Why Did We Build an eMAR That Doesn’t Use Barcode Scanners?

 In Know-How, Solutions, Trending

Sites look to barcode scanners to “reduce medication errors”, but an in-depth look at which medication errors occur at a site and why they occur should be done prior to assuming that barcodes would alleviate any medication errors.

A couple barcode scanning pros to consider:

1. Convenient retrieval of patient record at time of administration.
2. Verification of medications dispensed (pacmed / catalyst only).

Barcode scanning cons:

1. Every prescription needs to be barcoded, including those not included in scheduled pouch packaging.  For example, liquids, injectables, creams, patches etc.  Systems that rely on a barcode require all medications to be administered to contain a barcode.  Often the only way to do this is to put a barcode on the box (for patches) or on the jar (for creams), but vials for injections are too small to barcode, and sites often resort to putting a barcode on a separate paper to scan.  In any of these cases, the barcode does not necessarily indicate the right medication is being given.  (Ie: Nurse scans barcode for one external product but administers another).

2. Does not replace the “Rights” of medication administration.  Only facilitates data retrieval.  It’s important to remember that just because you scan a barcode and the computer brings up resident X at time Y and medications ABC does not mean that the nurse is standing in front of Patient X at time Y.  Bags can be mixed up and if a user has an over confidence in the barcode system, they may simply scan the barcode and administer the medications without going through the proper resident identification and medication verification process.

3. Does not notify missed doses.  Only the eMAR’s “To Do” list will identify those who have yet to be given medications.  Often barcode enabled emar systems do not identify which bags should be scanned at a particular time or for a particular resident until sometime after a synchronization occurs.  If a medication bag has gone missing, a barcode enabled system does not tell you what should be given, as it relies on the information contained in the barcode and without it the system can fail.  Using a system that knows which medications should be given at a particular time to every resident is the only effective way of knowing whether or not all medications required at a given time have been administered.

4. Does not verify medication of packaged medications. i.e. detecting pharmacy error.  If a pharmacy packing machine incorrectly packages a medication barcode enabled systems are unable to catch the mistake.  Meaning, if a resident is prescribed drug “A” and drug “B” slips into the packaging machine, the barcode will be encoded with the information for drug “A”.  Using an emar system that specifically displays each medication prescribed for a specific time period is the only way to give a nurse the information they require to check the medications that were packaged against the original prescribers instructions.  Users of barcode systems quickly become over confident in the barcode and assume that any information encoded in the barcode is an indication of what is in the pouch.

5. It happens often enough, that when packing machines print the bar code on the pouch, the scanners are unable to read the bar code.  This is often due to the heat mechanism in packager and if the pattern on the bar code is slightly off, the pouch will not register at the site.  The pharmacy must then re-package the medications with a new set of bar codes.  Since medications cannot be returned to pharmacy, this means the medications are wasted, often resulting in unnecessary charges to the tenant.

6. Often barcodes do not scan, if there is a tablet behind the barcode in the pouch the barcode becomes skewed and does not scan. Think of your trips to the grocery store. The barcodes on food products are very simple barcodes printed on to solid surfaces being scanned by top of the line scanners.  Yet, they often still do not work.  Now imagine a complex 3D barcode printed on a clear pouch that can wrinkle or crease being scanned by small inexpensive handheld scanners.

The most common medication errors in Assisted Living environments are:

1. Doses deemed for removal are not removed from the pouch packaging sequence. i.e. on hold or discontinued medications are not removed from the pouch sequence.  In a barcode enabled system, the barcode contains all of the medication and dosing information.  If a medication is placed on hold or is discontinued by the prescriber after a pouch is produced (and therefore a barcode printed) there is no way for a barcode enabled system to know of this change and unless the pharmacy calls the site and has the site staff physically pull a pouch out of administration sequence (and then therefore replaces the pouch with a new one that has the correct medications in it) the barcode on the pouch will be encoded with out of date information and will falsely instruct a nurse to administer the medications.  Using a system that is connected live to he Pharmacy ensures that the most up to date information is available to the nurses and even if a pouch physically contains an “on hold” or “discontinued” medication, the emar will notify and prevent the nurse from administering the on hold or discontinued medication.  Using this type of system saves the pharmacy time by not having to replace an existing pouch with a new one, saves the site time by not having to find and pull an out of date pouch and saves the resident money by not requiring them to pay a new dispensing fee for the pouch replacement.

2. The second most common medication error in Assisted Living homes using barcode enabled systems is over confidence in the barcode.

Confidence that a barcode scan will reduce the number of medication errors shouldn’t replace the understanding and executing of core medication administration processes.

Barcode scanning should only be used for ease of information retrieval.  Nurses are still required to initiate the checking sequence required for every dose at every pass time.  Over confidence that a barcode scan has completed some or all of the “medications administration rights” is in fact a cause in itself for creating a new realm of medication administration errors.


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