Med Admin using Bar Code Scanning

[DayOhioRn]

My hospital uses the computerized Epic charting system :typing, and we went live in Oct. 2006. In March we are going to incorporate the Bar Code scanners for medication administration. This requires the nurse to scan not only the medication, but the patient's ID band EVERY TIME you administer ANY type of medication.

My question is....has anyone here dealt with this system, and how is it going for you?:uhoh21:

Feedback is welcome in any form!

[DutchgirlRN, ASN, RN]

1) wrist bands don't scan well, so staff uses the "charge card on the wall" to scan.

2) some meds don't scan well or sometimes don't have a readable barcade, so one has to go to the "med list" on the hand held scanner.

4) the scanner pops up "med early" or "med late" unpredictably, sometimes when a med is one minute early or late. then one has to enter some kind of explanation using the tiny onscreen keyboard.

7) the scanners are bulky and a little grungy.

we have been using bar code scanning for 6+ years (emar) it took a little adjusting to get use to it but once i did i would not ever want to go back without it. our meds errors have dropped over 96%!

1)we had issues with the arm bands in the beginning and soon changed the type of armbands and now no more troubles. scanning the charge card will get you fired "pronto" and it has happened.

2)if our meds don't scan, which doesn't happen often we can override the system. we keep the packaging to turn into pharmacy so they can fix the problem.

4)we can give a scheduled med 2 hours before or 2 after time due without a problem.

7) we now have cordless scanners which takes the bulk out of the cart. we've also recently gone to rubbermaid carts which are much lighter and easier to navigate. grundy can always be cleaned. i would fault the hospital for that.

it took us several years to work the kinks out of the system. the drop in med errors is so awesome. it makes me feel safer when giving meds. it also alerts is if a med is out of date, if wrong dose of the correct med is scanned, a co-worker has to put their initials in before high risk drugs can be administered including insulin. we were the first hospital in our state to have barcode scanning. i love it!

[elkpark]

Could it be that the scanner system I'm using (don't know the name) is different from the one that everyone seems to like? Could our equipment be faulty? Or could it be a technology problem? We do use a pyxix system that is great.

I am not adverse to technology. My students have been using PDAs for years, and I am open to new things. It has been very interesting to read how satisfied some nurses are with this system.

There are a bunch of different systems out there, from different developers/manufacturers, for hospitals to choose from -- sounds like your facility chose one that is not as "user-friendly" as some others. I hope they will be able to find a way to fix the frustrating aspects of the system.

[elkpark]

Well, after I bragged and bragged about our system, I made a med error over the weekend -- some of the safety features built into both the administration system and the Pyxis machine just didn't function. I'm not saying that's an excuse -- it's still my responsibility; just found it v. interesting and enlightening to find out that I can't depend on the machines to always do what they're supposed to. I'll be (even) more cautious in the future. (Fortunately, it was not an error that could cause any harm to the client ...)

[Runman1914, MSN, RN]

We have the system at my hospital. It goes down all the time and we have to go to the old paper method. At least once a week it goes down and the computer specialist has to come to the floor.

Its great when its working but really puts us behind when it goes down.

[jackson145]

Our hospital recently upgraded to barcoding. I can't think of the system name. The first weekend 35 med errors were caught! One department is having a total shake-up of supervisors and staff.

[1993RNGrad]

We are supposed to be going to a system like that soon. It doesnt sound so good to me since we have a hard time trying to get meds in the pyxis so we can use them. We arent supposed to override the meds list for patients but find we have to frequently because they dont list the ones we actually need on that patients list. Another call to pharmacy and another fax with the order that should have been there in the first place.

So makes me wonder how it will go when we have to scan or check everything electronically.

We have been using a similiar system at our hospital for at least 3 years and I love it!!!!

At first we were all very resistant - how dare you take away my pencil and paper med lists, I NEED those!!! How quickly we got used to the electronic system......

The difficulty with frequently missing meds on the lists have long since passed, with only the occasional issue here and there. We are not supposed to override anything and most people are pretty good with that.

We do have issues with bar code scanners not working, but they are being replaced with better models. Each room (all private rooms) are equipped with a computer that can be used for charting as well as having the medication administration program on it. Each room has an individual scanner.

Honestly, I never want to go back to a paper and pencil system again - I love the extra check beyond our rights of med administration....

You will get used to it, the pharmacy will become more efficient at it and everyone will wonder how you did without it to begin with.

[wearingmanyhats, RN]

I work agency in a LTC that uses a pillow pack barcode system. The meds are prepared by pharmacy, and are labeled with the code number that is stamped on the med.

We do not have wristbands to scan, but it makes the med pass so much easier than a MAR.... as long as you pay attention to the screen, which you should be doing anyway.... if a med is changed, it shows up in HUGE RED LETTERS......" barcode1223222 lasix 20mg has been discountinued"

Occasionally the barcode doesn't scan, but it is still easier to use the computer than a MAR

Faye

[blondbella]

I am a clinical analyst (also an ICU nurse)and am currently working on a BMV implementation. I am so excited to see all of the positive comments regarding BMV. We start training in two weeks and go live April 15th. One of our biggest obstacles has been co-signing. We have decided to do away with co-sigs for everything but heparin and chemo. We will do a verification in nurse notes for high alert drugs that require calculations (like titrating an insulin gtt or adjustin heparin to an aPTT.) Curious as to what you all are doing about co-signing.

By the way, did anyone see Oprah the other day when she had Dennis Quaid on. Dr. Oz gave a list of things to look for in a hospital and he strongly endorsed BMV. We were thrilled!

[rrroyer]

We just recently implemented Meditech BMV in our hospital of 240 beds. We had piloted for 7 months on 2 units to work out the kinks and had a 2 week support period. It has been remarkably well received by all the Physicians, Nurses respiratory therapists and patients. Much of the factors to success include doing the research and avoiding the pitfalls.

We have a special character on the armband that differentiates it from other patient bar code labels. Test all drugs and make sure your bar code reader can read them all. Spend on a quality scanner. We use a Symbol DS6708 reads every bar code practically all the time. Make sure the cart is user friendly and will not run out of battery life and you have excellent wireless coverage in all rooms. Include the staff from Medical, Nursing, Respiratory and Pharmacy in the decision and make sure you have strong administrative backing. Use reporting to demonstrate the success and the number of prevented errors. Have a good training program and practice sessions available to staff and things should go well. Best of luck to everyone working on improving patient safety in the hospitals.

[boggle, ASN, RN]

I have used the BMV and Meditech system for a few years and overall I do like it. It does take a little longer than the old paper MAR med passes, but catches errors and easily allows documentation of VS or pain rating at the time of med administration.

I REALLY DISLIKE:

-how once the patient and meds are scanned, the computer shows the med as "given" even though it is still in my hand, or spit out, or the patient dropped it..... I don't think the med should be filed as given until I see it IN the patient.

-how I have to "full document" a reason why I'm one minute beyond the half hour window we have to give a scheduled med. There needs to be a little more room for this or an easier way to say "I was here with the med on time but had to wait for the patient to get out of the bathroom" or whatever. Any "late" med is an "incident"

[rrroyer]

Our system is set up differently. Our meds don't count as given until we file them. So we educated nurses not to file until the med is swallowed or administered. This gives them the opportunity to "undo" anymed that is rejected by the patient or spit out.

We have an admin comment to document reasons for lateness. Unlimited characters. We have set the late time as 60 minutes after med due for nursing and 120 minutes for respiratory. However there are often reasons to excede this as patients are often of the floor. So we monitor for trends from staff members and work to adjust our admin times.

[ONCRN84]

We have a MAK system.. and I love it. Our meds come in little prefilled packages with barcodes-1 pill per package. We log in, scan our name badge, scan the patient, ask name and date of birth to make sure it's indeed who came up, then scan the meds one by one. We have a 1 hour window either way to give the medication without a reason. If you're early or late, it wants to know why and it has a simple drop down menu to choose from. If it's, say 150mg of something and you have 50mg pills, it will pop up that you need to scan 3 packages. Most routine meds are kept in the patient's room in a locked cabinet. PRNs, narcotics, benzos, etc are in our accudose... those all have barcodes too. We have computers in every room and our new scanners are AWESOME. I swear I can hit the arm band from across the room.

Anyway, I love computerized medication administration. You still have to think, but you're less likely to make an error. With our system, you seriously have to override a lot of things and basically intentionally mess up.