Lieve Nijs,RN
University Hospitals Leuven, Belgium
Bedside scanning
Bedside Scanning a story
Not about barcodes …
… but patient safety
1. Introduction
• Medication errors are the main cause of
adverse events, they are repetitive and are a
continual risk for patients.
Marini (2009); Payne (2002); Brady (2009); Helmons (2009)…
1. Introduction
• The medication process in a hospital is
complex, which involves various people and
disciplines.
• Administering medication in a safe way,
without errors, is a challenge.
• The more complex medication therapy
needs our attention
Brady (2009); Folkmann (2010); Richardson (2012)…
1. Introduction
a. Medication errors
34%
6%4%
56% Prescription
Administration
Copy
Distribution
Based on Bates W, et al. Incidence of adverse drug events and potential adverse drug events,
implications for prevention. JAMA 1995;274(1):29-34
34% 62%
4%
CPOELarge impact of medication errors was
a determining factor to prioritize the
implementation of CPOE and BSS
1. Introduction
b. Types of medication errors– Prescription:
• Wrong patient, dosage, type, way of administring, time
• Unreadable
• Incomplete (posology, type, signature)
– Drug:• contraindication, allergy
• interaction, incompatibility
– Communication:• Oral orders
• No/too little information
In real Life….you’re not a number !
2. Reduce medication errors
a. Implementation of C.P.O.E
– Safe and readable prescription
– Monitor several interactions
(DD/DA/DP/DF/DD/DD)
From prescribing to C.P.O.E.
Visible for “everyone”…
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2. Reduce medication errors
b. Implementation of bedside scanning
– Registration of administration via bedside
scanning
– Final check on the “5 R’s”
The final check
bedside scanning
• Requirements
– Fully deployed CPOE
– Hardware and software
– Barcode on every single dose
Single Dose versus Unit Dose versus Nominative dose
BSS in practice …
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Dispensing
and ordering
Reconstitution
Administration
3. Advantages of CPOE and BSS
• A readable prescription
• Less reported medication errors
• Follow-up from a distance
• Paperless: billing, logistic process…
• Better packaging…
• Follow-up compliance possible!
4. Compliance BSS
• The introduction of BSS allows to map the
whole medication flow, to investigate the use
of BSS and to improve patient safety.
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4. Compliance BSS
– 4,973 prescriptions
– 25,487 medication orders
– 318,572 medication administrations
Lemaitre (2014)
4. Compliance BSS
(† p=0,11 ; ‡ p<0,000); ±
p=0,008)
Interactie type n (%) Alert Accept n (%)
Drug-Drug
Very serious interaction
Serious Interaction
4710 (94,71)
353 (7,50)
4357 (92,50)
2896 (61,49) †
61 (17,28) ‡
2835 (65,07) ‡
Drug-Allergy
Very serious interaction
Serious Interaction
239 (4,81)
49 (20,50)
190 (79,50)
142 (51,41) †
21 (42,86)±
121 (63,68)±
Drug-Pregnancy 24 (0,48) 10 (41,67) †
Total 4973 3048 (61,29)
4. Compliance BSS
• Scan rates
99.33% 99.84%98.75%
90.00%
91.00%
92.00%
93.00%
94.00%
95.00%
96.00%
97.00%
98.00%
99.00%
100.00%
4. Compliance BSS
• Percentage deviations of the prescription
1.05%
1.35%
0.36%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
5. Results of prescription and administering
via bedside scaning
• Right drug
• Right patient
• Right dose
• Right route
• Right time (of administration)
+ • Prevention of interactions (drug-drug, drug-patient, drug-
food, drug-pregnancy)
• Prevention of identical prescriptions (drug duplication)
Real life : a case
A 45 year old patient was hospitalised for 5 days on intensive
care for a Vancomycineintoxication.
When the patient was stabilized, he came back to the
hospitalisation ward.
The physician made a prescription for the C.P.O.E. for
Vancomycine 1000 mg, dosage : 0 mg.
At that moment BSS was NOT implemented.
The nurse saw the prescription and administered the
medication 1000 mg.
Result: the patient went back to the intensive care.
This would not have happened with bedside scanning, because
zero doses are NOT ALLOWED.
Prescription and administraiting of zero
dosage
Conclusion
• CPOE and BSS contributes to a safer medication
administration
• Check in every phase of the process
• Bigger attention for the medication process
• Focus on effectiveness and positive effects
• We must remain alert for new errors
Is this how we like our meds … ?
Because in our day-to-day life we don’t
have these “medicinal” problems…
These are the meds we need…
Thank you for your attention
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