Bar Coding

A Nursing Trend

Authors

Kim SimmelMary McGeerLaurie BlasiPhilip HughesVicki GutenkunstLucille YoungAnne MetzoJanelle WalawenderChristine RyanJustin Biondo

ObjectivesDefine and describe Bar CodingList and describe Bar Coding hardwareList, describe and evaluate Bar Coding softwareIdentify, describe and review the Bar Coding information systemDescribe advantages/disadvantages of using Bar CodingExamine legal and ethical issues related to the use of Bar CodingDescribe technology-related competencies needed by the

professional nurse working with Bar Coding Describe functions of the informatic nurse working with Bar Coding

Bar Code Charting

Tool in medication delivery to insure proper patient identification, right medication, right dosage, right route, and right time

Electronically scans patient and medication.Timestamps deliveryDesigned to reduce errors in medication adminstration

Trends in Barcoding"LVHHN nurses use wireless barcode medication charting during medication administration, the second most likely place for medication errors to occur."(Information Techology,2005,p,286)"By barcoding patient identification bands and medication doses, facilities can reportedly reduce medication errors by 65% to 86%." (Heinen,2003,p,18)

Trends in Barcoding"The Food and Drug Administration has issued its final rule requiring drug manufacturers to add bar codes on human drugs and biological products by early 2006, in hopes that it will spur hospitals to install bar-code scanning systems to prevent medication errors." (Wood,2003,p,1)

Healthcare Barcoding Hardware

Wristband printers, wristbands, and softwareID card printers, ID supplies, and softwarePharmacy label printersBarcode scannersMobile work carts and/or PDAsDocument imaging and software

( Healthcare Solutions, n.d)

Wristband Hardware

Contains at least two patient identifiersContains patient assigned barcodeDurable in many different environmentsMay contain allergies, color coding, and photographsMay contain organizational logo

( Inglesby, & Inglesby, 2005)

Barcode Scanners

Four types 1. Pen Type Readers or Bar Code wands 2. Laser Barcode Scanners 3. CCD Barcode Scanners4. Camera Based Barcode Readers

Pen Type Readers or Bar Code wands

light source and a photo diode to read barcodeSimplest, least expensive, durableRequires proper pressure, angle, and speed

(Barcode scanner POS barcode reader, 2000)

CCD Barcode Scannersuse array of tiny lights to read reads bar codes quickly and easilylimited width

(Barcode scanner POS barcode reader, 2000)

Laser Barcode Scanners Use laser beam light sourcemost popular bar code scannerHas multiple ranges (standard, long, extra long)can be expensive (price range $200-$2,000)

(Barcode scanner POS barcode reader, 2000)

Camera Based Barcode Readers

uses small camera to capture an image

(Barcode scanner POS barcode reader, 2000)

SOFTWARE USED IN BAR CODING

BAR CODING SOFTWARE

MCKESSON BIO-OPTRONICSOMNICELLENDUR IDMEDIWAREBAXTER CARDINAL HEALTH

McKESSON CONNECT-RNSingle hand-held deviceIntegrates bar coded medication administrationMedication cabinets, pharmacy information systemsEliminates medication errorsJCAHO compliant

CONNECT-RN

MEDICATION RETRIEVAL AND ADMINISTRATIONNOTIFY PHARMACY MISSING DOSES, OVERRIDES, AND REFILLS IMPROVES WORK FLOW OF NURSES

McKESSON CARE POINT CONNECT

SAVES QUE TIMES AT MEDICATION CABINETSREDUCES RISK OF ADVERSE REACTIONS EFFICIENT MEDICATION DELIVERY(McKESSON 2009)

Data Capture Solutions

Dynamic Hospital" AdministratOR Management Station

FOCUS GROUP INCLUDEDNURSES PHYSICIANSPHARMACISTSMANAGEMENTINFORMATION TECHNOLOGY

DATA CAPTURE SOLUTIONS DYNAMIC HOSPITAL AdministratOR MANAGEMENT

SOLUTION MEDICATIONS AND SERVICES

TABLET- MOBILE ENVIRONMENT

IMPLEMENT AND MONITOR PATIENT CARE

DOWNLOAD ORDERS FROM PORTABLE STATION

SCANNING CAPABILITES(DATA CAPTURE SOLUTIONS/BIO-TRONICS,2009)

Focus group

According to Jeremy Reitz, Director or Development and Archutecture, at Bio-Optronics "They wanted to ensure the usability of Administrator. Their goal was that nurses with poor vision and those inexperienced with PDA'S would be able to use and excel with this software".(Thomasnet,2009)

Omnicell Safety Med

ENSURE PATIENT SAFETYINCREASE EFFICIENCY IN MEDICATION ADMINISTRATIONENSURES THE 5 "RIGHTS"BEDSIDE POINT OF CARECORRECT MEDICATION VIA BAR CODEWARNINGS AND ALERTS (OMNICELL,2009)

Summary of Evaluation ofthe Usability of Omnicell

Omnicell uses heuristic evaluation"Heuristic evaluators assess the degree to which the design will comply with usability principles"Mcgonigle(2009,p.71)Omnicell also used focus groupsFocus group;Registered nursesRN's involved in design processInput for correct content

Usability

"Term that denotes the ease with which people can use an interface to achieve a goal" Mcgonigle(2009)

Usability Criteria

Early and often evaluationsEase of use Ease of learning Satisfaction with the usabilityEfficiency of use Staggers,(2003)

SOFTWARE IN USE

Information Systems Bar-coding: A line on the future of health care“A Bar-code system truly is a tool to support nursing practice, to help ensure safety at a time when patients are sicker and medication therapies are more complicated.”Mary Beth Navarra RN, MBA, Director of Medication Safety, McKesson Corp

Components

Review

Review Continued5) The patient’s medication administration record appears on computer screen.6) Nurse scans the bar-coded medication package before administration. 7) An alert is generated if the computers notes any discrepancies.8) An electronic administration record is generated automatically at the end of the process.

Information System

McKesson’s Paragon® community hospital information system - integrated applications that addresses patient safety, revenue cycle management, regulatory and HIPAA compliance. Designed for critical access hospitals of all sizes.Paragon multidisciplinary care solutions include order management, medication administration, care planning, pharmacy, laboratory and radiology solutions. Computerized physician order entry (CPOE) functionality is currently in development.Paragon also is integrated with McKesson’s Practice Partner® solution to improve connectivity with smaller physician practices.

Review of McKesson's ParagonMission and goals:

Information safety -- secure complete accurate medical records for each patientCommunications safety -- relevant real time information available to authorized parties via secure portals and web-based ambulatory solutionsMedication safety -- dockside to bedside medication administration to ensure the Five RightsDiagnostic safety -- supporting optimal care planning and treatmentTreatment safety -- assessment driven documentation with alertsEnvironmental safety -- enhancing patient safety through disinfection protocols for mobile equipment and devices

Legal/Ethical Issues

Legal/Ethical Advantages

Decreases illegal documentation (ie: charting meds not ordered)Decreases failure to report med errorsDecreases drug administration errors by 60%Quick access to deliver right dose, right timeGives alerts for medication allergiesSignificant improvement in quality of carePatient & family satisfaction = decrease law suits

Legal/Ethical Advantages

Enhances patient safetyFaster med delivery improving staff utilizationImproves tracking of meds & decreases wasteProvides legal documentation of the facts of the administrationUser friendlyAccurate billing, avoiding errors and unintentional Medicare fraud

Legal/Ethical Disadvantages

Failure of healthcare workers to report errorsLack of trust of patientsDecrease in individuals entering the healthcare fieldDecrease in retention of RN's

Legal/Ethical Disadvantages

Drug packaging & labeling are incorrect Scanner malfunctionsBarcodes are damagedHome meds are not barcodedNurses scanning a badge that is not on patient

Functions and Responsibilities

Where technology and nursing come together

Delicate balance of adding technology to nursing Combination of patient care, standards and technologyComputer technology essential to maintain and improve quality of nursing careGoal is harnessing technology, improving nursing practice and enhancing quality of care

Competencies

Are you smarter than a 5th grader

A nurse with specialized skills, knowledge and competences in Informatics.Three categories

Computer skillsInformatics knowledgeInformatics skills

Four LevelsBeginning nurse - E-mail, Internet, patient monitoring systemsExperienced - defines and applies monitoring system, basic troubleshooting

Competencies Continued

Four levels continued

Informatics nurse specialist - Fluency in Informatics, applied human factorsInformatics Innovator - develops models, evaluates performance

ADVANTAGES

Increase staff satisfactionTrack errors in careAssurance of “The 5 Rights”

The right patientThe right drugThe right doseThe right timeThe right route

(Inglesby, 2006)

DISADVANTAGES

Standardization does not existErrors in barcode printingRelabeling and repackaging can increase cost“workarounds”(McGonigle, Mastrian, 2009, p.64)

Scanning can interrupt nursing careQuestionable reliability and function of hardware

( Cummings, Ratko, & Matuszewski , 2005)

Summary Bar Code Charting is used in medication delivery designed to decrease errors, illegal documentation, failure to report errors and trach errors in care. It also holds the advantage in allerts for medication allergies. It assures the five rights of medication administration to enhance safety. The FDA requires Bar Coding on all human drugs and biological products. Several types of hardware and software components are utilized for this growing trend. The information systems integrate-doctor order to computer - EMAR produced - ID badge nurse-pt - scanner identifies nurse-med-patient - Omini Cell dispenses.

References

Barbieri, Marisa. "Bar coding for medication administration." HospitalBarCoding.com. Competitive Solutions. Web. 15 Sept. 2009.Barcode scanner POS barcode reader. (2000). Retrieved September 28, 2009, from http://semicron.com/scannertips.html Data capturing solutions (2009). Software solutions for healthcare. Retrieved September 21, 2009 from http://www.datacapturesolutions.com/capability.asp?cat1id=2&capabilityID=30 Healthcare Solutions . (n.d.). Retrieved September 27, 2009, from BarcodesInc: http://www.barcodesinc.com Heinen, M.G., Coyle, G.A, & Hamilton, A.V. (2003). Barcoding makes its mark on daily practice. Nursing Management: IT Solutions,18-20. Retrieved September 21, 2009, from ProQuest Nursing & Allied Health Source. (Document ID: 442886571).

Refercnces

Information Technology; Pennsylvania hospital group upgrades to enterprise clinical software system. (2005, March). Medical Devices & Surgical Technology Week,286. Retrieved September 21, 2009, from ProQuest Nursing & Allied Health Source. (Document ID: 802581671). Inglesby, R. M., & Inglesby, T. (2005, September/October). Automatic Identification. Retrieved September 27, 2009, from Patient Safety & Quality Healthcare: http://www.psqh.com JHQ 154- Using Bar Code Point of Care Techology for Patient Safety (2009). Retrieved October 5, 2009, from http://www.nahq.org.

References

McGonigle, D., & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett . McKesson. (n.d.). Mckesson website . Retrieved October 12, 2009, from http://www.mckesson.com/en_us/McKesson.com/Our%2BBusinesses/McKesson%2BProvider%2BTechnologies/Electronic%2BHealth%2BRecords McKesson (2009). Patient and medication safety:connect-RN .Retrieved September 21, 2009 from http://www.mckesson.com/en_us/McKesson.com/For%2BHealthcare%2BProviders/Hospitals/Nursing%2BSolutions/Connect-RN.html Medication Malpractice (2009). Retrieved October 5, 2009, from http://www.medicationmalpractice.com.Omnicell (2009). Bedside point of care . Retrieved September 21, 2009 from http://omincell.com/solutions/medication_use_process/mobile_nursing/default.as

References

Reitz, J. (2007). Bio-Optronics and Hand Held Products to Introduce Handheld Point of Care Solution at HIMSS Conference. Retrieved February 6,2009 from http://news.thomasnet.com/companystory/507533 Saba, V. K. (n.d.)Nursing Informatics yesterday, today and tomorrow , International Council of Nurses. Rep. no. 48(3),177. Print. Setting Safe Standards: Homegrown Barcoding Medication Administration System Helps VA (2009). Retrieved October 5, 2009, from http://www.allbusiness.com. Wood, D. (2004). FDA issues final bar code rule . Retrieved from http://www.nursezone.com/Nursing-News-Events/more-news/fda-issues-final-bar-code-rule_25416.aspx