Barcode Medication Administration John Boss, R.N. The Pennsylvania State University

Objectives Describe barcode medication administration Describe hardware utilized Required software components Describe clinical information system

Objectives Discuss the advantages/disadvantages from nursing perspective Examine legal and ethical issues Describe informatics competencies Describe functions and responsibilities

What is Barcode Medication Administration (BCMA)? Handheld barcode scanning device Electronic documentation A handheld barcode scanning device is used to scan barcode information on the patient’s wristband identification and the packaging of the medication to be dispensed. The administering nurse’s identification is also scanned to confirm the nurse’s authority to dispense the medication to the patient. After scanning all required barcodes, the system confirms the patient’s identity, matches the patient with the medication order, and confirms that the administering nurse has the authority to dispense the medication. If any variables do not match correctly, the administering nurse will be notified via a combination of warning tones and text messages. BCMA also allows users to electronically document the administration of medications at bedside using real-time network connection and barcode labeling to assure accurate administration.

Function of Barcode Medication Administration Ensure “Five Rights” of safe medication administration Right patient Right medication Right dose Right route Right time (Thomas, 2009) The main function of barcoded medication administration is to reduce medication errors. Medication errors can be avoided by using barcode technology in bedside medication. Barcodes ensure the “Five Rights” of the patients. Right patient: Barcode scanning on patient’s wristbands using handheld barcode scanners enables healthcare providers to identify the right patient. The wristbands with barcodes given at the admission point are vital in tracking the right patient throughout the treatment period in the hospital. Right medication: Scanning the barcode label on the medications prescribed to a patient enables accurate treatment. In many cases, the ID of the administering nurse is also scanned to check the nurse’s authority to dispense the medication to the patient. This avoids administering wrong drugs to a patient. Right dose: Confirming the right dose being given to the patients is more complex than ensuring the right medication is administered. The medicine dose administered is prone to change at least in small quantities during the treatment period. Recording data using barcodes can help in maintaining the consistency in the dose administered. This avoids further complications and side effects by reducing overdose medications. Right route: Right method of administration means administering the prescribed drug using the right method such as pills, syrup or intravenous medication. This may also include special instructions such as taking medication along with food or other supplements. Using barcodes will help in reducing the avoidable mistakes that might happen when the information is not properly shared and coordinated. Right time: The schedule of medication and the time interval is vital in medical administration. Especially when there is a situation where a missed or late medication has to follow a revised schedule of medication. In such situations, barcode technology will help to maintain the consistency by having the accurate information.

Required Hardware Handheld Scanning Device Computer at Bedside Barcode on Medication Barcode on the Patient Identification Band The hardware that is required for barcode medication administration includes the handheld scanning device, a computer at the patient’s bedside, a barcode on the medication and a barcode of the patient identification band.

Patient Identification Band Personalized individual wristband Encoded bar code for identification Patient’s name, medical record number and date of birth Barcode scanning on patient’s wristbands using handheld barcode scanners enables healthcare providers to identify the right patient. The patient identification band is one of the hardware components. The personalized wristbands are encoded with an individual bar code assigned to the patient and given at the admission point. The identification band also includes the patient’s name, medical record number and date of birth. The personalized identification bands are vital in tracking the right patient throughout the treatment period in the hospital.

Required Software VeriScan Siemens Med Administration Check Datalogic Eclipsys There are many software products available today used to implement and successfully run a barcode medication administration system. Some examples of software product or software companies include: VeriScan, Siemens Med Administration Check, Datalogic and Eclipsys.

VeriScan Software Uses barcode and Radio Frequency Identification (RFID) Runs on PC equipped with RFID and barcode reader Updates available in real-time (Hanlon, n.d.) VeriScan medication administration system uses a combination of bar codes and Radio Frequency Identification (RFID) tag readers. The system is designed to follow the medication administered at the patient's bedside. VeriScan runs on a personal computer and a handheld scanner that reads both the identification on the medicine as well as the patient and nurse’s identification bands. One of the major advantages to the system is that any changes to a patient's medication order are immediately available. This element provides the nurse immediate access to those changes. Another advantage provided by using VeriScan software is the automatic logging of the medication that is administered into the patient's electronic medical record. This saves the nurse time because he/she is no longer required to manually enter the data and also lowers the risk of human error.

Software Usability User focus and “real-world” input Repeatedly tested in hospital Evaluation and Experimentation (Hanlon, n.d.) I would now like to evaluate the usability of the software. I feel that the system has met the first axiom of user focus during the design process. VeriScan was developed by software engineers using "real-world" input of St. Clair Hospital physicians, nurses and clinicians. In my opinion, the system has also met the second axiom of the design process being iterative. The system was repeatedly tested at the 331-bed St. Clair Hospital. The nurses found that they were immediately notified of discrepancies and were able to avoid potential errors in medication administration. Axiom #3 was also met during the evaluation and experimentation St. Clair Hospital. The software system provides nurses with the flexibility of preparing orders with up-to-the-minute medication administration data. The system also required fewer physical patient touches which reduced the chance of infection and accelerated the process of administering medication. In addition, St. Clair Hospital is now piloting enhancements to VeriScan that check and record lab specimens and blood transfusions.

MAK System What is the MAK system? What is the purpose of the MAK system? How to use the MAK system. What is the MAK system? MAK stands for medication administration check. What is the purpose of MAK? MAK provides that a safety check is made during the medication administration process. It also ensures the “five rights” of patient medication administration are followed. How to use the MAK system: A census of patients is downloaded into the system. The medications are verified against the doctor’s orders. The medication is scanned using the barcode on the package or in the case of IV medicines, on the label that the pharmacy has provided. Next, the barcode on the patient’s identification band is scanned and confirmed. The patient is then asked to identify themselves, using their name and date of birth. Some medications, which are considered high risk require dual verification by two registered nurses. In that case, after scanning the medication, the system prompts for another nurse’s identification band to be scanned confirming that the medication has been dually verified. When the right medication is aligned on the computer a beep is heard to verify that it is the correct medication. In some cases, medication are supplied in a larger dose than was ordered. As a safety protocol, the MAK system will alert the user that the ordered medication and the medication supplied are different and it will provide how much of the medication should be administered. In the event that an incorrect medication is scanned, the system will alert the nurse that the wrong medication was scanned. In instances where the wrong patient was selected, a red stop sign flashes on the computer screen alerting the nurse to recheck the patient’s identification and re-scan their identification band. Charting is performed automatically when the right medication is administered to the correct patient. (Slojkowski & Swasey, 2008)

MAK System Review Type of system User description System function System configuration Data standards Nursing practice standards The MAK system is a clinical information system. Nurses uses this information system. The function of this system is medication administration and charting. The system configuration used is a personal computer located in the patient’s room along with a handheld scanner. The data standards used in this system are: American National Standards Institute (ANSI), American Society for Testing and Material and Healthlevel 7 (HL7). This system does not use a Disease and Procedure Classification system. The nursing practice standards classification scheme used includes: Nursing Intervention Classification (NIC) and International Classification for Nursing Practice (ICNP). I would recommend this system to other institutions implementing barcode medication administration.

Advantages Safety Electronic Documentation The advantages of barcode medication administration include: Safety – Using the scanner ensures that the proper medication in its correct dosage is being administered to the correct patient, at the correct time. It ensures that some medications deemed as high risk are co-signed electronically by two nurses to verify the medication. Documentation – When the bar code scanner is utilized, it electronically documents what medication was administered. It also documents the dosage and time administered.

Disadvantages Cost Time Consuming Frustration The disadvantages of barcode medication administration include: Cost – The financial obligations of establishing and implementing this trend are high. The costs include the equipment (scanners, computers, barcode technology), packaging and labeling of medications, training nurses, troubleshooting technology help desk staff. Time Consuming – It takes time to scan each individual medication. Many times, patients take multiple medications. Often times the barcodes are unreadable and require multiple scanning attempts before the medication is recognized and recorded. The time spent at the bedside and computer, scanning each medication is extensive. Frustration – Often times, the equipment malfunctions or breaks. Scanners are dropped, network connections are lost and the barcodes are not always readable.

Ethical/Legal Issues Illegal documentation is prevented Provides legal documentation of medication administration Patient’s own medications brought in to the hospital are not barcoded The barcode medication administration system prevents tampering with the documentation. Once the medication is administered, it is recorded and, if changed, there is a recorded event. The scanning of the medications provides legal documentation of each medication administered. Not every single medication can be scanned into the system. Often times, patients bring their own medications from home. When these medications are administered, it circumvents the safety protocols put in place by the bar code system.

Informatics Competencies Computer Skills Informatics Knowledge Informatics Skills Nursing informatics competencies by skill level: Beginning Nurse – ability to use e-mail and the internet, ability to identify basic components of a computer system, ability to navigate a computerized patient monitoring system Experienced Nurse – ability to define the impact of technology and the role of the nurse, ability to perform basic troubleshooting, participate in the selection and implementation of systems Informatics Nurse Specialist – fluent in informatics and nursing terminology, ability to apply human factors and consult in design of software Informatics Innovator – develops models and evaluates performances, ability to apply advanced analysis and design concepts (McGonigle & Mastrian, 2009)

Nurse Functions & Responsibilities Ability to safely integrate and apply computer technology Improve the quality of nursing care (McGonigle & Mastrian, 2009) The informatics nurse must have the ability to incorporate the technology of bar code administration. They should have knowledge of computers. They should know the policies and procedures of their institution. They should be able to provide basic trouble shooting techniques. Specific responsibilities of the informatics nurse include: identifying issues, problem solving and evaluating the results following the implementation of alternative solutions. The informatics nurse should be a computer resource to other nurses and assist nurses when incorporating new technology. The informatics nurse acts in many different roles, such as, project manager, consultant, educator, researcher, developer, decision support and outcome manager, advocate policy developer, system specialist and entrepreneur.

Summary Decreases errors and increases patient safety Provides Alerts Electronic Documentation Bar code medication administration is designed to decrease errors and increase patient safety while administering medications. Barcode medication administration prevents false documentation, and decreases drug administration errors. The systems ensures safety by providing alerts for allergies, and drug interactions as well as an incorrectly scanned medications, incorrect strengths, incorrect routes, the wrong timing of administration or the wrong selected patient. Dual signatures are required for high risk medications. The medication is electronically documented in the patient’s chart that the right patient received the right medication in the right dosage through the right route at the right time. As technology advances, nurses must be able to incorporate these changes into practice with the goal to provide the safest, most efficient care possible.

References Hanlon, M. (n.d.). Barcode and RFID Medication Administration System. Retrieved January 28, 2010, from http://www.gizmag.com/go/5707/ McGonigle, D., & Mastrain, K (2009). Nursing Informatics and the Foundation of Knowledge . Massachusetts: Jones and Bartlett Publishers.

References Slojkowski, P. & Swasey, K. (2008). MAK Training, Student Nurse Reference Guide. Retrieved March 22, 2010, from http://edr.ucsd.edu/NR/rdonlyres/42B339EE-472B- 4F9B-8BAC- 35B7FE8BD954/0/MAKStudentNurseReferenceGuidewith outsignoninst908.doc Thomas, P. (2009). Importance of Barcodes in Bedside Medication Administration. Retrieved January 28, 2010, from http://www.buzzle.com/articles/importance-of- barcodes-in-bedside-medication-administration.html