Bedside Barcode Scanning for Medication Administration

1. Bedside Barcode Scanning forMedication Administration Table of Contents

2. Table of Contents • Navigating the eLearning • Who will Use Bedside Barcode Scanning? • Principles for BBC • Why Use Bedside Barcode Scanning? • Benefits of Bedside Barcode Scanning • Follow Recommended Procedures • About the Barcode Scanner • What do the Barcodes Look Like? • The Patient Wristbands you will Scan • Pharmacy Workflows • Medication Administration Workflows • Exceptions and Variations Table of Contents

3. Navigating the eLearning This training is an overview of how Allina will use Bedside Barcode Scanning for Medication Administration To move through this module, you may: • Click anywhere on the screen to move forward. • Click the Back or Forward buttons on the screen. • Use the Arrow keys on your keyboard to move forward or back. • Use the button to view the Table of Contents and locate topics. Table of Contents Table of Contents

4. Who will Use Bedside Barcode Scanning? • Patient bedside barcoding (BBC) will be implemented in the Allina hospitals and used in the Excellian® workflow for medication administration. (Later implementation for blood administration). • Primary users of BBC are nursing, respiratory therapy and pharmacy staff. Table of Contents

5. Principles for BBC • All barcoded medications will be scanned in units-areas where barcoding has been enabled. • All medications will be scanned in the Pharmacy to assure a readable barcode prior to dispensing. • RN or RT will scan the patient’s wristband at bedside to open the patient’s chart to the MAR. • Medications will be scanned with the MAR opened at the bedside. • Allina-wide workflows have been developed for medication types and should be followed as able at individual sites. Table of Contents

6. Barcode Scanning will NOT be used for: • Items that will not be scanned: breast milk, implants, lab specimens • Areas: Allina clinics, Intra-procedural • Users: Provider administered Medications Table of Contents

7. Why Use Bedside Barcode Scanning? • Patient safety • Clinician support • Clinician recruitment • Competitive marketing for consumers & nursing recruitment Table of Contents

8. Benefits of Bedside Barcode Scanning Help to protect a patient from transcription, dispensing, and administration errors. Supports the following benefits for medication administration: Medication administration safety Enforces, not replaces, checking the 5 rights. Scanning the patient checks for correct chart (right patient). Scanning the medication, checks for right medication, right dose, right route, and right time. Table of Contents

9. MAR Actions that will require a medication to be scanned or an override reason (Medication was administered by RN or RT): Table of Contents

10. MAR Actions NOT requiring medication to be scanned or an override reason Table of Contents

11. Alerts to Potential Problems MAR documentation. Patient Not Scanned Alert: Override Reasons • Barcode Unreadable • Emergency • Scanner Not Available Table of Contents

12. Alerts to Potential Problems If the action you choose does not require scanning, you do not need to provide an override reason. If you need to administer the medication without scanning, you will use one of the following override reasons: Medication Not Scanned Alert: • Barcode Unreadable • Emergency • Scanner Not Available Table of Contents

13. Is populated from the scan of medication (Excluding range dose) • Manual edits to the administration form require an override reason IF medication is scanned. Dose field Override reasons: Partial Package and Obtain New Order Table of Contents

14. Follow recommended site workflows, policies and practices for medication administration. • Read medication label information and the MAR. • Verify patient ID as well as scan the wristband. • Comply with requirements and recommendations of the site and the manufacturer for use and handling of the scanner. • Do not develop “workarounds” to replace recommended use of the bedside barcode scanner or the approved workflows associated with medication administration. Follow Recommended Procedures Table of Contents

15. Follow Recommended Procedures • Report problems to the appropriate site or IS support staff. • Be specific and accurate about the source and nature of the problem you are reporting. • Perform a visual check of the patient’s wristband AND of medication name and dose. • Identified as a potential high risk area. (Remember: Bedside Barcode scanning enforces, not replaces, checking the 5 rights.) Table of Contents

16. Motorola Symbol DS6878 Scanner. About the Barcode Scanner Scanner Cradle Table of Contents

17. The metal contacts on the bottom of the scanner handle should touch the contacts on the cradle. Push the handle lightly, engaging the contacts in the cradle and scanner. Inserting the Scanner into the Cradle Horizontal Cradle Mount Vertical Cradle Mount Table of Contents

18. Ensure all connections are secure. • Aim the digital scanner at the bar code. • Most barcodes are readable if you hold the scanner between 1 and 5 inches from the barcode you are scanning. • Press the trigger. • Upon successful decode, the digital scanner beeps and the LED turns green. Scanning the Barcodes Table of Contents

19. Aiming the Scanner The scanner projects a red laser aiming pattern for positioning the bar code within its field of view. • Center the symbol in any orientation within the aiming pattern. • Be sure the entire symbol is within the rectangular area formed by the cross pattern. • The scanner can also read a bar code within the aiming pattern but not centered. • The top examples show acceptable aiming options, while the bottom examples can not be decoded. Table of Contents

20. Distance from the “dock” or cradle The Range of the Scanner • The scanner will work if you are within about 30 – 33 feet of the cradle. • How do I know if the scanner is out of range? • If you try to scan when the scanner is out of range, there will be a series of beeps indicating it is out of range, rather than the standard confirmation beep. The light on top of the scanner will be flashing green.  Table of Contents

21. Leave the Scanner in the Room! Keep the scanner in one room and do NOTgo between rooms with one scanner!! Data will be sent to the other room if this happens. The scanner is paired with a cradle that is associated with a specific computer. There is a one to one correspondence between a scanner and a cradle. Wherever a scanner is cradled, it is associated with that cradle (and computer). Table of Contents

22. The types of barcodes we will be using for scanning medications are as follows: What do the Barcodes Look Like? Table of Contents

23. The Patient Wristbands you will Scan The patient wristbands will have a 2D barcode on them. Sample patient wristband: Scan any 2D barcode on the wristband. Do not scan the linear barcode. 2D barcodes will be positioned around the band, to allow successful scanning from many possible angles. Table of Contents

24. Pharmacy Workflows Pharmacy will label medications to facilitate scanning of the correct barcode. Table of Contents

25. What Label Do I Scan? Medication from Pyxis Floor Stock: Scan Manufacturer Barcode unless it is one of the following: • Repackaged Meds from Pharmacy • Scan pharmacy adhered (Medi-Dose) Barcode • Batched Meds from Pharmacy • Scan pharmacy adhered (Medi-Dose) Barcode Table of Contents

26. What Label Do I Scan? Medication from Pharmacy: Does pt. label have a barcode near the patient & drug name? No: Scan pharmacy adhered (Medi-Dose) Barcode or Mfg barcode. Yes: Use this Barcode. Table of Contents

27. Labeling Principles • Un-altered products • Only barcode is manufacturer’s • Pre-made, repackaged products • Only visible barcode is Pharmacy Adhered (Medi-Dose) barcode • Patient-specific preparations • Only visible barcode is Excellian® barcode Table of Contents

28. ADD-Vantage®(one or both options acceptable) Table of Contents

29. Ciprofloxacin 200 mg in D5W Unaltered, pre-mixed, patient-specific • RPh adheres label • RPh scans linear barcode • RPh removes linear barcode • RN to scan manufacturer’s barcode Table of Contents

30. MVI, folic acid 1 mg in D5W 50 mLPrepared, patient-specific • RPh adheres label • RPh scans 2D (Excellian®) barcode • RN to scan Excellian® barcode Table of Contents

31. Hydrochlorothiazide 25 mg tablet Patient-specific, dispensed from Pharmacy • RPh adheres label • RPh scans linear barcode • RPh removes linear barcode • RN to scan manufacturer’s barcode Table of Contents

32. PCN 5 million units IVPB Pre-made, Pyxis stock • RPh to place Medi-Dose label over manufacturer barcode • RPh to scan Medi-Dose barcode • RN to scan Medi-Dose barcode Table of Contents

33. Digoxin 0.125 mg/.5mL syringePre-made, Pyxis stock RPh adheres Medi-Dose label on syringe • RPh scans Medi-Dose barcode • RN to scan Medi-Dose barcode. Table of Contents

34. Famotidine 20 mg oral suspensionPrepared, patient-specific • RPh adheres label • RPh scans 2D (Excellian®) barcode • RN to scan Excellian® barcode Table of Contents

35. Med Administration Workflows Patient Communication: Prior to scanning your patient’s wristband and medication barcodes, letting the patient know what you are doing can reassure the patient. "For your safety, I am scanning your wristband and your medications.  This helps to assure that this is the medication that your doctor ordered for you at this time." Table of Contents

36. Med Administration Workflows Use Standard Process • Review medication(s) due on MAR Report. • Gather and prepare medications. • Scan patient wristband to open MAR. (This will reinforce that you are administering the medication to the right patient.) • Scan medication barcode(s) to open the administration record (& verify the remaining 5 rights—medication dose, time, route). • Administer medication(s). • Press Acceptto document administration(s). • Dock the scanner. Table of Contents

37. Medication Administration Workflows • Scan thePatient • Scan the Medication • Accept • Dock In a nutshell: P M A D Table of Contents

38. Multi-dose (Bulk) products for a single patient • Multi-dose medication (Example: Insulin, Cream, Ointment) • Draw medication into syringe. • Obtain independent double-check (per policy). • Scan patient wristband. • Scan medication barcode (bring original product into patient room). • Administer. • Accept. • Dock the scanner. • Return product to place of origin. Table of Contents

39. Crushed Meds Workflow Use best practice/policy of obtaining medication, remove from package (trying to maintain bar code) • Crush meds. • Pair crushed med with bar code and bring into patient’s room. • Log into Excellian. • Scan the bar code, if possible. • Otherwise, select “Barcode Unreadable” if the bar code is destroyed when package is opened to crush the medication. • Administer the medication to the patient. • Accept. • Dock the scanner. Table of Contents

40. Partial Waste Use standard workflow where: • Assess the patient. • Go to Pyxis. • Remove the medication from Pyxis. • Waste. Document waste, (and/or obtain witness as needed per site policy and procedures). • Bring the partial dose to patient’s bedside. • Log into Excellian. • Scan the patient’s wristband. • Scan the product. • Administer the medication to the patient. • Document the dose given. • Accept. • Dock Scanner Table of Contents

41. Medication Ampules • RN/RT will enter the patient’s room with the ampule and syringe. • (Identified as a potential high risk area due to possible change in current workflow.) • Log into Excellian. • Scan the patient’s wristband. • Scan the ampule. • Open the ampule and draw out the dose into the syringe. • Administer the medication to the patient. • Accept. • Dock the scanner. Table of Contents

42. Fentanyl Partial Waste NOTE: For Fentanyl, pharmacy is no longer stocking ampules. The medication will be dispensed in one of the following ways: • Vial • Syringe • Carpuject® Partial waste may occur prior to entering the patient’s room. Table of Contents

43. Patient’s Own Medication • Follow current site policy and procedure for Patient’s Own Medications. • If the patient’s own medication is used, select the override “Barcode Unreadable.” Table of Contents

44. Independent Double Check • The verifying nurse will not need to scan the patient or the medication. • Select Double Checked as MAR action and Accept. Table of Contents

45. IV Flush Order Sets No change from current practice or other scanning workflows. (Remember to enter the IV Flush Order Set!) • Immunizations • Use the standard workflow: • Nurse will scan the syringe or multidose vial • Nurse will still manually enter the immunization’s lot and expiration Table of Contents

46. Exceptions and Variations Scenario 1: What if the barcode does not scan? (try scanning 3 times first) • Select override “Barcode Unreadable” • Administer the medication. • Send MAR message to Pharmacy for follow up. Table of Contents

47. Exceptions and Variations Scenario 2: • What if the medications are administered as more than one tablet? How should these be scanned? • Example: Prednisone 30 mg PO, where the nurse would scan the 10mg tablet x 3. • The nurse should scan each tablet, rather than the same tablet 3 times.  Table of Contents

48. Congratulations! • You have finished the eLearning module. • To review any topics you may click the Table of Contents button below. • Please click the Close button at the top right to continue with this course. Table of Contents