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Medication Administration and Barcode Scanning in Ambulatory Practices

  • 1.  Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-11-2024 20:40

    Hi all,

    As part of our focus on monitoring NSIs, I was hoping to connect with someone on Bar Code Medication Administration (BCMA) use in the ambulatory setting. Is there anyone out there who is using it? If so, at what point in the process are you scanning?

    We currently have some practices following a two-point process:

    1.       Medication area: Retrieve med, verify rights, scan, prep/label, pend administration in EPIC

    2.       Bedside: re-verify rights, administer, complete administration in EPIC.

    Other practices are following a one-point process:

    1.       Medication area: Retrieve med, verify rights, prep/label

    2.       Bedside: scan, re-verify rights, administer, complete administration in EPIC

    We are trying to make the case that it is safest and reduces the risk of errors to scan at the bedside (point of administration), but literature in the ambulatory space is limited, especially as it relates to when in the process scanning should occur.

    Looking to my friends on here to see if anyone has identified any best practices! If anyone would like to discuss please reach out!



    ------------------------------
    Jennifer Wagner MSN RN NE-BC
    Director of Nursing
    Lancaster General Health Physicians
    Lancaster, PA 17603
    (717)606-9110
    ------------------------------


  • 2.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 10:04

    Good morning,

    We are in the process of rolling this out to our primary care teams now.  We are doing this at bedside.

    1. Team verifies patient with 2 identifiers against a printed label
    2. scans all meds that are to be given
    3. administers meds
    4. finishes documentation while giving after care instructions 

    I have had other teams deviate from this practice but it was not as efficient or successful as doing it bedside.

    Happy to connect



    ------------------------------
    Donna Furlong MSN NEA-BC RN-BC
    RN Clinical Services Senior Director
    Banner Medical Group
    Phoenix AZ
    (719)233-1810
    ------------------------------



  • 3.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 12:12
      |   view attached

    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.



    ------------------------------
    Dawn Vonderheide DNP RN AMB-BC NE-BC
    Dir-Ambulatory Clinical Practice
    Kaiser Permanente
    Pasadena CA
    (714)309-2171
    ------------------------------

    Attachment(s)



  • 4.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 12:55

    For those doing BCMA at the bedside how are you handling multi-dose vials?

     

    Thanks

     






  • 5.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 02-01-2025 09:15

    Hi!
    Multi dose vials are out of scope at this time within our organization; we do require clinical team member to label and follow med admin best practices and policy. As we sustain and optimize, we are looking at having our centralized pharmacy warehouse potentially (serves 100s of outpatient practices)  create barcodes for multi-dose vials that would be shipped with the medication to our outpatient practices. 

    We scan the patients armband or sticker along with the medication at the point of administration. Pts are given an armband or sticker at check in. 

    Thanks for asking this question as we are striving to bring all multidose vials into scope. 

    Margaret 



    ------------------------------
    Margaret Beckner, BSN, RN
    Practice Administrator, Nursing
    Indiana University Health Physicians
    Indianapolis, Indiana
    317-709-1282 mbeckner@iuhealth.org
    ------------------------------



  • 6.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 13:00

    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.



    ------------------------------
    Sharon Peacock, MSN-Ed., RN, AMB-BC
    Nursing Professional Development Generalist
    Sentara Ambulatory Services Division
    Charlottesville, VA
    sjpeacoc@sentara.com
    ------------------------------



  • 7.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 13:20

    Sharon

     

    I am intrigued by this workflow.  Do you scan a patient label or anything to link the patient to the meds?  This is our issue we can't scan in the med prep area because our workflow dictates that the patient label be scanned in the room after verifying with 2 patient IDs. 

     

     

    Thanks

     

    Have a Wonderful Day!!

     

    Donna Furlong, MSN, RN, NEA-BC

    RN, Clinical Services Senior Director – Arizona

    Banner Medical Group

    Office:  623-285-0200

    Cell:  719-233-1810

     

     

     






  • 8.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 13:30

    Hi Donna,

    We do not have patient labels or bands. The order is entered in the EMR, multidose vials are scanned in the medication prep area, and labeled with the patient's name, date of birth, medication name (if the staff person preparing is also administering), additionally add dose/amount, date/time prepared, date/time expires, and name of the preparer (if the syringe is being prepared for someone else to administer, i.e. a Provider). Then we go into the patient's room, verbally verify name and date of birth with patient, compare the syringe label, name/DOB with what was verbalized and in the chart with the order, and administer.

     

    Thank you,

     

    Sharon J-J Peacock, MSN-Ed., RN, AMB-BC

    Nursing Professional Development Generalist

    Sentara Ambulatory Services Division

     

    Office: 434-654-4529

    Email: SJPEACOC@sentara.com | SASDClinEduTeam@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

    RQI: RQI_SASD@sentara.com | Resuscitation Quality Improvement (RQI) (sharepoint.com)

     

    Shape  Description automatically generated with medium confidence

     






  • 9.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 02-01-2025 09:23

    Hi ! 
    Our EMR is Cerner and we give armbands in our pediatric practices and then stickers in our adult practices at check in to our patients. 

    We had to have an EMR analyst write code to produce a QR code on our stickers to make it work. No easy feat !  Armbands were already baked in for printing - we mimicked the hospital side of our organization. 

    Enjoying reading about all of the efforts ! Thanks for sharing ! 

    Margaret 



    ------------------------------
    Margaret Beckner, BSN, RN
    Practice Administrator, Nursing
    Indiana University Health Physicians
    Indianapolis, Indiana
    317-709-1282 mbeckner@iuhealth.org
    ------------------------------



  • 10.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-12-2024 16:50
    Edited by Melissa Ropella 06-12-2024 16:52

    My practice advises that we scan in the exam room after verifying patient's identity. 

    Our multi-dose medications come with barcode labels (we call them tadpoles) from the pharmacy warehouse, that we pull off when preparing the medication and then take into the room with us to scan.

    ------------------------------
    Melissa Ropella
    Clinic Triage Nurse
    Fairview Medical Group
    Burnsville MN
    ------------------------------



  • 11.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-13-2024 10:13

    Hi,

    It depends on the workflow.  Education and any required consents (verbal or written) are obtained prior to retrieving medication. We promote scanning in the medication room as the preferred workflow since it addresses most issues and allows a single standard.  We occasionally administer from multi-dose vials which is considered a single-dose vial if prepped in a room with patient present. Additionally, we do not have scanners in every exam room. Scanning the medication in the prep area gives the opportunity to correct any near miss event (incorrect med, dose, formulation, expired med, etc.) before being in the presence of the patient.  Patient ID is then performed with patient and documentation is completed immediately after administration at bedside.  We also have a workflow for clinics that do not have a dedicated medication prep area, but do have a wireless scanner to perform BCMA at bedside or in a procedure room.



    ------------------------------
    Tammi Viancos BSN RN
    UT Southwestern
    Spring Branch TX
    ------------------------------



  • 12.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 06-18-2024 10:40

    Hello, 

    So glad to see this topic come up. We currently have 10 practices utilizing BCMA, and onboarding 3 more practices later this year. At this time, we do not have patient ID wristbands. We use EPIC as our EHR.

    Our workflow for single-dose medications/vaccines - "one-point process"

    • Medication Room - the team member retrieves med/vaccine as per provider order
    • Patient room – verbally verify pt name and DOB, scans, review 5 rights, completes administration in EPIC, administers

     Listed below are exceptions to the one-point process where a "two-point process" is followed:

    • Vaccine Multi-dose (vials ppd, polio) can't be brought in/and out of patient rooms.
      • Medication Room – Retrieve vaccine, verify rights, scan, pend the order, prepare vaccine, prep label (if needed)
      • Patient room - Re-verify rights in pt room, completes administration in EPIC, administers
    • Mediation Multi-dose (nebulizers, liquid Tylenol, liquid Benadryl)
      • Medication Room – Retrieve medication, verify rights, scan, completes administration in EPIC, prepare medication, label (if needed)
      • Patient room - Re-verify rights and provider order in EPIC, administer

    *Since prepped medication doesn't have a barcode (like weight-based liquid Tylenol poured into a cup), it cannot be scanned in a patient room, it has to be scanned in the med room.

    This workflow works for us and follows best practices with medication administration.  Following along to hear more about what others are doing. 



    ------------------------------
    Patricia Baxter
    Manager Infection Prevention
    Atlantic Medical Group
    Morristown NJ
    (973)971-7948
    ------------------------------



  • 13.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 01-30-2025 14:23

    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



    ------------------------------
    Christine Conran
    Metro Health - University of Michigan Health
    Grand Rapids MI
    ------------------------------



  • 14.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 01-31-2025 12:40

    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. 



    ------------------------------
    Margaret Beckner, BSN, RN
    Practice Administrator, Nursing
    Indiana University Health Physicians
    Indianapolis, Indiana
    317-709-1282 mbeckner@iuhealth.org
    ------------------------------



  • 15.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 01-31-2025 12:43

    Yes, thank you!

     

    Christi Conran, MSN, RN, NEA-BC, FACHE

    She/Her/Hers

    Director

    Specialty Services

    Professional Building

    2122 Health Drive  |  Wyoming, MI  49519
    p 616.252.7463  |  c 616.634.6441 
    christine.conran@umhwest.org


    UofMHealthWest.org

     


    University of Michigan Health-West

    The contents of this message and any attachments may be confidential and privileged. Please do not share contents without the permission of the author. If you believe this message has been received in error, please inform the sender, and then delete the message. Your receipt of this message is not intended to waive any applicable privilege.







  • 16.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 01-31-2025 12:35

    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. 



    ------------------------------
    Margaret Beckner, BSN, RN
    Practice Administrator, Nursing
    Indiana University Health Physicians
    Indianapolis, Indiana
    317-709-1282 mbeckner@iuhealth.org
    ------------------------------



  • 17.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 01-31-2025 12:39

    Thank you!  This aligns with the direction we are headed.  Working on the policy now!  If anyone has an ambulatory-focused policy they would share, it would be much appreciated!

     

    Christi Conran, MSN, RN, NEA-BC, FACHE

    She/Her/Hers

    Director

    Specialty Services

    Professional Building

    2122 Health Drive  |  Wyoming, MI  49519
    p 616.252.7463  |  c 616.634.6441 
    christine.conran@umhwest.org


    UofMHealthWest.org

     


    University of Michigan Health-West

    The contents of this message and any attachments may be confidential and privileged. Please do not share contents without the permission of the author. If you believe this message has been received in error, please inform the sender, and then delete the message. Your receipt of this message is not intended to waive any applicable privilege.







  • 18.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 01-31-2025 15:26

    Our organization implemented BCMA in 2023. For single dose vials and containers, staff are to scan in the patient room, after completing our administration rights and patient verification. For multidose vials and containers, those are scanned in our medication preparation area, labeled and then administered in the room after completing our administration rights and patient verification. It does decrease the risk of error scanning at the bedside when the steps are followed.

     

    Thank you,

     

    J.J. Peacock, MSN-Ed., RN, AMB-BC

    Nursing Professional Development Generalist

    Sentara Ambulatory Services Division

     

    Office: 434-654-4529

    Email: SJPEACOC@sentara.com | SASDClinEduTeam@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

    RQI: RQI_SASD@sentara.com | Resuscitation Quality Improvement (RQI) (sharepoint.com)

     

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  • 19.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 02-03-2025 08:00

    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.



    ------------------------------
    Ray Snider DNP MSN RN NEA-BC
    Emory Healthcare
    ------------------------------



  • 20.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 02-03-2025 08:16

    Hello Ray,

    Our organization orders medications through Henry Schein and they come packaged directly from the manufacturer. The scanner populates what information is embedded in the barcode or QR code. We have noticed QR codes have more data than the barcodes. The data that does not populate is manually added by staff. As offices need medications added to their list for administration to patients, whether patient supplied or clinic supplied, a ticket is submitted to have it added to their preference list for ordering and documentation. IT manages it from there and adds the medication so it can be ordered for administration and documentation.

     

    Our ambulatory sites do not use Rover for scanning.

     

    Thank you,

     

    J.J. Peacock, MSN-Ed., RN, AMB-BC

    Nursing Professional Development Generalist

    Sentara Ambulatory Services Division

     

    Office: 434-654-4529

    Email: SJPEACOC@sentara.com | SASDClinEduTeam@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

    RQI: RQI_SASD@sentara.com | Resuscitation Quality Improvement (RQI) (sharepoint.com)

     

    Shape  Description automatically generated with medium confidence

     






  • 21.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 02-03-2025 12:20

    All our medications for the ambulatory offices come from our pharmacy. The pharmacy department verifies that the bar coding works properly prior to distributing to offices. If new medications or dosages are needed, a helpticket is entered for pharmacy informatics to build within Cerner.

     

    Here's our workflow:

    1. Provider enters order (best practice) or clinical staff enters medication order as RVVO
    2. Clinical staff reviews order and assesses for appropriateness and if questions, checks with provider
    3. Medication is pulled from stock and medication, dose, strength, route, lot, and expiration are reviewed
    4. Medication and scanner are taken into the exam room  
    5. Patient/parents is asked to verify patient name, date of birth, medication to be given
    6. Arm band is scanned for areas using this additional safety feature (Peds, Primary Care, Urgent Care)
    7. Medication is scanned – staff review an alert that pop up which would indicate the medication doesn't match what was ordered, if medication is expired, or if contraindicated due to another medication the patient is taking
    8. Medication is administered as ordered with documentation completed on the med administration form

     

     

     

     

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  • 22.  RE: Medication Administration and Barcode Scanning in Ambulatory Practices

    Posted 02-03-2025 14:51

    Our medications are ordered through our Central Pharmacy, so they manage all of the ERx records within EPIC.  We order a few things through other parties, but our Pharmacy is still managing the ERx for these. 

     

    Rover – is likely far more expensive (unless you're already using it) than a simple wired or wireless handheld scanner.  We also went live with specimen barcoding recently and I'm currently exploring Rover for label printing at the bedside.  But, unsure the feasibility of that.

     

    Christi Conran, MSN, RN, NEA-BC, FACHE

    She/Her/Hers

    Director

    Specialty Services

    Professional Building

    2122 Health Drive  |  Wyoming, MI  49519
    p 616.252.7463  |  c 616.634.6441 
    christine.conran@umhwest.org


    UofMHealthWest.org

     


    University of Michigan Health-West

    The contents of this message and any attachments may be confidential and privileged. Please do not share contents without the permission of the author. If you believe this message has been received in error, please inform the sender, and then delete the message. Your receipt of this message is not intended to waive any applicable privilege.