Transcript Chandler Regional Hospital

Chandler Regional Hospital
Barbara Tausch, CPhT
Technician Supervisor, Buyer
 One
of the primary goals of Catholic
Healthcare West is to provide outstanding
patient care. Patient bed side barcoding or
Patient Medication Verification (BMV) is one
of the ways that the Pharmacy and Nursing
Departments work together to meet this
goal.
 How
big is your facility?
 Will it justify buying your own equipment –
which could mean a capitial equipment
purchase upward of $500,000?
 Is it better to contract an outside company to
do your barcoding?
 Can you justify a dedicated person?
 Pharmacy
and nursing staff members
must collaborate closely with information
management staff, if the medication
administration arm of a hospital care
system is to work optimally, just as rapid
computer response time is crucial to the
success of a computerized medication
administration system.
 Patient
safety is forefront in today’s
healthcare environment. Several years ago
several babies died and others severely
impaired due to the wrong dose of
Heparin being administered to neonates.
 This
error originated in pharmacy, when
two technicians incorrectly filled the
automated dispensing machines with a
high Heparin concentration. It continued
with nursing not verifying the dose they
pulled from the machines prior to
dispensing it.
This
type of error can
be reduced or
eliminated by BMV
and additionally the
use of bar-coding
within the unit based
cabinet dispensing
machines for those
who use them.
 If
not, there is either a wrong
drug/patient, or pharmacy failed to scan
the drug into the system prior to it
leaving the pharmacy.
 All drugs need to be scanned into the
system.
 The Buyers roll in BMV can be a lead role.
We are the ones who control the purchase
of the drugs, and a lot of the expenses
involved.
 Bedside
Medication Verification is when
the nurse scans the patient Identification
bracelet, the Medication Administration
Record (MAR) and the barcode on the
drug. They must all verify against each
other.
The first step, regardless if you have BMV is
to keep your shelf labels current.
This ensures that your purchases are
compliant with your contracts. When you
are not there, it also makes it EASY for
the staff to order the CORRECT item in
your absence.
 If
you do have BMV it
becomes even more
important that you
purchase the same item
every time – as often as
feasibly possible given
the number of
shortages we are faced
with!
 Make sure your shelves
are neat and clearly
marked.
 Ordering
the same product ensures that
the barcode will be a valid one in the
system.
 When alternative products are ordered,
we as the Buyer are the ones who KNOW
this.
 When
the product comes in, I pull the
product from the order and scan it into
both the computer system database
 Tech verifies the drug, and stocks into Unit
based cabinet out on the floor.
 Our
hospital system moved
to a new vendor for unitbased cabinets.
 One of the options in our
unit-based cabinet is a bar
code scanning system.
 This requires the technician
who is loading the
machines to scan the drug
prior to placing it into the
machine.
 Safety
Feature on some Unit Based Cabinets
 Uses
barcode scanning to ensure accurate
placement of items on issue and return
 Alerts
users when a possibility of error occurs
on issue/return
 Highly
configurable: feature can be enabled on
the cabinet-by-cabinet/item-by-item basis
and activated on restock only as well as on
issue/return
 If
it does not scan then it is brought back
to the pharmacy for the barcode to be
entered. This reduces the risk of a
technician filling any bin with the wrong
medication.
 For scanning to work correctly, the
barcode from each medication must be
added to a computer file and mapped to a
specific barcode in the formulary, so that
recognition is achieved in the software.
 Package
is “read” by a handheld scanner used
by the staff nurses. If a drug manufacturer’s
barcode label can’t be scanned successfully,
or if bulk-packaged products are transferred
to unit dose packaging by the pharmacy staff,
these items then must receive a pharmacygenerated barcode label that is affixed to or
printed directly onto the outer wrap of the
dose packaging

It does require a lot of work to maintain the
system, again, each new drug manufacturer
needs to be scanned into Unit based cabinet–
both those that come commercially packaged and
those we package. I do this at the same time I
add a drug into our database.
New and Generic Drug Approvals
 Visit Drugs@FDA to search Drug Approval
Reports by Month.
I
only have one other person who has
access to do this as the possibility of
entering bar codes on the wrong drug is
too easy to make and accountability
would be hard to keep track of.
Code 128
Code 128 is high-density symbology used throughout the world which permits
the encoding of alphanumeric data. The barcode uses a checksum digit for
verification, and can also be verified character-by-character. The calculation of
the check digit typically gives programmers an interesting problem to solve. It is
used when a large amount of data needs to be placed into a small space.

The “Barcoding”
Technician needs to
be a dedicated
person and one
who works either
directly under the
Buyer, or who can
work closely with
the Buyer. The two
must establish
inventory levels for
the items that need
to be unit dosed
with barcodes.
 Again,
each time a new manufacturer is
barcoded by us, the bar code needs to be
scanned into the system.
 Inventory
levels can also increase for
certain items, primarily injectables.
Caution must be taken because a large
expense is in injectables.
 We add a barcode label to injectables
because nurses do not draw the
medication up at the bedside – thus not
having the vial with them to scan at the
bedside. Our barcode label has a peel off
portion with the barcode and medication
information that is put on the syringe to
be scanned at the bedside.
 Labor
intensive? Yes. But it provides the
extra step in patient safety. Because it is so
labor intensive we cannot wait unto the last
minute to barcode fast movers. We always
have several hundered of the fastmoving
injectables done (Ondansetron, Promethazine,
Ketorolac, Methylprednisolone, Heparin, etc).
I
have a report automatically generated
and emailed to me daily that shows
everything by patient and by nurse that
did not scan in our computer database.
 It also includes the reason why it did not
scan – as the nurse must enter a reason
when she overrides the scan function in
the system. I review those daily for
problems. Occasionally there will be an
item that just does not scan consistently.
 Usually
the report indicates which nurse
is having difficulty scanning her patient
medications. If it is a consistent problem
it is followed up with the nurse.
 Some barcodes do not read well if there is
a foil or clear background.
Manufacturer oral solid U.D. is a much “cleaner”
product - Takes up less space in ADMs, OTC
barcodes usually scan.
 If Mfg oral solid U.D. costs $15-20 more, don’t
purchase - Calculated cost to package oral solid –
2.8 cents per tab.
 Oral liquids are drawn up into oral syringes with
circle sticker labels – a lot of liquids are available
U.D. from Manufacturer.

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Chandler Buyer had Unit based cabinet
company build report for inventory purpose
with pricing included
Buyer should be one who “owns” bar-coding
Initial entry of barcode items into computer
system database is a lot of work
Chandler and Mercy Gilbert share database
(pricing considerations for 340B vs non 340B)
Can be set up so one hospital cannot see item
If item is discontinued, must de-activate, not
delete item from computer system database
Barcode on tube must match
barcode on outer box.
 Both barcodes must be scan
able.
 Manufactures do have NDC
changes, item usually comes
back an a bad scan able
item on daily report.
 Some items come as a kit,
one sticker is put on, billing
is done as a kit

All patient specific I.V.s have barcode on label.
Some I.V.s in the E.D. come as a kit, (med plus bag),
sticker is put on vial. Billing is done as a kit based off of
sticker on vial through E.D. ADM
Patient name has been covered by star