We are currently using BMV. While it doesn't "require" you to be at the bedside, we train our staff that this is where they need to be. First, if they have scanned the wrong med they will catch it quicker. Second, removing the med from the package can make the bar code unreadable. Third, if you have scanned the wrong med and you scan all the meds and patient prior to removing them from the package the facility doesn't have to bear the expense. Fourth, if the "wrong" med is a look alike med your staff may be unable to easily determine which pill should be removed from the cup.
We get our meds from an accudose machine and if they have a med that must be cosigned they call a nurse on the way to the room. Then they scan that med first so it asks for the cosign. The second nurse does not have to stay there through the administration. And, if you don't document it you didn't do it. So, if you are taken into court over an over dose or a wrong med issue will it fly for you to say I had another nurse who I can't recall the name of verify it was right? Even if you did remember who it was, would they remember? Even if they did, would they always come forward and agree they were involved in this negative situation? High Risk meds are verified by a second licensed person for a reason. If it is important enough to be done it should be documented. High risk meds should not be treated differently in the process from the other meds for the same reasons I noted in my initial paragraph. I'll get off my soap box now! :-) Daniel Davis ________________________________ From: Witt, Sharon L. [mailto:[EMAIL PROTECTED] Sent: Friday, May 04, 2007 9:48 AM To: Davis Daniel - Southern Hills; [EMAIL PROTECTED]; [email protected] Subject: RE: [MEDITECH-L] Med documentation of High Alert Meds... Daniel, Thanks for you comments. I do agree that we would like them at the bedside and we did instruct them in that light. But we realize that it isn't happening that way. BMV doesn't required that you be at the bedside for Med preparation since you scan the medication first. For our Med/Surg unit, because of our nurses getting their scheduled meds at the patients door, we at least have them by the patient's room. We don't have the same issue that a lot of sites would have where there nurses goes to pyxis and gets several patients meds at the same time. In the discussion we have been having on this with several sites, we realize that while almost all of do the verification of dose with another nurse, not all sites document that verification. We are also looking at it from a verification of dose verus witnessing the administration. Requiring the 2nd nurse at the bedside to put in their pin add the witnessing of the administration which doesn't seem to be the common practice. Since you were kind enough to respond, I would appreciate if you could share with us what your site does in regard to verification of HA meds and documentation of the same process. Regardless if you are currently doing BMV or not. Also, at what point to do seek out that second nurse to go into the room with you so they can cosign? When you initially go into the room? What about when you are giving multiple medications, one of which would require the co-signing? Do you keep the 2nd nurse in the room the whole time or would you scan just that med, scan the patient, and then get the co-signature? That would require that you then scan the rest of your meds, and scan the wristband again. Kevin, To answer your initial question a little more fully, we are verifying Insulin, Anticoagulants, Cordarone, Integrilin, Narcotic epidurals, Natrecor, Thrombolytics. We are also verifying pediatric medications but don't document the verification since you can't have the screen appear for a drug only if the patient is a pediatric patient. Only meds that are co-signed are if given by a student. The co-sign consists of user ID. We opted to not use PIN or password since it meant setting up all the nurses with E-signing. Sharon ________________________________ From: Davis Daniel - Southern Hills [mailto:[EMAIL PROTECTED] Sent: Thursday, May 03, 2007 2:04 PM To: Witt, Sharon L.; [EMAIL PROTECTED]; [email protected] Subject: RE: [MEDITECH-L] Med documentation of High Alert Meds... I believe you can limit the number of high risk meds that you require the signature on and make this work. I don't believe it is best to design the process to allow/encourage poor behavior. If you are using BMV then you should be preparing the meds at the bedside. So, if that is happening how can an RN/LPN verify that med except at the bedside. The whole purpose of BMV and eMAR is patient safety. If you circumvent that what do you have? Daniel Davis ________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of Witt, Sharon L. Sent: Tuesday, May 01, 2007 5:14 PM To: [EMAIL PROTECTED]; [email protected] Subject: RE: [MEDITECH-L] Med documentation of High Alert Meds... Please post. We are currently using Emar and just document that it was verified by an RN/LPN - Y/N. We changed this when going to BMV because of the difficultly of needing someone at the bedside otherwise. I am currently involved in another project looking at this very topic and it would be great to know what others are doing. Sharon ________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Monday, April 30, 2007 6:24 PM To: [email protected] Subject: [MEDITECH-L] Med documentation of High Alert Meds... Either on paper or electronically, do you require a "co-sign" on High Alert Meds? If so: 1. Briefly, which meds are considered HA at your site 2. If electronically, do you require a PIN or just the User ID If not, does your site have nursing use a non-documented visual verification of any meds (insulin, peds doses, etc.)? Thanks to all - Kevin. Kevin McConnell, PharmD. Clinical Consultant (713)480-6810 [EMAIL PROTECTED] <http://www.RPhInformatics.com> <http://www.RPhInformatics.com>
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