Next PRN dose on Bridge. Do you have a window?

Nurse Ratched, RN · Jul 27, 2005

I'm not sure what Bridge is? Is it a Pyxis type of system? If you've got 5 patients scheduled to get meds at 0900, it stands to reason that not everyone is going to get them at exactly 0900, so if it's software it sounds like it needs some fine-tuning .

SmilingBluEyes · Jul 27, 2005

I agree with Ratched. Sounds like a software/program tweaking is needed.

2rntish · Jul 27, 2005

I,m sorry, I should have explained. Bridge is the Bardode scanning system that is supposed to help varify the 5 basic rights of med admin. Scan your badge, scan the pt armband, scan the med...It does a cross check for allergies, order in system, wrong dose, wrong time...

With routine meds we have an hour before to an hour after the "scheduled" time. a 2 hour window.

With PRNs it can not be prior to the exact time stated in the order: q 3 hr, if you give a dose at 0700 it had better be 1000 or later before you scan another dose...If you scan 15 sec early it generates a warning which does 2 things:

1. It desensitizes the nurse to warnings. After several of these type warnings, I am afraid they will disregard the really important ones.

2. Every warning that is generated, I get a report and have to justify who, what, where, why...It is about to wear me out.

We have the ability to set parameters but most administrators think that q 3hr means exactly q 3hr. I would like to see a ......15 min window....or something along those lines.

Bridge has been wonderful so far. Without a doubt, it has prevented MAJOR MED ERRORS. We just need to fine tune the system.

P.S. NurseRatched, Love your post about JCAHO. We are 2 months out and the usual BS has started...nothing to do with improving patient care.

gypsyatheart · Jul 27, 2005

It sounds like your problem is more w/the system your'e using than when to give a med, right? I mean, say if you have Percocet given 0700, not due til 1100, obviously you are not going to give it at 0900. I have used that type of system before, we didn't call it Bridge, but on ours, there is a place you can input "actual time given"....basically you do all your "justifying" at the time.

Tweety, BSN, RN · Jul 27, 2005

I appreciate you concern that it desensitizes nurses to warnings. I agree with you.

I think our hospital eventually is going to that system. I'm not looking forward to it, but if it increase patient safety, I'm sure it's a good thing.

suzanne4, RN · Jul 27, 2005

We use a barcode system also, and do not have any warnings issued like that with PRN doses. Sounds like your IT people need to fix that part of the system.

takniteze · Jul 27, 2005

I understand where you are coming from and in most facilities there IS a 15 minute window which allows for the medication to be given up to 15 minutes PRIOR to the hour of accepted delivery for a Narcotic. (e.g. original dose was 0900, med ordered was q 4h next dose is available @1300, med CAN be given as early as 1245 hrs. but NOT before.) There IS a way to incorporate this INTO your system so that warnings Will not go off, it will be upto your pharmacist and computer programmer to discuss this option. Also bring this up to your lead Supervisor and explain how this is affecting patient care and work performance by taking time away from patients to write explanations and by making the Nurses slower to respond to the patient need due to the fear of reprisals and reprimand for having too many warning notices.

I,m sorry, I should have explained. Bridge is the Bardode scanning system that is supposed to help varify the 5 basic rights of med admin. Scan your badge, scan the pt armband, scan the med...It does a cross check for allergies, order in system, wrong dose, wrong time...
With routine meds we have an hour before to an hour after the "scheduled" time. a 2 hour window.
With PRNs it can not be prior to the exact time stated in the order: q 3 hr, if you give a dose at 0700 it had better be 1000 or later before you scan another dose...If you scan 15 sec early it generates a warning which does 2 things:
1. It desensitizes the nurse to warnings. After several of these type warnings, I am afraid they will disregard the really important ones.
2. Every warning that is generated, I get a report and have to justify who, what, where, why...It is about to wear me out.
We have the ability to set parameters but most administrators think that q 3hr means exactly q 3hr. I would like to see a ......15 min window....or something along those lines.
Bridge has been wonderful so far. Without a doubt, it has prevented MAJOR MED ERRORS. We just need to fine tune the system.
P.S. NurseRatched, Love your post about JCAHO. We are 2 months out and the usual BS has started...nothing to do with improving patient care.

2rntish · Jul 27, 2005

I appreciate you concern that it desensitizes nurses to warnings. I agree with you.
I think our hospital eventually is going to that system. I'm not looking forward to it, but if it increase patient safety, I'm sure it's a good thing.

Look forward to it. I am looking at 21 computer generated "prevented med errors" right now. 3 are actual prevented errors. The rest are "noise" like the PRN time issue. I am more than happy to wade thru all of these if we can prevent even 1 error.

We are still in the learning phase of what is an error and what is not. That is the reason for my question to the group. It is very obvious that it has prevented errors from reaching our patients.

Before you implement your system, visit with as many users as possible and learn from their trials and errors. There are growing pains with any change but this one has been worth it.

HappyNurse2005, RN · Jul 27, 2005

We have the MAK for med scanning at our hospital, and if you have a q4 prn, give one at 0700. If you go to scan one before 1100, you get a window that pops up and says something to teh effect of remining you that it hasn't been long enough, are you sure you want to continue? and you have to click yes or click cancel.