Open Forum

Good Morning!

We have been barcode scanning since 2017 in all of our ambulatory settings. We have a workflow to support this work and weekly monitoring reports to the managers of the staff and provide scanning., As well as a monthly review deep drive by our team to assist areas that experiencing success and barriers. When we started, our compliance was low, and with leadership support and staff engagement, we are at 97% and climbing with over 20,000 medications each month. 

The process overview

Provider place order

Review order in the medication area, 

Use 10 rights of medication administration

Scan to ensure right medication

Select Cancel after scan in the medication area

Take medication to exam room, or where the patient is located

Use 10 rights of medication administration

Access MAR in our EMR

Scan the medication,

Document site given, lot# expiration date

Document CAM med waste for any single dose order

Click accept

Document reason for the medicaiton and patient response using a smart phrase.  

I have uploaded the workflow, as it covers other situations with medication barcode scanning. Let me know if this helps or you need more information.

Good Morning!

We have been barcode scanning since 2017 in all of our ambulatory settings. We have a workflow to support this work and weekly monitoring reports to the managers of the staff and provide scanning., As well as a monthly review deep drive by our team to assist areas that experiencing success and barriers. When we started, our compliance was low, and with leadership support and staff engagement, we are at 97% and climbing with over 20,000 medications each month. 

The process overview

Provider place order

Review order in the medication area, 

Use 10 rights of medication administration

Scan to ensure right medication

Select Cancel after scan in the medication area

Take medication to exam room, or where the patient is located

Use 10 rights of medication administration

Access MAR in our EMR

Scan the medication,

Document site given, lot# expiration date

Document CAM med waste for any single dose order

Click accept

Document reason for the medicaiton and patient response using a smart phrase.  

I have uploaded the workflow, as it covers other situations with medication barcode scanning. Let me know if this helps or you need more information.

Greetings,

Our organization has been barcode scanning since July 2023. Our workflow depends on whether it's a multidose or single-dose vial, as the CDC recommends that multidose containers not be used in patient care areas (https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html) (https://www.cdc.gov/infection-control/hcp/core-practices/index.html). 

1. Order is entered and signed in the EMR 
2. Staff go to their medication prep area and prepare the medication. If it's a multidose vial, the syringe/container is labeled per policy and scanned in the preparation area. If it's a single-dose vial/syringe/container, it is brought into the patient's room after preparation.
3. Staff enter the patient's room, confirm identity, scan the barcode, complete any incomplete fields that did not populate, administer the medication, and complete the documentation.

It is our best practice to scan at the bedside when possible too, to reduce the risk of errors. I agree Jennifer, literature is limited in the ambulatory setting on this.

Greetings,

Our organization has been barcode scanning since July 2023. Our workflow depends on whether it's a multidose or single-dose vial, as the CDC recommends that multidose containers not be used in patient care areas (https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html) (https://www.cdc.gov/infection-control/hcp/core-practices/index.html). 

1. Order is entered and signed in the EMR 
2. Staff go to their medication prep area and prepare the medication. If it's a multidose vial, the syringe/container is labeled per policy and scanned in the preparation area. If it's a single-dose vial/syringe/container, it is brought into the patient's room after preparation.
3. Staff enter the patient's room, confirm identity, scan the barcode, complete any incomplete fields that did not populate, administer the medication, and complete the documentation.

It is our best practice to scan at the bedside when possible too, to reduce the risk of errors. I agree Jennifer, literature is limited in the ambulatory setting on this.

Hello!

I know this is an older thread, but I have a related question and might have more.  :)

We just went live with BCMA for all of our practices.  

How are you all handling clinical staff (like PCTs) who are acting like a scribe in a procedure (think IUD insertions, joint injections, MOHS procedures, etc).  Or, do you just not utilize them in that way?  In our state, they can technically administer medications, but we are still not allowing medication admin by non-MA, LPN, RNs.

Thanks!

Christi

Hi! I assume a PCT is a "patient care tech." Our outpatient organization has set up a committee/process to understand the scope of practice and define it for our leaders. We do not allow medical admins to be made by persons who are outside of that of an LPN, RN, MA, or provider. We are beginning to look at Ophthalmic techs and athletic trainers. 

Our outpatient organization pushed BCMA into our outpatient practices in 2024. We scan at the point of administration. This is noted in the literature as best practice (inpatient literature).  We scaled the scanner distribution to the number of medications administered per day. Most of our practices have computers and scanners in EVERY room. This model of inpatient practices is in alignment with the literature. clinics with lower admin volumes were given a laptop + scanner, which were taken to the point of administration. Patients are given a barcoded sticker or armband (in pediatrics) at check-in. Both the patient and the medication are scanned, along with the patient or caregiver verbally verifying the name and dob. The BCMA implementation included not only the use of the technology but also level setting all clinical team members who administer medications on med admin best practices and medication administration policy, calling out the 5rights +2 and 3 checks, with the incorporation of BCMA at the 3rd check at the point of administration. Documentation is completed in the room in front of the patient after medication administration. This year, we will publish and implement a BCMA policy that takes med policy a step further. Policy alignment with practice is crucial to implementation and sustainment. Most of our medications are administered by medical assistants with varying degrees of background and education. Sustainment is a work in progress as a power bi-scanning dashboard has been developed for clinic leaders and executives. Report out on metrics is expected once a month. Our metrics for medication scanning are a little lower than hospital and literature metrics due to some complexities in how different medications are used.  We have noted infidelity to the prescribed workflow (batch scanning after the patient leaves) and are mitigating that through optimization of the dashboard to catch time stamps and constant communication. Finding workarounds outside of the workflow is also noted in the literature!  Happy to discuss and share more! 

It's great to see others pushing into BCMA in outpatient! Incredibly, it took 2-decades to get to outpatient; the tech has been available since the mid-90s. We've caught many errors since we deployed!  It's been a game changer and placed a spotlight on the importance of safe medication administration in the outpatient side of our healthcare system. 

Our outpatient organization pushed BCMA into our outpatient practices in 2024. We scan at the point of administration. This is noted in the literature as best practice (inpatient literature).  We scaled the scanner distribution to the number of medications administered per day. Most of our practices have computers and scanners in EVERY room. This model of inpatient practices is in alignment with the literature. clinics with lower admin volumes were given a laptop + scanner, which were taken to the point of administration. Patients are given a barcoded sticker or armband (in pediatrics) at check-in. Both the patient and the medication are scanned, along with the patient or caregiver verbally verifying the name and dob. The BCMA implementation included not only the use of the technology but also level setting all clinical team members who administer medications on med admin best practices and medication administration policy, calling out the 5rights +2 and 3 checks, with the incorporation of BCMA at the 3rd check at the point of administration. Documentation is completed in the room in front of the patient after medication administration. This year, we will publish and implement a BCMA policy that takes med policy a step further. Policy alignment with practice is crucial to implementation and sustainment. Most of our medications are administered by medical assistants with varying degrees of background and education. Sustainment is a work in progress as a power bi-scanning dashboard has been developed for clinic leaders and executives. Report out on metrics is expected once a month. Our metrics for medication scanning are a little lower than hospital and literature metrics due to some complexities in how different medications are used.  We have noted infidelity to the prescribed workflow (batch scanning after the patient leaves) and are mitigating that through optimization of the dashboard to catch time stamps and constant communication. Finding workarounds outside of the workflow is also noted in the literature!  Happy to discuss and share more! 

It's great to see others pushing into BCMA in outpatient! Incredibly, it took 2-decades to get to outpatient; the tech has been available since the mid-90s. We've caught many errors since we deployed!  It's been a game changer and placed a spotlight on the importance of safe medication administration in the outpatient side of our healthcare system. 

It is timely to see this discussion.

We are using Epic and considering BCMA for Ambulatory. Thank you all for sharing your workflows. I have a couple questions I have not seen addressed. 

1) Each of our clinics order medications from an approved formulary from McKesson and the supply is delivered directly to the clinic site. Does anyone else have a process for managing the barcode library in a model like this?

2) Has anyone leveraged Epic Rover devices in an ambulatory setting for medication administration?

Thanks all for sharing best practices.

It is timely to see this discussion.

We are using Epic and considering BCMA for Ambulatory. Thank you all for sharing your workflows. I have a couple questions I have not seen addressed. 

1) Each of our clinics order medications from an approved formulary from McKesson and the supply is delivered directly to the clinic site. Does anyone else have a process for managing the barcode library in a model like this?

2) Has anyone leveraged Epic Rover devices in an ambulatory setting for medication administration?

Thanks all for sharing best practices.

It is timely to see this discussion.

We are using Epic and considering BCMA for Ambulatory. Thank you all for sharing your workflows. I have a couple questions I have not seen addressed. 

1) Each of our clinics order medications from an approved formulary from McKesson and the supply is delivered directly to the clinic site. Does anyone else have a process for managing the barcode library in a model like this?

2) Has anyone leveraged Epic Rover devices in an ambulatory setting for medication administration?

Thanks all for sharing best practices.