Bedside Barcode Scanning for Medication Administration

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Bedside Barcode Scanning forMedication
Administration
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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

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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

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Table of Contents
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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.

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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 patients wristband at
  bedside to open the patients 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.

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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

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Why Use Bedside Barcode Scanning?

• Patient safety
• Clinician support
• Clinician recruitment
• Competitive marketing for consumers nursing
  recruitment

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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.

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MAR Actions that will require a medication to be
scanned or an override reason

• (Medication was administered by RN or RT)

Given New Bag
Push Bolus
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MAR Actions NOT requiring medication to be
scanned or an override reason
Due Double Checked Filter Changed
Missed Criteria Not Met Self Administered Med
Refused Double Check IV Downtime Recovery
Cancelled Entry Rate Change IV Pt. on Pass
Held IV Started Remove Patch
Restarted IV Stopped Started Prior to Admission
Stopped IV Restarted PROVIDER ADMINISTERED
Rate Change Tubing Changed Dose Taken Prior To Arrival
Rate Verify Tubing/Filter Changed Placeholder Acknowledged

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Alerts to Potential Problems

• MAR documentation.
• Patient Not Scanned Alert
• Override Reasons

• Barcode Unreadable
• Emergency
• Scanner Not Available

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Alerts to Potential Problems

• Medication Not Scanned Alert

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

• Barcode Unreadable
• Emergency
• Scanner Not Available

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Dose field

• Is populated from the scan of medication
  (Excluding range dose)
• Manual edits to the administration form require
  an override reason IF medication is scanned.

Override reasons Partial Package and Obtain New
Order
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Follow Recommended Procedures

• 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.

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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 patients 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.)

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About the Barcode Scanner
Motorola Symbol DS6878 Scanner.

Scanner Cradle
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Inserting the Scanner into the Cradle
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.

Horizontal Cradle Mount
Vertical Cradle Mount
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Scanning the Barcodes

• 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.

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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.

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The Range of the Scanner
Distance from the dock or cradle

• 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. 

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Leave the Scanner in the Room!
Keep the scanner in one room and do NOT go
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).


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


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The Patient Wristbands you will Scan
The patient wristbands will have a 2D barcode on
them.
Sample patient wristband


2D barcodes will be positioned around the band,
to allow successful scanning from many possible
angles.
Scan any 2D barcode on the wristband. Do not
scan the linear barcode.
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Pharmacy Workflows

• Pharmacy will label medications to facilitate
  scanning of the correct barcode.

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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

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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.
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Labeling Principles

• Un-altered products
• Only barcode is manufacturers
• Pre-made, repackaged products
• Only visible barcode is Pharmacy Adhered
  (Medi-Dose) barcode
• Patient-specific preparations
• Only visible barcode is Excellian barcode

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ADD-Vantage (one or both options acceptable)
Option 1 Option 2
RN retrieves products from Pyxis Pharmacy assembles and dispenses with Excellian label for patients.
RN scans manuf. barcode on individual products RN scans patient-specific Excellian barcode
RN assembles, activates and administers RN activates and administers
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Ciprofloxacin 200 mg in D5W Unaltered,
pre-mixed, patient-specific

1. RPh adheres label
2. RPh scans linear barcode
3. RPh removes linear barcode
4. RN to scan manufacturers barcode

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MVI, folic acid 1 mg in D5W 50 mL Prepared,
patient-specific

1. RPh adheres label
2. RPh scans 2D (Excellian) barcode
3. RN to scan Excellian barcode

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Hydrochlorothiazide 25 mg tablet Patient-specific,
dispensed from Pharmacy

1. RPh adheres label
2. RPh scans linear barcode
3. RPh removes linear barcode
4. RN to scan manufacturers barcode

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PCN 5 million units IVPB Pre-made, Pyxis stock

1. RPh to place Medi-Dose label over manufacturer
   barcode
2. RPh to scan Medi-Dose barcode
3. RN to scan Medi-Dose barcode

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Digoxin 0.125 mg/.5mL syringe Pre-made, Pyxis
stock

• RPh adheres Medi-Dose label on syringe
• RPh scans Medi-Dose barcode
• RN to scan Medi-Dose barcode.

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Famotidine 20 mg oral suspensionPrepared,
patient-specific

1. RPh adheres label
2. RPh scans 2D (Excellian) barcode
3. RN to scan Excellian barcode

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Med Administration Workflows
Patient Communication

• Prior to scanning your patients 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."

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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
  rightsmedication dose, time, route).
• Administer medication(s).
• Press Accept to document administration(s).
• Dock the scanner.

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Medication Administration Workflows
In a nutshell P M A D

• Scan the Patient
• Scan the Medication
• Accept
• Dock

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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.

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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
  patients 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.

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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 patients bedside.
• Log into Excellian.
• Scan the patients wristband.
• Scan the product.
• Administer the medication to the patient.
• Document the dose given.
• Accept.
• Dock Scanner

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Medication Ampules

• RN/RT will enter the patients 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 patients 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.

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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
patients room.
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Patients Own Medication

• Follow current site policy and procedure for
  Patients Own Medications.
• If the patients own medication is used, select
  the override Barcode Unreadable. 

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Independent Double Check

• The verifying nurse will not need to scan the
  patient or the medication.
• Select Double Checked as MAR action and Accept.

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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
  immunizations lot and expiration

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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.

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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. 

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