Medication Administration with Care Admin and Care Mobile by Karen Biggio Debbie Chapman

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Medication Administrationwith Care Admin and
Care Mobile by Karen Biggio Debbie Chapman
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Objectives

• What is PPID
• How to maintain NDC numbers
• stacking vs identifiers
• Bar Codes
• 1D vs 2D
• Pharmacys process for adding new NDC numbers in
  the formulary

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Objectives

• Choosing between Care Admin and Care Mobile
• Scanner Selection Tips
• Tweaking the Order Catalog
• PPID Reports

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Objectives

• Implementation Plan
• Medication Safety Catches
• Questions??

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About Spectrum Health

• Who we are
• 7 hospitals
• 13,000 staff
• 1,400 physicians
• 2,000 volunteers
• 140 service sites
• Who we serve
• 3 million people
• 450,000 health plan members
• 6,300 employers

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About Spectrum Health

• Regional Neonatal Center
• Regional Poison Center
• Regional Burn Center
• Regional Level I Trauma Center most trauma care
  in Michigan
• Aero Med regional medical transport service
• More than 40 national quality awards

• Largest not-for-profit health care system in West
  Michigan
• DeVos Childrens HospitalOnly childrens
  hospital in West Michigan
• Largest open heart program in the state
• Largest regional provider of cancer care
• Priority Health Ranked 1 by National Business
  Coalition on Health

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2001 2006 Process
PowerChart Firstnet

PharmNet Nursing Documentation
I-View Meds Integration eMar
Task Lists Meds Reconciliation
CPOE in Firstnet Auto Verification
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2007 PPID

• The ability to use barcode technology in
  conjuncture with medication administration. This
  is accomplished by scanning the patient
  identification band and then scanning the
  medication, thus enabling the clinician to check
  the five rights.

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2007 PPID

• 5 Rights
• Right person
• Right medication
• Right route
• Right dose
• Right time

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NDC Numbers Unique IDs

• Drug products are identified and reported using a
  unique, ten-digit, three-segment number, called
  the National Drug Code (NDC), which is a
  universal product identifier for human drugs. 
  This number identifies the labeler, product, and
  trade package size.  When the barcode is scanned,
  the scanner is looking for the NDC number.

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NDC Numbers

• In order for the scanner to read and identify the
  drug, every products barcode must be scanned
  into the the product tool (phadbproductmgr.exe).
• There are 2 ways to place a NDC number in the
  product tool
• Stacking the NDC number
• Using identifiers

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NDC Numbers - stacking

• Add each manufacturer (each NDC number) to the
  supply tab in phadbproductmgr. There is no limit
  as to how many manufacturers you can add here.

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Stacking
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NDC Numbers - identifiers

• Under the identifier tab add each NDC number as
  Rx Misc1. There is a limit of 5 Rx Misc1 that
  can be added.
• We also added the item_id of each product as Rx
  Misc2. If the cerner label is scanned, the label
  contains the dispense_id which goes back to the
  item_id and the medication is identified by that.

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Rx Misc 1
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Medication Labels

• Patient specific medications may be sent up from
  pharmacy with a Cerner label.
• This label contains
• Patient name and Fin
• Room and bed
• Drug name (included is order_id, dispense_id, and
  item_id)

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Bar Codes

• Different bar and space patterns represent
  different characters. Patterns grouped together
  form a symbology. Most medication barcodes
  incorporate the NDC number in the barcode.

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Bar Codes 1D

• Most scanners can read 1D (linear) barcodes.
  Code 128 and Code 39 are two common linear
  barcodes used in healthcare. A linear barcode
  requires more area than a 2D barcode and they
  have a limited data storage capacity.

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Bar Codes 1D
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Bar Codes 2D

• 2D barcodes have a higher capacity of data
  storage and require less space on the label. Not
  all scanners will read 2D barcodes or a scanner
  may not read all the types of 2D barcodes.

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Bar Codes 2D
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Pharmacys Process

• All medications are scanned into the system in
  pharmacy receiving area to make sure they are in
  the system.
• The PDA device is used to complete this process
  because of mobility of the device.
• If a medication is not found this is forwarded to
  the management team to add prior to dispense.

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Care Admin

• Care Admin is a scanner that is connected to
  either a stationary computer or a computer on
  wheels (COW). The user has a full-screen view
  and is able to use the workstation in conjunction
  with the bar code scanning device

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Care Admin Pros

• Use it in conjunction with the computer
• You are able to see and chart current due
  medications, prn medications, continuous
  infusions and overdue medications
• IO 2G compatible
• An option for nursing units that have a computer
  in every patient room

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Care Admin Cons

• Can only use for Begin Bag on continuous
  infusions, cannot Infuse, Change Rate, etc.
• Depending on how you customized your frequencies
  and when your DCP Task Status Overdue ops job
  runs, there may be a time period where some
  overdue medications will not show in the care
  admin box.
• Not only has to be plugged into the computer but
  also has a second plug for power.

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Care Admin Scanner
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Care Admin
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Care Mobile

• Care Mobile is a hand held device. Users have
  full medication administration capabilities along
  with the barcode verification of the 5 rights.
  Can also document on a simple powerform and place
  an order for a stat medication (ad hoc order).

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Care Mobile - Pros

• Its small, light weight, not connected to a
  computer
• Able to do complete charting on continuous
  infusions, such as Begin Bag, Rate Change,
  Infused, etc
• Have the ability to chart on simple power forms
• An option for nursing units that do not have many
  computers per patient ratio.

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Care Mobile - Pros

• Have the ability to add a stat one time order.
  That order will go to pharmacy med manager, the
  orders tab and to eMAR
• Have the ability to chart titratable drips
• User can view most recent laboratory results,
  radiology results and vital signs
• Utilizes Multum checking
• Drug-allergy
• Drug-drug
• Duplicate

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Care Mobile - Cons

• It has a small viewing screen
• Does not have the ability to do more complex
  power forms
• It is not fully integrated with IO2G yet but
  that is coming in the near future

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Care Mobile Scanner
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Care Mobile Scanner
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Care Mobile Scanner
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Care Mobile Scanner
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Scanner Selection

• What to look for in a scanner
• Must have the ability to read ALL 2D symbology
• How heavy is the scanner
• How easy is it to set the scanner back in the
  cradle
• How easy is it to point and scan
• How easy is set up of the device

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Scanner Selection

• How is power delivered to the device
• Is the device wireless whether Care Admin or Care
  Mobile

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Tweaking the Order Catalog

• Scenario 1
• Multi strength physician orders
• Lipitor 30mg po, pharmacy sends 1-20mg and
  1-10mg tablet. How will the scanner know?
• Customization of Order Catalog for multi strength
  orders
• Scope synonyms for multi strength doses at the
  primary and brand name level

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Tweaking the Order Catalog

• Scenario 2
• Multi form same route orders
• 325mg po tablet. Order is changed to NG,
  liquid form of drug is now required. How will the
  scanner know?

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Tweaking the Order Catalog

• Customization of order catalog for same route
  orders
• Scope synonyms for same route different form of
  doses at the Rx Mnemonic level. This allows for
  the order to be modified from one form to the
  other such as, oral tablet to oral liquid without
  creating a complete new order.

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Tweaking the Order Catalog
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PPID Reports

• Currently there are 3 canned reports from Cerner
  (4 more available in 2007 code)
• Utilization Report
• Identification Issues Report
• Alert Counts Report

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Utilization Report

• Assesses the usage of barcode scanning and
  compares the usage with the number of alerts that
  fired
• Date/Time
• Facility/Nurse Unit
• User
• Total of Medication Events

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Utilization Report

• Total of Medication Events where patient
  wristband is scanned
• of Medication Events where patient wristband is
  scanned
• Total of Medication Events where the medication
  barcode is scanned
• of Medication Events where the medication
  barcode is scanned

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Utilization Report

• Total of Audit Alerts that fired for the
  medication events recorded
• of Audit Alerts for the medication events
  recorded

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Utilization Report
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Identification Issues Report

• Designed to assess the usage and reliability of
  the barcodes being used
• Date/Time
• Facility/Nurse Unit
• User
• Total of Medication Events
• Total of Medication Events where patients
  wristband was scanned

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Identification Issues Report

• Total of Medication Events where the medication
  barcode was scanned
• Total of Times patient was not identified
• Total of Times the medication was not identified

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Identification Issues Report
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Alert Counts Report

• Shows the total of all the different alerts that
  fired within a specific time period
• Date/Time
• Facility/Nurse Unit
• User
• Total Medication Events

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Alert Counts Report

• Total of Alerts Fired (overdose, underdose,
  expired med, incompatible drug form, incompatible
  drug route, patient mismatch, task not found)
• of Alerts for the Medication Events Recorded

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Alert Counts Report
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Implementation - Pilot

• One ICU unit
• 3 Nurses (different shifts)
• Different Scanners (to decide which scanner
  worked the best for their process)
• Nurses kept a log of what did and did not work.
  If a medication did not work, the empty package
  was sent back to pharmacy for evaluation

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Implemenation - Compliance
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Implementation - Compliance

• Reports identify tasks that are not medications
  but need to be charted i.e. water for flush, aMAR
  comment, pre-made IVs and medications
• Reports identify areas in nursing process that
  need further education or a change
• Strives to make staff accountable

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Implementation Plan

• Adult ICU at Butterworth Care Admin
• Adult ICU at Blodgett Care Admin
• Med Surg floors at Butterworth which scanner?
• Med Surg floors at Blodgett which scanner?
• ED Dept at Butterworth Care Mobile?

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Implementation Plan
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Medication Safety Catches

• Wristband catch- wrong patient chart already open
  when wristband was scanned
• Wrong time catch- medication scanned outside of
  time window allowed for overdue meds
• Wrong time catch- medication scanned too early of
  time window for due meds

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Medication Safety Catches

• Wrong route catch- oral medication scanned for IV
  dose
• Wrong volume catch- floor stock medication
  removed from Pyxis machine by RN was not the
  product used by pharmacy to enter order

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Questions??

• karen.biggio_at_spectrum-health.org
• debbie.chapman_at_spectrum-health.org