medication.

akulahawkRN, ADN, RN, EMT-P · Jan 11, 2015

I've also used Cerner and Epic... and paper MARs. The hardest thing for me when transitioning back to scanning the patient was remembering to scan the patient first to "unlock" the MAR page and scan the meds before I open them and ruin the barcode. I did finally figure out how to get the system to list the meds by time due instead of alphabetically... That helped a lot too in keeping organized.

Graduatenurse14 · Jan 11, 2015

Thanks!

I love scanning and I'm a nervous wreck passing meds without it! It's not as safe and takes much longer the way it is now. I'm dreading the transition as it will be nightmare, I'm sure. Then it will be really good, I hope!

I too remember a few times opening the med before scanning thus ruining the barcode and making more work for me and my clinical instructor.

Gooselady, BSN, RN · Jan 11, 2015

Scanning takes all 5 Rights into account and prevents human error. We first scanned the patient's wrist band, then the medication. The 5 Rights are a done deal at that point besides also recording the administration in the MAR. We had EPIC at my last hospital job, it's a pretty good system

Graduatenurse14 · Jan 11, 2015

Thanks Gooselady!

Question: Was it an integrated system?

What I mean is this: On clinicals using Cerner, the hand held scanner gun (looked just like the ones at the stores) was actually part of the same system so there were less issues whereas where I did my preceptorship they used Sunrise with VeriScan Rx scanners.

Since we are going to Epic, I'm curious about the type of scanners you all have used.

Thanks!!!

dudette10, MSN, RN · Jan 12, 2015

Scanning takes all 5 Rights into account and prevents human error. We first scanned the patient's wrist band, then the medication. The 5 Rights are a done deal at that point besides also recording the administration in the MAR. We had EPIC at my last hospital job, it's a pretty good system

Disagree. It only does right patient and right med. Right dose, right route, and right time still require active attention by the RN.

If you get a partial package through EPIC, I suggest that you draw up the med or cut the pill immediately after scanning it. If you have multiple meds to give at a time, you might get caught up in education or answering patient's questions if you just scan, scan, scan. Then, when you go to give the partial package, you could forget to draw up or cut for the right dose. That's happened to me.

mandy13086 · Jan 12, 2015

I don't use Epic, unfortunately...but when I have a pill that needs to be cut in half, this is what I do to help me remember:

At the pyxis, when I'm pulling out the medication, I'll see that the dose needs to be halved & will put a mark on the pill package on the side of the barcode. Then, in the room, the system reminds me that the dose I have scanned is too much (which I know since I knew it had to be cut), so I set that 1 aside from the rest & continue scanning. Once finished, that's most often the first medication that I remove from the packaging while it's fresh in my mind to cut it. Just an idea for any other newer nurses out there.

akulahawkRN, ADN, RN, EMT-P · Jan 12, 2015

Disagree. It only does right patient and right med. Right dose, right route, and right time still require active attention by the RN.
If you get a partial package through EPIC, I suggest that you draw up the med or cut the pill immediately after scanning it. If you have multiple meds to give at a time, you might get caught up in education or answering patient's questions if you just scan, scan, scan. Then, when you go to give the partial package, you could forget to draw up or cut for the right dose. That's happened to me.

I've had that happen using traditional methods... but it's very easy to do with an electronic system as well. I was lucky to have caught it when doing a "5 rights" check one last time... About the only "gripe" that I ever earned was being a little slower at doing the med pass and that's because I tend to be a bit more paranoid about it.

As far as the scan devices I've used, I have used a couple different types. I've used wired and wireless scanners that just read barcodes and "report back" to a workstation, be it mobile or mounted in the patient's room. I've also used an handheld device that could also be used as a portable workstation, but was usually used just for scanning meds without tying up a mobile workstation, but you wouldn't want to do all of your charting on it and you could miss additional data entry sheets on that handheld if you weren't looking for it when doing med admin.

seanynjboy, BSN · Jan 12, 2015

I have been involved in both an EPIC and CERNER barcode transitions from paper to electronic. EPIC is WAY easier to use in my opinion. Cerner has way too many things to click through. EPIC has its faults as well, but all in all, I find EPIC easier, more user friendly, and just an overall better system.

Here.I.Stand, BSN, RN · Jan 12, 2015

I use Epic. I'm not sure what you mean by integrated system, but where I work there's a computer in every pt room. The scanner is connected to the computer. You open up the chart, go to the MAR, scan the pt's wrist band, and scan the meds.

It's doesn't completely eliminate the need for checking rights. For example, the system "lets" you scan PRN meds more frequently than the ordered interval, so you do have to look and see when it was last given and if you can give it again yet. Or an IV med; the system verifies the med, dose, and time, but of course won't program the pump for you. But it eliminates a TON of human error.

But if you're only giving a portion of the med (e.g. multidose vial, pill cut in half), when you scan it gives you a big red warning that the dose entered exceeds the order. If you need to give multiple tabs of one med (e.g. two Percocet), if you only bring one and scan one, the screen for the med just scanned gives you a little "!" by the "dose" field which populates when you scan...so when you see the "!" that's a reminder that you haven't scanned the full dose.

Hope that makes sense, but anyway you'll see what I'm talking about once you use it. I like the system a lot once I got used to it!

akulahawkRN, ADN, RN, EMT-P · Jan 12, 2015

I use Epic. I'm not sure what you mean by integrated system, but where I work there's a computer in every pt room. The scanner is connected to the computer. You open up the chart, go to the MAR, scan the pt's wrist band, and scan the meds.
It's doesn't completely eliminate the need for checking rights. For example, the system "lets" you scan PRN meds more frequently than the ordered interval, so you do have to look and see when it was last given and if you can give it again yet. Or an IV med; the system verifies the med, dose, and time, but of course won't program the pump for you. But it eliminates a TON of human error.
But if you're only giving a portion of the med (e.g. multidose vial, pill cut in half), when you scan it gives you a big red warning that the dose entered exceeds the order. If you need to give multiple tabs of one med (e.g. two Percocet), if you only bring one and scan one, the screen for the med just scanned gives you a little "!" by the "dose" field which populates when you scan...so when you see the "!" that's a reminder that you haven't scanned the full dose.
Hope that makes sense, but anyway you'll see what I'm talking about once you use it. I like the system a lot once I got used to it!

While I have gotten somewhat used to Cerner, I like Epic better. It's just a bit more user-friendly, IMHO, and pretty much for the same reasons.