“ Implementing A Bar-Coded Bedside Medication Administration System ”

1. “Implementing A Bar-Coded Bedside Medication Administration System” Presented by: Barbara Seebold RN

2. Objectives • Describe the Barcode System • Describe the benefits of barcode medication administration system • Describe the hardware and software in the barcode system • Evaluate the Usability of the Software (Mitch Work,2005)

3. Objectives • Summarize The Criteria • Review of Information System • Recite a Recommendation • Summarize the advantages and disadvantages of barcode medication administration system • Summarize the legal and ethical issues of barcode medication administration system • Describe the Nurse InformaticistCompetencies, Functions and Responsibilities (St. Luke’s 2008, Cummings and Ratko, 2005, LaDuke 2009)

4. System Description • Barcodes provide valuable verification of medication administration , assuring "five rights" are confirmed • Barcode technology at bedside shows impressive gains in reducing medication administration errors (Mitch Work,2005, Sakowski, 2006)

5. Utilized Hardware • Laptops in patient rooms instead of computers on carts • Wireless bar code readers • Bar-code point-of-care • Automated drug-dispensing systems and Robotics (St. Luke’s 2008)

6. Laptops • Priority for hardware ease-of-use • Acceptable to all parties • Soliciting feedback and including pharmacy and clinical personnel • Getting nursing input was essential in device selection (St. Luke’s, 2008)

7. Utilized Software • Implementation of e-MAR in inpatient areas • Computerized physician order entry (St. Luke’s, 2008)

8. eMar • Caregiver establishes Bluetooth connection between bar code reader and laptop • Caregiver logs in by scanning identification badge and entering PIN • Caregiver identifies patient by scanning the patient identification wristband • Caregiver scans dosed medication with either manufacture or hospital generated barcode • Software ready at bedside with patient-specific information viewable to caregiver during medication administration (St. Luke’s, 2008)

9. eMar • Caregiver watches on-screen for warnings of 'Five Rights' violations • - Right Patient • - Right Medication • - Right Dose • - Right Time • - Right Method of Administration (St. Luke’s 2008)

10. eMar • Caregiver reviews warnings, and determines next step • Caregiver exercises clinical decision-making responsibilities and documents decisions/actions • All data captured/actions taken are stored in patient's medication administration record (St. Luke’s, 2008)

11. Usability of eMar • Adequate design characteristics • Focus group used to begin process of use • Understandable and easy to learn interface • Problems with system detected early and worked out • End users evaluation passed for final use (McGonigle, 2009)

12. Review Of Information System • Clinical information system • Physicians, Nurses and many others use this application to monitor patient care • Allows for the function of scanning and documentation • Configuration used is the Workstation • Health level 7 is the data standard • Clinical Care classification scheme (McGonigle, 2009)

13. Recommendation • YES, I recommend this system to others implementing this trend because I have used it so I have experienced it and already know how it works and have no trouble with it. It is very easy once you get to know it. It may not seem that way once you start, but after you learn it, it is very, very easy.

14. Advantages • Reduction of medication administration errors • Increased patient safety and accurate reporting • Improved communication between departments • Improved process integration and information sharing • Reduction in overall cost of care • Valuable management-level decision-making tools (St. Luke’s 2008)

15. Advantages • Decrease errors: right medication, right route, right patient, right amount, right time • Increased efficiency at bedside • Minimally increasing nurse staffing time requirements • Improve nursing staff job satisfaction • Improve patient satisfaction • Generate positive public relations with the local community(Mitch Work,2005) (

16. Disadvantages • Barcode scanning can interrupt nurse workflow processes, leading to frustration/fatigue among staff. • Barcode equipment must be reliable, readily available, and user-friendly to be used effectively. • Select barcode technologies may lack certain desirable features/functions, which limit their usefulness. • Barcode system approaches to complex IV solutions, non-typical formulations, and other pharmacy compounded products are still in the development phase. • Interfacing between various hospital computer systems can be problematic. (Cummings and Ratko, 2005)

17. Legal/Ethical Issues • Scanning is a form of documentation • Scan bar-code on the patient's ID wristband • Scan medication bar code after removing the medication • Investigation could constitute professional misconduct • Criminal charges • Nurses can and have lost their jobs (LaDuke 2009)

18. Nurse InformaticistCompetencies, Functions and Responsibilities • Establishes connection between bar code reader and laptop • Logs in by scanning identification badge and entering PIN • Identifies patient by scanning the patient identification wristband • Scans dosed medication with either manufacture or hospital generated barcode • Watches on-screen for warnings of 'Five Rights' violations • Reviews warnings, determines next step, exercises decision-making responsibilities, documents decisions/actions (St. Luke’s 2008)

19. Summary • Having BPOC in place is the ultimate objective • Addressing Pre-BPOC situations is a purposeful and well thought out method • This can be a welcomed precursor that aids in determining the needs of the institution about BPOC

20. References • McGonigle, D. and Mastrian, K. (2009), Nursing Informatics and the Foundation of Knowledge, Jones and Bartlett Publishers, Sudbury, Massachusetts, Retrieved March 1, 2010 • Sakowski , J. (2006), Using a Bar-Coded Medication Administration System to Prevent Medication Errors, American Journal of Health-System Pharmacy, Retrieved January 31, 2010 from http://www.medscape.com/viewarticle/519719 • St. Luke’s Hospital,(2008) Implementing a Bar Coded Medication Administration System. Retrieved January 31, 2010 from http://codecorp.com/stlukes.html

21. References • Cummings, J. and Rayko, T. (2005) Bar-coding to Enhance Patient Safety, Patient Safety and Quality HealthCare, Retrieved February 1, 2010 from http://www.psqh.com/sepoct05/barcodingrfid1.html • LaDuke, S. (2009) Playing it safe with bar code medication administration. Nursing 2010. Retrieved February 6, 2010 from http://journals.lww.com/nursing/Fulltext/2009/0500/Playing_ it_safe_with_bar_code_medication.17.aspx • Work, M/ (2005)Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital, Patient Safety and Quality HealthCare, Retrieved February 1, 2010 from http://www.psqh.com/mayjun05/casestudy.html