“Implementing A Bar-Coded Bedside Medication

Administration System”

Presented by:Barbara Seebold RN

ObjectivesDescribe the Barcode SystemDescribe the benefits of barcode medication administration

systemDescribe the hardware and software in the barcode systemEvaluate the Usability of the Software

(Mitch Work,2005)

ObjectivesSummarize The CriteriaReview of Information SystemRecite a RecommendationSummarize the advantages and disadvantages of

barcode medication administration system Summarize the legal and ethical issues of barcode

medication administration systemDescribe the Nurse Informaticist

Competencies, Functions and Responsibilities

(St. Luke’s 2008, Cummings and Ratko, 2005, LaDuke 2009)

System DescriptionBarcodes 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)

Utilized HardwareLaptops 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)

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)

Utilized SoftwareImplementation of e-MAR in inpatient areas Computerized physician order entry

(St. Luke’s, 2008)

eMarCaregiver establishes Bluetooth connection

between bar code reader and laptopCaregiver logs in by scanning identification badge

and entering PINCaregiver identifies patient by scanning the patient

identification wristbandCaregiver scans dosed medication with either

manufacture or hospital generated barcodeSoftware ready at bedside with patient-specific

information viewable to caregiver during medication administration

(St. Luke’s, 2008)

eMarCaregiver 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)

eMar

Caregiver reviews warnings, and determines next step Caregiver exercises clinical decision-making

responsibilities and documents decisions/actionsAll data captured/actions taken are stored in patient's

medication administration record

(St. Luke’s, 2008)

Usability of eMarAdequate design characteristicsFocus group used to begin process of useUnderstandable and easy to learn interfaceProblems with system detected early and worked

outEnd users evaluation passed for final use

(McGonigle, 2009)

Review Of Information SystemClinical information systemPhysicians, Nurses and many others use this

application to monitor patient careAllows for the function of scanning and

documentationConfiguration used is the Workstation Health level 7 is the data standard Clinical Care classification scheme

(McGonigle, 2009)

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.

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)

AdvantagesDecrease 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)

(

DisadvantagesBarcode 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)

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)

Nurse Informaticist Competencies, 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' violationsReviews warnings, determines next step, exercises decision-making responsibilities, documents decisions/actions

(St. Luke’s

2008)

Summary

Having BPOC in place is the ultimate objectiveAddressing Pre-BPOC situations is a purposeful

and well thought out methodThis can be a welcomed precursor that aids in

determining the needs of the institution about BPOC

ReferencesMcGonigle, D. and Mastrian, K. (2009), Nursing Informatics and the

Foundation of Knowledge, Jones and Bartlett Publishers,

Sudbury, Massachusetts, Retrieved March 1, 2010Sakowski , 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/519719St. Luke’s Hospital,(2008) Implementing a Bar Coded Medication Administration System. Retrieved January 31, 2010 from http://codecorp.com/stlukes.html

ReferencesCummings, 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