BarCoding : From the Buyer's Perspective

BarCoding: From the Buyer's Perspective Chandler Regional Hospital Barbara Tausch, CPhT Technician Supervisor, Buyer

One of the primary goals of Catholic Healthcare West is to provide outstanding patient care. Patient bed side barcoding or Patient Medication Verification (BMV) is one of the ways that the Pharmacy and Nursing Departments work together to meet this goal.

Considerations prior to implementation • How big is your facility? • Will it justify buying your own equipment – which could mean a capitial equipment purchase upward of $500,000? • Is it better to contract an outside company to do your barcoding? • Can you justify a dedicated person?

collaboration • Pharmacy and nursing staff members must collaborate closely with information management staff, if the medication administration arm of a hospital care system is to work optimally, just as rapid computer response time is crucial to the success of a computerized medication administration system.

According to Jcaho, Patient Safety Solutions are defined as:"Any system design or intervention that has demonstrated the abilityto prevent or mitigate patient harm stemming from the processes of health care." • Patient safety is forefront in today’s healthcare environment. Several years ago several babies died and others severely impaired due to the wrong dose of Heparin being administered to neonates.

This error originated in pharmacy, when two technicians incorrectly filled the automated dispensing machines with a high Heparin concentration. It continued with nursing not verifying the dose they pulled from the machines prior to dispensing it.

Bedside medication verfication • This type of error can be reduced or eliminated by BMV and additionally the use of bar-coding within the unit based cabinet dispensing machines for those who use them.

If not, there is either a wrong drug/patient, or pharmacy failed to scan the drug into the system prior to it leaving the pharmacy. • All drugs need to be scanned into the system. • The Buyers roll in BMV can be a lead role. We are the ones who control the purchase of the drugs, and a lot of the expenses involved.

Bedside Medication Verification • Bedside Medication Verification is when the nurse scans the patient Identification bracelet, the Medication Administration Record (MAR) and the barcode on the drug. They must all verify against each other.

The first step, regardless if you have BMV is to keep your shelf labels current. This ensures that your purchases are compliant with your contracts. When you are not there, it also makes it EASY for the staff to order the CORRECT item in your absence.

Order consistently • If you do have BMV it becomes even more important that you purchase the same item every time – as often as feasibly possible given the number of shortages we are faced with! • Make sure your shelves are neat and clearly marked.

Ensure a valid barcode • Ordering the same product ensures that the barcode will be a valid one in the system. • When alternative products are ordered, we as the Buyer are the ones who KNOW this.

When the product comes in, I pull the product from the order and scan it into both the computer system database • Tech verifies the drug, and stocks into Unit based cabinet out on the floor.

Double check – Triple check! • Our hospital system moved to a new vendor for unit-based cabinets. • One of the options in our unit-based cabinet is a bar code scanning system. • This requires the technician who is loading the machines to scan the drug prior to placing it into the machine.

Safety Feature on some Unit Based Cabinets • Uses barcode scanning to ensure accurateplacement of items on issue and return • Alerts users when a possibility of error occurs on issue/return • Highly configurable: feature can be enabled onthe cabinet-by-cabinet/item-by-item basisand activated on restock only as well as on issue/return

If it does not scan then it is brought back to the pharmacy for the barcode to be entered. This reduces the risk of a technician filling any bin with the wrong medication. • For scanning to work correctly, the barcode from each medication must be added to a computer file and mapped to a specific barcode in the formulary, so that recognition is achieved in the software.

Package is “read” by a handheld scanner used by the staff nurses. If a drug manufacturer’s barcode label can’t be scanned successfully, or if bulk-packaged products are transferred to unit dose packaging by the pharmacy staff, these items then must receive a pharmacy-generated barcode label that is affixed to or printed directly onto the outer wrap of the dose packaging

Barcode Maintenance • It does require a lot of work to maintain the system, again, each new drug manufacturer needs to be scanned into Unit based cabinet– both those that come commercially packaged and those we package. I do this at the same time I add a drug into our database. New and Generic Drug Approvals • Visit Drugs@FDAto search Drug Approval Reports by Month.

Limit access to data entry • I only have one other person who has access to do this as the possibility of entering bar codes on the wrong drug is too easy to make and accountability would be hard to keep track of. Code 128 Code 128 is high-density symbology used throughout the world which permits the encoding of alphanumeric data. The barcode uses a checksum digit for verification, and can also be verified character-by-character. The calculation of the check digit typically gives programmers an interesting problem to solve. It is used when a large amount of data needs to be placed into a small space.

Collaboration is key • The “Barcoding” Technician needs to be a dedicated person and one who works either directly under the Buyer, or who can work closely with the Buyer. The two must establish inventory levels for the items that need to be unit dosed with barcodes.

Again, each time a new manufacturer is barcoded by us, the bar code needs to be scanned into the system.

Inventory levels can also increase for certain items, primarily injectables. Caution must be taken because a large expense is in injectables. • We add a barcode label to injectables because nurses do not draw the medication up at the bedside – thus not having the vial with them to scan at the bedside. Our barcode label has a peel off portion with the barcode and medication information that is put on the syringe to be scanned at the bedside.

Fast mover preparation • Labor intensive? Yes. But it provides the extra step in patient safety. Because it is so labor intensive we cannot wait unto the last minute to barcode fast movers. We always have several hundered of the fastmoving injectables done (Ondansetron, Promethazine, Ketorolac, Methylprednisolone, Heparin, etc).

Valuable daily reports • I have a report automatically generated and emailed to me daily that shows everything by patient and by nurse that did not scan in our computer database. • It also includes the reason why it did not scan – as the nurse must enter a reason when she overrides the scan function in the system. I review those daily for problems. Occasionally there will be an item that just does not scan consistently.

Follow up with Nurses • Usually the report indicates which nurse is having difficulty scanning her patient medications. If it is a consistent problem it is followed up with the nurse. • Some barcodes do not read well if there is a foil or clear background.

Cost considerations • Manufacturer oral solid U.D. is a much “cleaner” product - Takes up less space in ADMs, OTC barcodes usually scan. • If Mfg oral solid U.D. costs $15-20 more, don’t purchase - Calculated cost to package oral solid – 2.8 cents per tab. • Oral liquids are drawn up into oral syringes with circle sticker labels – a lot of liquids are available U.D. from Manufacturer.

Other considerations • Chandler Buyer had Unit based cabinet company build report for inventory purpose with pricing included • Buyer should be one who “owns” bar-coding • Initial entry of barcode items into computer system database is a lot of work • Chandler and Mercy Gilbert share database (pricing considerations for 340B vs non 340B) • Can be set up so one hospital cannot see item • If item is discontinued, must de-activate, not delete item from computer system database

Creams and Ointments • Barcode on tube must match barcode on outer box. • Both barcodes must be scan able. • Manufactures do have NDC changes, item usually comes back an a bad scan able item on daily report. • Some items come as a kit, one sticker is put on, billing is done as a kit

All patient specific I.V.s have barcode on label.Some I.V.s in the E.D. come as a kit, (med plus bag), sticker is put on vial. Billing is done as a kit based off of sticker on vial through E.D. ADM Patient name has been covered by star

And lastly….

BarCoding : From the Buyer's Perspective