I agree that the best place for medication prep, etc is at the bedside. That is our desire. We do know that it a lot of it is occurring at the doorway instead. A lot due to discomfort of doing the process in front of the patient. We do have the opening of the med packages happening on the "WOW" right outside of the room. Didn't take long for the nurses to realize that they needed to scan the medication before opening. Our biggest problem we had was the scanning of the patient's barcode using the facesheet on the chart. Once we found that out, we did identify that we no longer needed that barcode and removed it as well as educating why it shouldn't be done that way. The reason we got for using that barcode was to not disturb the patient when sleeping or it was an isolation room. The really disturbing thing was that it was a supervisor that was telling staff to use that barcode.
We are going to be changing to a different vendor along with all the other sites in our system. One of the decisions we had to make was whether we would scan the patient first or scan the medication first. We did discuss this at length and came to the decision that we would scan the patient first because of the safety issue even though it would impact the current workflow for the nurses at the majority of the sites involved in this project. Sharon, you make a good point about what steps nurses will go to in order to work around the system. Especially if they don't understand the importance of why it needs to be done this way. The original question was: do you require a co-signature for your high alert medications and if so, what medications? If you are electronic, do you use a PIN or just User ID? I would be very interested in hearing from others as to what they currently do. The discussions that we have had around this seems to indicate that there are a variety of ways this issue is being handled. -----Original Message----- From: Sharon LaDuke [mailto:[EMAIL PROTECTED] Sent: Friday, May 11, 2007 9:26 AM To: Davis Daniel - Southern Hills; Witt, Sharon L.; [EMAIL PROTECTED]; [email protected] Subject: RE: [MEDITECH-L] Med documentation of High Alert Meds... Daniel's comments about bedside medication prep and verification resonate with me. I worked at a facility that had had eMAR/BMV for 3 years. Nurses did things like open all the meds and remove them from their packaging somewhere other than the patient bedside, and scan patient labels instead of the wristband. They were completely circumventing the purpose of BMV. They did it because they perceived that it saved time, and most of them really had not thought through the threat, not only to patients, but to their own licenses. The facility recently put a big emphasis on retraining the nursing staff to use the system properly. With all nursing directors, Pharmacists and even Administrators involved, and weekly medication safety meetings to discuss scan rates and plan followup with noncompliant nurses, things turned around in a hurry. I believe the cycle of nurses training new nurses to do things incorrectly has been broken at that hospital. Sharon -----Original Message----- From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of Davis Daniel - Southern Hills Sent: Thursday, May 03, 2007 1:04 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] www.RPhInformatics.com <http://www.RPhInformatics.com> <http://www.RPhInformatics.com> =*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*= To subscribe or unsubscribe to the meditech-l, visit MTUsers.NET. To check the status of the meditech-l, visit MTUsers.NET. For help, email [EMAIL PROTECTED] Visit the MTUsers WikiPedia at MTUsers.NET/mwiki ______________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l
