Palmyra Medical Centers BARCODING TECHNOLOGY PUTS PATIENTS FIRST IN PATIENT SAFETY

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Palmyra Medical CentersBARCODING TECHNOLOGY
PUTS PATIENTS FIRST IN PATIENT SAFETY

• Joy Washburn, Director Quality Management
• Susan Hampson, Director Surgical Nursing and
  Project Lead

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Why Barcoding

• Establish patient safety as a visible commitment
  to putting patients first philosophy
• Move from blaming people to improving processes
• Improve use of technology to prevent and detect
  error
• Use data to identify and measure improvements
• Meet JCAHO Patient Safety Standards
• Improve Medication Error Reporting

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Why Barcoding

• Maintain Focus on Medication Practices with
  Implementation of new safety Technologies
• eMAR Barcoding

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Getting Started

• Steering Committee is essential for
  interdisciplinary dialogue and decision-making
  required throughout the project
• Membership
• Administration ITS
• Education Pharmacy
• Quality/ Risk Nursing
• Respiratory

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Communication Can Not Start Too Soon..
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Did I mention that there Is Never Too Much
Communication?
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And then Communicate Some More.
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And Some More.. The sooner you start talking the
better

• M E M O R A N D U M
• TO Medical Staff
• SUBJECT Electronic Medication Administration
  Record (eMAR)
• and Bar Coding
• 1. What is eMAR? Electronic Medication
  Administration Record (eMAR) and Bar Coding
  allows nurses to document medication
  administration in the nursing module that is live
  and up-to-date within the Pharmacy system. As a
  result, the most current administration data is
  posted to Pharmacy to allow real-time billing
  based upon nursing documentation.
• 2. What will eMAR do for physicians? eMAR will
  give physicians an increased assurance that their
  patients are receiving the appropriate medication
  and dosage. Medication administration errors
  will decrease, and the documentation of
  medication administration will also be more
  accurate.
• 3. What will eMAR do for nurses? eMAR will
  provide an electronic method of confirming that
  the correct medication is being given to the
  correct patient by matching patient bar codes to
  medication bar codes through Meditech. eMAR will
  do away with the cumbersome paperwork currently
  used for medications. The printed MARs will be a
  thing of the past.
• 4. What will eMAR do for the patient? It will
  give the patient more confidence in the
  administration of medications and will reduce the
  error rates within our facility, providing a
  better quality of care for our patients.
• 5. Where are we now? A committee at PMC is
  already working on implementing eMAR, discussing
  scenarios, and resolving the few problems that
  have been encountered by sites already using
  eMAR.
• 6. Our goal? PMC is dedicated to giving the
  best in patient care. eMAR will provide another
  avenue for us to continue that quality of care.

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Medication Safety Improvement Schedule

• Computer System and Bar Coding Preparation in the
  Pharmacy
• ITS Technology Deployment
• Computer System and Process Redesign for Nursing
  and Respiratory
• Project Management

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CPCS and Bar Coding Preparation in the Pharmacy

• Identify barcoding vendor
• Drug dictionary edits
• Flow diagram current processes in the Pharmacy
  and assess impact of eMAR Bar Coding

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ITS Technology Deployment

• Complete WLAN self-survey, site survey, and
  installation
• Support laptop selection, deployment, and
  maintenance
• Develop a plan for monitoring and staying current
• Develop plan for interdisciplinary testing of
  eMAR Bar Coding software

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PRODUCT SELECTION

• Packaging Options
• Bar Code Packaging Vendors
• Contact information
• Vendor Internet sites
• Get Photos
• Demo Details (Who to contact)

• Armbands
• Cleaning Products
• Laptop/PC Computer
• Keyboard Cover
• Thermal IV Printer Labels
• Bar Code Scanner
• Printer (thermal IV labels)
• Carts
• Wall Unit

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CPCS and Process Redesign for Nursing and
Respiratory

• Determine number of carts needed to support
  bedside medication administration
• Design Customer Defined Screens to support
  documentation of medication administration
• Flow diagram current processes for Medication
  Administration and assess impact of eMAR Bar
  Coding
• Dont forget the other items that get documented
  on MAR..

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CHOOSING EQUIPMENT AND ACESSORIES

• Dont forget things like JCAHO and EPA
  requirements when deciding where to put med boxes
  if you will use them.
• Dont forget cleaning aids, cleaning policies.
  Will accessories eventually over-ride any good
  deal you got with the original equipment?
• Where will you store the carts that need battery
  charging? IV fluids? Will you keep a med cart or
  have individual med boxes?

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Project Management

• Identify team leader
• Audit barcoded armbands
• Develop communication plan
• Implement measurement plan
• Identify pilot unit roll-out plan
• Develop staff training plan
• Develop downtime printing policies

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ISSUES LIST UPDATE AT EVERY MEETING!
UPDATE TASK LIST AT EVERY MEETING!
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TEST EQUIPMENT AUDIT ARMBANDS

• Test Armbands for Durability How well do they
  hold up
• Last for how many scans, how many days?
• Shower with
• Test on Real Person
• Test equipment for getting in and out of rooms
• Where will it be stored? Are there enough
  outlets?

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Measurement Tool Box

• Charging and Documentation Audits
• Staff Perception Surveys
• Analyze Gallup Results

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Audit Tools

• Check Process in TEST mode
• Check to be sure meds are going to Patient
  Accounting
• Are credits and charges crossing over?
• Test to be sure different methods work?
• Baseline audits can be compared to identical
  audits after go-Live to point out financial
  benefits.
• Are all patients being recorded?
• Are all drug doses being recorded?
• What about nutritionals, fingersticks What do
  you document on paper MAR besides medicine? Have
  to make these decisions ahead of time.

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STAFF PERCEPTION TOOLS

• Staff survey forms were completed in the early
  stages of project development
• Results were analyzed to know where to focus
  education
• All areas were surveyed Nursing, Pharmacy, RT

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STAFF TRAINING

• Healthstream (Our web-based training)
• Training Scripts for teachers ensures
  consistency
• Scenario Question Games
• Issues Board in Training sessions
• Use hospital email to communicate each day as
  Go-Live approaches and through Go-Live
• Competency Forms
• Training Tests
• Post Test Assessments
• Respiratory Scenarios
• Pocket Cards
• Laminated Cart Reminders

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Communication Intensifies the Closer to GO-Live

• Communication Tool Box
• Videos
• Posters
• Superuser shirts
• Badgeholders, Pocket Tools

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GO LIVE

• Pilot Unit
• Parallel first
• Have a GO / NO-GO decision meeting before Go-Live
• Super Users
• Balloons
• Laminated Cheat Cards
• Party Atmosphere
• Daily meetings to determine if anything was going
  wrong or needed to be addressed with users.
• Publicity
• Inform doctors, patients, and families

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TIPS FOR SUCCESSFUL GO-LIVE

• Start project planning early, like ASAP devote
  the time to preparatory planning and work.
• Get the whole team involved on the steering
  committee including RT, NUR, IS PHA. Team
  together with the project lead.
• Approach eMAR as an ongoing project have your
  hospital form a multi-disciplinary committee to
  address issues in a formal process.
• Be positive with staff, even when theyre
  negative.
• Use available resources (We had Corporate Support)

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More Tips

• Use the Facility Issues List Template as a
  to-do list for the steering committee.
• Do the Workflow Diagram of your inpatient units
  to identify and resolve med admin process issues
  early on to make sure eMAR isnt blamed. This
  also helps improve interactions between Pharmacy
  and Nursing.
• Figure out a process for anything you currently
  write on the paper MAR, ex. Co-signatures,
  nutritional supplements blood products,
  fingersticks, etc.
• Select an initial go-live unit that has a manager
  with great working knowledge of CPCS and staff
  buy-in.

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MORE TIPS

• Educate staff thoroughly.
• Emphasize scanner training to the end users.
  Training immediately before their go-live did the
  best
• Be sure to get the carts and systems to the
  nursing units early (1 week is not long enough).
• Identify and train your super users early
• Train staff on PC usage
• Have plenty of Super Users available (1 trainer
  per 2 RN works well).

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More Tips

• Run a Parallel for up to 1 week prior to go-live
  using a few patients. It allows you to check
  system integrity, gain confidence with the
  system, and ensure proper training.
• Get the carts and equipment to floor early, 2-3
  weeks is preferable.
• Make sure RNs understand the need to keep carts
  plugged in.
• Resolve any scanning issues quickly. Devise a
  reporting system to notify IS department when
  there are equipment or software issues.
• Devise a process for the Discharge MARs to be
  printed upon discharge. Have your HIM department
  test the Discharge Summary MAR.

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CONTINUED MONITORING

• Patient Scan Rates
• Medication Scan Rates
• Occurrence Reports
• Medication Error Reports (Given late, warnings
  over-ridden, etc.)

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Summary

• Has greatly improved patient safety and lowered
  med errors, but you have to continuously monitor
  usage and work-arounds, troubleshoot problems.
• Individual feedback is mandatory for successful
  implementation and continued compliance.
• Involvement, participation, commitment from all
  levels is needed and expected
• Ultimate outcome will be better patient care

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Were still not throughWhats next? Outpatient
areas and Surgical Services