Bar code medication administration

1. By Marina Yuan, RN Bar code medication administration

2. Objectives Describe bar code medication administration (BCMA) Identify BCMA hardware and software Describe / review information system Identify advantages / disadvantages of BCMA Identify ethical / legal issues Describe Informatics Nurse role with BCMA

3. Bar Coding Involves . . . • use of a scanner • Bar coded bracelet for patient identification • Medications dispensed in bar coded unit doses • EMAR software

4. BCMA can . . . • Reduce medication errors • Illegible handwriting • Alerts • Allergies • Wrong time • Wrong medication

5. Administratively BCMA . . . • enhances record keeping • streamlines inventory control and billing • saves time • Pharmacy • at the bedside

6. Hardware • Barcode scanner - Laser or Area Imager • Computer - wireless capability • Barcode printer • Re-packager / Re-labeler

7. Bar Code Scanners LASER SCANNER • reads 1D barcodes • fast-moving laser beam (Metrologic Instruments, 2006, p. 3-4)

8. Bar Code Scanners AREA IMAGER • can read 1D and 2D barcodes • visualizes the entire barcode (Metrologic Instruments, 2006, p. 3-4)

9. Software • Eclpsys SCM, TDS • Siemens Invision • MeditechC/S • IDX Lastword • CliniComp • McKesson Horizon • GE Centricity (KLAS Enterprises, 2005, p. 3)

10. IDX Lastword an EHR - assessment documentation enables CPOE access transcriptions, ancillary results, and labs Trending EMAR - barcode administration of meds

11. Lastword - Usability “Typical usability indicators include ease of use, ease of learning, satisfaction with using, efficiency of use, error tolerance, and fit of the system” to the task.” (Effken, 2009, p. 70)

12. Usually easy to use Command names are confusing to learn Duplicate meds cause difficult scanning Error tolerance poor, many glitches Inefficient with errors -> workarounds, less satisfaction Lastword - Usability

13. IDX LastordInformation System (IS) Computer based Access to reports, labs, trending Printable Alerts during BCMA Limited feedback

14. Lastword – System Review Nursing - medication administration and documentation Pharmacists - medication dispensation Physicians - CPOE Administrators - inventory control and patient safety monitoring

15. System Review • configured to be used at the bedside via a permanent or mobile computer and bar code scanner • standardized by the FDA with the National Drug Code (NDC) • bar code symbology (ASHP, 2004, p. 4)

16. BCMA - Advantages Reduce medication errors Streamlines inventory control Increases efficiency / Saves time / manpower Enhances record keeping

17. BCMA - Disadvantages Large investment Workarounds Downtime Malfunctioning equipment (ASHP, 2004) (Patterson, Rogers, & Render, 2004, p. 361)

18. Legal Issues HIPAA BCMA = computer records = need password protection = need more security Improper training => med errors (ASHP, 2004, p. 55) (Patterson, Rogers, and Render, 2004,)

19. Informatics Competencies Fluent in informatics and terminology Able to evaluate system Can anticipate effects of changes Applies ergonomics to design Fluent in troubleshooting (Staggers, et al., 2002)

20. Nursing Informatics (NI) Role Lead in applying BCMA to practice Monitor and report issues Continued evaluation Recommend changes Liaison between administration and staff

21. Summary BCMA . . . Can improve med administration Saves time manpower Utilizes proven technology Can be a NI specialty

22. References: Agency for Healthcare Research and Quality. (2008, August). Decisionmaker brief: bar-coded medication administration (publication no. 08-0085) [Brochure]. American Society of Health-System Pharmacists Research and Education Foundation. (2004). Pharmacist’s toolkit: implementing a bar coded medication safety program. Cochran, G. L., Jones, K. J., Brockman, J., Skinner, A., Hicks, R. W. (2007, May). USP medication safety forum: errors prevented by and associated with bar-code medication administration systems. The Joint Commission journal on quality and patient safety, 33, 293-301.

23. References, cont. Effken, J. A. (2009) Improving the human-technology interface. In McGonigle, D. &Mastrian, K. (Eds.), Nursing informatics and the foundation of knowledge (pp. 61-76). Sudbury, MA: Jones and Bartlett. Federalgovernmentjobs.us. (2006). BCMA/Informatics coordinator. [Job posting]. Retrieved November 22, 2008, from http://federalgovernmentjobs.us/jobs/Registered-Nurse-(rn)-Bcma-Informatics-Coordinator-1347099.html Johnson, C. L., Carlson, R. A., Tucker, C. L., Willette, C. Using BCMA software to improve patient safety in Veterans Administration medical centers. Journal of healthcare information management, 16, 46-51.

24. References, cont. KLAS Enterprises, Hospital Leadership and Systems Improvement. (2005). Computerized physician order entry (CPOE) vendor information. Metrologic Instruments. (2006). The healthcare professional’s guide to bar code scanning. [Brochure]. National Coordinating Council for Medication Error Reporting and Prevention. (2005). Defining the problem and developing solutions. Retrieved September 10, 2008, from www.nccmerp.org.

25. Refernces, cont . . . Patterson, E.S., Rogers, M.L., & Render, M.L. (2004). Fifteen best practice recommendations for bar-code medication administration in the veterans health administration. Joint Commission Journal on Quality and Safety, 30(7), 355-365. Staggers, N., Gassert, C., & Curran, C. (2002). A Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research, 51(6), 383-390.