[MEDITECH-L] eMAR/BMV

[Bowles, Jodi]

My facility is once again attempting to  start BMV and eMAR.  I have noticed lots of inquires on the “L” regarding workarounds with BMV. Can someone give an example of a “workaround”. Is there anything that I can do in the planning and teaching phase of eMAR and BMV to help decrease workarounds?

Thanks

Jodi Bowles  RN, BSN

Clinical Systems Coordinator

Princeton West Virginia

[Kimberly Frick]

Here are examples:

1) Scanning a barcode label instead of the patient's wristband when administering meds. The wrong patient can be given the meds when scanning a label. Some facilities have put an extra character on their wristbands so the barcode on the label won't work when documenting meds.

2) Scanning the first pill of a two pill dose, but not the second one. The dose can be changed manually by the user at the dose field without scanning the second pill. The danger in this practice is if the second pill is stocked incorrectly, the user won't know they gave the wrong drug. We had two similar name drugs stocked together in our Pyxis machine recently. Fortunately, the nurse noticed the error when she removed the drug, but if she had not scanned the second pill, she could have given the patient the wrong med.

3) Full documenting med administrations that should be scanned. Full documentation is a way to document without scanning the drug and should be used when documenting a med as not given or when a med doesn't have a barcode to scan. The safety features of barcoded meds is completely circumvented when this feature is used inappropriately.

 

Nurses that use workarounds are usually doing it for a reason. Workarounds are generally a symptom of a problem with the process or inadequate training. If nurses are scanning labels instead of patient's wristbands, it is usually because the wristband doesn't consistently scan. They typically won't tell you about the problem; they just find a workaround and go on with their day. That's just the nature of nurses-fix it and forget it! Watching for these workarounds will alert you to process problems or bad habits that need to be corrected.  

 

Kim Frick, RN
Project Coordinator
Licking Memorial Health Systems
Phone: 740-348-4114
Fax: 740-348-4769
kfr...@lmhealth.org
www.LMHealth.org
 

[Sharon LaDuke]

What I personally saw as a nursing director was

1)       scanning a label instead of the ID band on the patient’s wrist. This was in a facility that had big med carts on wheels, with a laptop attached, and a hardwired scanner. The nurses said they were scanning labels because “it makes too much noise to roll the med cart across the threshold to the room, and we don’t want to wake up the patient”. A real barrier to rolling the med cart into the room was that the nurse often had to move furniture and equipment around to be able to get close enough to the patient to reach him with the hard-wired scanner. The label-scanning thing was happening at a lot of facilities until everyone figured out that they had to have a way to ensure that the ID band, and only the ID band, could be scanned in the eMAR system. So you need a way to allow the system to differentiate between ID bands and labels. And it might be helpful to consider what equipment is being provided, whether nurses have room to get the equipment to the patient, etc. For training purposes, I think you have to emphasize that scanning is a form of documentation, and point out the illegality of intentionally falsifying information and what the consequences could be.

2)       opening medications prior to scanning – this is a big no no – works OK in some circumstances, but you have to draw the line somewhere. Otherwise, you have nurses who will open meds at the nurses station two hours ahead of time, if that’s when they have a free moment. Two hours later – or 10 minutes later – if those meds haven’t been under that nurse’s direct observation for the entire time, who is to say what’s in there now? Plus, if the nurse opens containers before scanning, the bar code labeled can be ripped. You then have nurses looking through the patient’s med drawer for another pill so they can scan THAT one instead. The nurse THINKS it’s the same pill, but is it? As far as training goes, this may be a more subtle point. It is more obvious to people, I think, that scanning something other than the bracelet on the patient’s wrist is wrong. There may need to be discussion and consensus among nursing leadership regarding the issue of opening meds before scanning, so that everyone is on the same page. There may be times and settings when this could be permissible and those may need to be defined.

3)       scanning the med but using the recall function at the “patient name” prompt, instead of scanning the patient - the system was reconfigured so that this could no longer be done. I don’t know if this was happening outside of my multi-site hospital system. You’ll want to check and make sure your system doesn’t let you do that.

4)       rarely scanning for whatever reason - training, attitude, and/or the belief that no one is paying attention (the standardized stat reports can be used to disabuse nurses of the notion that nobody knows what they are doing). Scanning numbers can also be down because there simply isn’t enough equipment to go around, eg 5 nurses on a unit sharing 4 med cart/emar laptops, or because equipment is poorly supported, eg IT tech staff insisting that all the laptop problems are due to stupid users. What I (and others) would like to see happen is a follow-up retraining about one month after initial eMAR/BMV training

5)       using the edit function (if I recall correctly) to “backtime” medication administration time, to make it look like the med was given within the (admittedly unrealistic) 30 minute administration window. This, too, could be tracked with a report – but it might have been a custom.

What I have heard of is

1)       carrying an extra patient ID band in one’s pocket to scan (reportedly, the nurse believe this was OK because, after all, she was scanning the patient’s ID band)

2)       scanning the patient and med AFTER administration (reported to me by a colleague recently hospitalized)

Sharon

 

---

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Bowles, Jodi
Sent: Tuesday, June 26, 2007 8:53 AM
To: medit...@mtusers.com
Subject: [MEDITECH-L] eMAR/BMV

 

My facility is once again attempting to  start BMV and eMAR.  I have noticed lots of inquires on the “L” regarding workarounds with BMV. Can someone give an example of a “workaround”. Is there anything that I can do in the planning and teaching phase of eMAR and BMV to help decrease workarounds?

[Roy Coutts]

Hi Jodi,

 

I have seen many of the same workarounds that Sharon has mentioned.  While I was visiting a sister hospital, I noticed every room had a poster in it that said something like “We scan the band every time”.  They did some sort of marking campaign and had a great little mascot in the shape of a pill saying they always scan the medications and ID band.  If the patient was not scanned they had the phone number to the administration office to be reported by the patient.

 

I’m not sure how well it worked but I am sure having the patients involved with their own care and possibly catching a nurse perform a workaround put pressure on them to do things correctly.

 

Roy Coutts
Project Manager
Interface People, LP
396 W. Main St, Lewisville, TX, 75057
office: 214.222.1125 
fax: 214.292.9783
roy.c...@ipeople.com

 

---

[Horsley, Randi - CRH]

I am not the one that did it at this facility, but we had our MIS/NPR gurus alter the patient ID label so that the account and MRN numbers are combined on the barcode of ALL labels EXCEPT the one that is designated clearly for the ID band. Any equipment that is designated to function using the barcode (Accuchecks, BMV scanners, etc) will not recognize the other labels' number. That cut off some of the very creative workarounds with labels we had seen even though the policy is scan the ID band only.

---

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Roy Coutts
Sent: Tuesday, June 26, 2007 12:27 PM
To: Sharon LaDuke; Bowles, Jodi; medit...@mtusers.com
Subject: Re: [MEDITECH-L] eMAR/BMV

Hi Jodi,

 

I have seen many of the same workarounds that Sharon has mentioned.  While I was visiting a sister hospital, I noticed every room had a poster in it that said something like "We scan the band every time".  They did some sort of marking campaign and had a great little mascot in the shape of a pill saying they always scan the medications and ID band.  If the patient was not scanned they had the phone number to the administration office to be reported by the patient.

 

I'm not sure how well it worked but I am sure having the patients involved with their own care and possibly catching a nurse perform a workaround put pressure on them to do things correctly.

 

Roy Coutts
Project Manager
Interface People, LP
396 W. Main St, Lewisville, TX, 75057
office: 214.222.1125 
fax: 214.292.9783
roy.c...@ipeople.com

 

---

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Sharon LaDuke
Sent: Tuesday, June 26, 2007 2:05 PM
To: Bowles, Jodi; medit...@mtusers.com
Subject: Re: [MEDITECH-L] eMAR/BMV

 

What I personally saw as a nursing director was

1)       scanning a label instead of the ID band on the patient's wrist. This was in a facility that had big med carts on wheels, with a laptop attached, and a hardwired scanner. The nurses said they were scanning labels because "it makes too much noise to roll the med cart across the threshold to the room, and we don't want to wake up the patient". A real barrier to rolling the med cart into the room was that the nurse often had to move furniture and equipment around to be able to get close enough to the patient to reach him with the hard-wired scanner. The label-scanning thing was happening at a lot of facilities until everyone figured out that they had to have a way to ensure that the ID band, and only the ID band, could be scanned in the eMAR system. So you need a way to allow the system to differentiate between ID bands and labels. And it might be helpful to consider what equipment is being provided, whether nurses have room to get the equipment to the patient, etc. For training purposes, I think you have to emphasize that scanning is a form of documentation, and point out the illegality of intentionally falsifying information and what the consequences could be.

2)       opening medications prior to scanning - this is a big no no - works OK in some circumstances, but you have to draw the line somewhere. Otherwise, you have nurses who will open meds at the nurses station two hours ahead of time, if that's when they have a free moment. Two hours later - or 10 minutes later - if those meds haven't been under that nurse's direct observation for the entire time, who is to say what's in there now? Plus, if the nurse opens containers before scanning, the bar code labeled can be ripped. You then have nurses looking through the patient's med drawer for another pill so they can scan THAT one instead. The nurse THINKS it's the same pill, but is it? As far as training goes, this may be a more subtle point. It is more obvious to people, I think, that scanning something other than the bracelet on the patient's wrist is wrong. There may need to be discussion and consensus among nursing leadership regarding the issue of opening meds before scanning, so that everyone is on the same page. There may be times and settings when this could be permissible and those may need to be defined.

3)       scanning the med but using the recall function at the "patient name" prompt, instead of scanning the patient - the system was reconfigured so that this could no longer be done. I don't know if this was happening outside of my multi-site hospital system. You'll want to check and make sure your system doesn't let you do that.

4)       rarely scanning for whatever reason - training, attitude, and/or the belief that no one is paying attention (the standardized stat reports can be used to disabuse nurses of the notion that nobody knows what they are doing). Scanning numbers can also be down because there simply isn't enough equipment to go around, eg 5 nurses on a unit sharing 4 med cart/emar laptops, or because equipment is poorly supported, eg IT tech staff insisting that all the laptop problems are due to stupid users. What I (and others) would like to see happen is a follow-up retraining about one month after initial eMAR/BMV training

5)       using the edit function (if I recall correctly) to "backtime" medication administration time, to make it look like the med was given within the (admittedly unrealistic) 30 minute administration window. This, too, could be tracked with a report - but it might have been a custom.

[McNamara, Tara]

If you are magic, they can do a partial name look-up at the patient name instead of scanning. They can use the right control key to check off the meds instead of scanning. Supposedly this is fixed in 5.6.

 

---

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Bowles, Jodi
Sent: Tuesday, June 26, 2007 10:53 AM
To: medit...@mtusers.com
Subject: [MEDITECH-L] eMAR/BMV

 

My facility is once again attempting to  start BMV and eMAR.  I have noticed lots of inquires on the “L” regarding workarounds with BMV. Can someone give an example of a “workaround”. Is there anything that I can do in the planning and teaching phase of eMAR and BMV to help decrease workarounds?

---

This email and any files transmitted with it are confidential. And intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please contact the system administrator for Cape Cod Healthcare.

Admini...@CapeCodHealth.org

[David S. Dickason]

I understand that it is not difficult to ad a prefix or suffix to the labels and not the band or vice-versa that prevents the scanner from reading that number for bmv.  There was a note in the L several months ago about this. 

 

---