MEDICATION ADMINISTRATION USING BAR CODING FEBRUARY 2, 2009
Obtain meds from med station
Take medications in packaging to pt room
Log on to KPHC. remain in your home screen
Scan patient arm band confirm it is the pt you want to administer med to
Scan medication confirm on screen correct med, dose, route, site date, time
Give medicati on to patient
Confirm documentation is correct in medication screen, click accept
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HAND OFF Handoff required
Enter patients room with oncoming RN
Log on to KPHC
Scan pt id band
The person who logged on to KPHC will take scanner to the meds that need to be signed off
Scan med
Second person change action to handoff
Second person puts initials in comments section
Repeat process until all meds are entered, click accept
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ID BAND NOT SCANNING BCMA
Obtain meds from med station
Take medications in packaging to pt room
Log on to KPHC. remain in your home screen
Scan patient arm band. Did eMAR open in KPHC
no
Is this a critical med
yes
no
Confirm correct pt chart opened
Leave room and print new ID band
yes
Confirm correct pt using 2 identifyers
Continue medication adminstration using override
yes
Continue workflow
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MEDICATION NOT GIVEN FEBRUARY 2, 2009
Medication due and not going to be given
Open pt chart and go to eMAR
Find medication that you will not be giving and open the due time
When pt band not scanned message appears enter override reason
When medication not scanned message appears enter override reason
Enter not given action and enter reason
Click accept
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MEDICATION NOT ORDERED BCMA
Obtain meds from med station
Take medications in packaging to pt room
Log on to KPHC. remain in your home screen
Scan patient arm band. Did eMAR open in KPHC
yes
Scan medication. Did medication come up on MAR?
yes
Confirm correct medication
yes
no
Warning med not ordered on screen
Research to see why med did not scan. Do not proceed until you confirm med should be given
yes
Confirm correct medication
Medication is present on MAR however incorrect scanning occured
Continue medication adminstration using override
Notify pharmacy immediately to change product in KPHC
Medication is not on MAR
Continue workflow Investigate if it should be given. If so have order entered on MAR first (except in emergency)
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SCANNER HELP When you turn on the scanner for the first time or have changed the battery, before attempting to scan:. Before attempting to scan:
•
Turn on scanner. You will hear THREE quick beeps, a slight delay, then a FOURTH, quieter beep. NOTE: First THREE beeps indicate that the scanner is looking for the Bluetooth Modem and the FOURTH beep indicates that it has found the Bluetooth modem, has paired, and is now ready to scan.
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When Scanning, you will hear ONE Beep. You will hear TWO beeps when scanning barcodes when the battery is 10% or less.
3.
The BLUE LIGHT on the battery indicates power is ON.
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If scanner does NOT SCAN your barcode, please call the National Help Desk @ 8-395-1143. Be prepared to supply Floor, Room Number, PC Name, AND Detailed Description of the Issue.
SDMC Inpatient Product and Package Information on the MAR Medications come in different dosages or concentrations. Scanning medication dose or concentration different from what is ordered on the Medication Administration Record (MAR) result in MAR Alert “No order found”. In order to make sure that the medication dose/concentration matches the actual medication nurses are scanning, follow these steps: 1. Go to the MAR 2. Search for the medication(s) to be administered 3. Pay close attention to the Product and Package sections of the medication information
4. Select and scan the medication dose/concentration according to the Product and Package dose/concentration. For example (see above screenshot) – Morphine 2 mg/ml syringe ordered per MAR Select and scan Morphine 4mg/ml syringe; 1 ml syringe and waste. Nifedipine 30 mg ordered Select Nifedipine 30 mg SR tab
Medications that have the potential to cause difficulty If the medication ordered does not match the product as seen in the screen shot, call pharmacy to have the product changed in KPHC Example: potassium 20 meq is ordered. Depending on the order the physician orders the incorrect product might come up. This will create an error when you try to scan Call pharmacy to change to the correct product.
Sometimes the product comes from a different manufacturer than the way it was ordered. You will get a “this medication is not ordered” error message yet you will see it on the MAR. Call pharmacy for them to change the product.
The following are scanning idiosyncrasies that will not change: Oral vancomycin will always scan 50mg. This is because it is the concentration. You must compare the dose ordered to the enter dose that you see in the syringe and enter the correct dose. 50mg/ml so 5 ml will be 250mg Half tabs: Use the pt specific label Peridex: The scan will bring up 15ml. Double check that you have 5 ml in the syringe, then select “partial dose” in the warning message. Then enter the dose of 5 ml.
Bar coding for medication administration BCMA Unit: _________________________ Bar coding demonstration and process validation
Meets Required Objectives
Needs direction, Coaching, Prompting*
Demonstration of BCMA Medication given using BCMA Medication not given Using multidose vial Medication not ordered Changing battery Scan multiple NDC’s to match ordered dose
Verbalizes process Giving multiple medications MAR handoff Correct place in KPHC to scan UCI Correct place in KPHC to scan NDC NDC not scan able UCI not scan able
State 2 acceptable reasons for override
Employee Printed Name ________________________________ Employee Number _____________________________________ Employee Signature/ Date_______________________________ Instructor signature _______________________________
Unable to Perform*
Comments
SDMC Inpatient Bar Code Medication Administration Troubleshooting Tips When this happens…
…do this:
Unable to scan the patient’s armband
•
Make sure that the scanner matches the computer.
•
Check to see if you are scanning the correct bar code.
•
o
For inpatient, ED, HOV, and RT, scan the Unique Contact Identifier (UCI) bar code.
o
For Periop areas, scan the MR # bar code.
Ensure that you are in the appropriate section in KPHC. o
Patient list for inpatient, and respiratory therapy.
o
Greaseboard for Periop units.
o
Track Board for ED.
o
Patient List for HOV.
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Check to see if the patient’s arm band is intact. o
Is there writing on it?
o
Was it cleaned with alcohol?
o
Is it torn?
•
Ensure that the arm band states “SDMC Medical Center”.
•
Check that the scanner is on. o
When this happens…
Click on Patient List button in the Activity tool bar
Point the scanner to your hand, ensure that there is a red light displaying.
If still not able to scan the patient’s armband, reprint a new armband. If critical medication needs to be given, open the MAR manually. Select the appropriate override reason for not scanning the armband. …do this:
Unable to scan the medication
•
Make sure that the scanner matches the computer.
•
Check that the scanner is on. o
•
Point the scanner to your hand, ensure that there is a red light displaying.
Check to see if you are scanning the correct bar code. o
Some medications like ointments have two barcodes.
o
Scan the AccuPrint labels if available.
o
Examples are insulin vials and albuterol inhalers.
Scan the medication, not the packaging.
Example - For IV piggybacks like Ancef, scan the medication vial NOT the base IV fluid.
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Ensure that the medication label is intact.
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Ensure that there is an order for the medication being scanned.
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Send communication to Pharmacy via MAR “Rx” to send up new label for future administrations. Follow up with a phone call as necessary.
If critical medication needs to be given, open the medication box manually. Select the appropriate override reason for not scanning the medication. Scanner and or battery not working
•
Check that the scanner is on. o
Check if there is a blue light on the bottom of the scanner’s handle.
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Make sure that the scanner matches the wireless on wheels.
•
Replace the battery. o
Turn off the scanner BEFORE removing the battery!!!!
Call ITFS by calling the HELP desk. Be prepared to state the unit location and the computer identification located on the scanner. Write down the ticket number for future reference.
Acceptable reasons for overriding the bar code scanning
• • •
• During a procedure if the arm band is not accessible based on positioning or draping you may override the armband • When documenting medication not given • If the armband does not scan and the medication is critical • If the medication does not scan and the medication is critical
• Scanner is broken
