Jerry Fahrni » BCMA

Quick Hit – A couple of interesting bar-coding tidbits

Jerry Fahrni — Thu, 08 Jul 2010 02:57:15 +0000

There were a couple of things about bar-coding in the web-stream that caught my attention today.

The first item was a tweet from @hospitalrx mentioning an application at USA.gov for the iPhone and Android OS that can be used to identify product recalls. The application is appropriately called Recalls.gov.

Now, those recalls are right at your fingertips, thanks to the new RECALLS.GOV mobile application. Whether you’re at your child’s day care center or a yard sale, whether you’re at a store or at home, you can now type a product’s name into your phone and learn immediately whether that product has been recalled because of a safety concern. You can also see photos of recalled products and learn what to do with recalled products in your homes.

Even though the website is lacking detail, the application does offer the ability to scan the bar-code on a given item to determine its recall status, although I have not tested this functionality. Additional mobile applications from USA.gov can be found here.

And from Barcode.com: “Motorola has released a tiny new barcode scanner called the CS3000. The CS3000, shown below, is just about 3.5 inches long, 2 inches wide and less than an inch thick. It weighs only 2.45oz according the Motorola spec sheet. It is capable of scanning 1D barcodes and has a 24 hour battery life. The CS3000 has a USB connector and also Bluetooth. It’s 512MB of flash memory can hold roughly a million bar codes.“

These things are neat. You can download the spec sheet for the Motorola CS3000 scanner here (PDF).

Is the 30-minute rule for medication administration good or bad?

Jerry Fahrni — Mon, 05 Jul 2010 15:32:58 +0000

The June 17, 2010 issue of ISMP Medication Safety Alert I received has an interesting article on the unintended negative consequences of the Centers for Medicare & Medicaid Services (CMS) regulation requiring medications to be administered within 30 minutes of their scheduled dosing time. I’m sure that the CMS 30-minute rule was created with good intentions in mind, but in reality it creates a lot of anxiety and bad habits. According to the ISMP article, the CMS 30-minute rule “may be causing unintended consequences that adversely affect medication safety. While following the 30-minute rule may be important to hospitals, many nurses find it difficult to administer medications to all their assigned patients within the 30-minute timeframe. This sometimes causes nurses to drift into … unsafe work habits.” Those unsafe work habits include removing meds from automated dispensing cabinets (ADC) for multiple patients at once, removing meds ahead of time, falsifying documentation to meet the 30-minute rule and preparing doses ahead of time; all dangerous practices.

The problem is more widespread than most realize and often flies under the radar. I knew about the issues, but wasn’t prepared to deal with them until we went live with our bar-code medication administration (BCMA) system. A side effect of the BCMA system is that it tends to catch things like late and/or early medication administration. That means no more mythical med passes with all medications administered at exactly the same time.

One thing to remember here is that the problem does not reside with the nurses, per se. There are many factors involved. Nurses are frequently asked to do too much with too little time and resources, thus forcing them into undesirable situations. The system is the problem. And as much as it pains me to say, this is one problem where a technology-only solution is not the answer.

The solutions are simple, but not always obvious or practical for many health care facilities. For example, the 30-minute rule could be changed to a 60-minute rule, i.e. medications would need to be administered within 60 minutes before or after their schedule administration time. This was recently done by the American Association for Respiratory Care (AARC) in a position statement that basically said that inhaled medications shouldn’t be held to the same CMS 30-minute rule because “Inhaled medication administration incorporates a unique methodology and has a recognized delivery time between 9-20 minutes, depending on the delivery device used for administration.” The AARC statement is supported by CMS. Or perhaps the facility could stagger standardized frequencies to give nurses additional time to admister medications, i.e. not have all morning medications due at 9:00 am. It may be as simple as moving some medications like aspirin, warfarin or HMG-CoA reductase inhibitors, i.e. atorastatin and the like to the evening time. How about this one: hire more nurses. I know, easier said than done, but very practical nonetheless. It’s important to remember that this is first and foremost about safe and effective patient care.

Ultimately there isn’t a one size fits all approach to the problem and it is clear that it will be some time before we have a solution, but it is certainly something that needs to be addressed. Unfortunately this isn’t a problem that immediately available technology can fix. ADCs are not designed to be a time saver for nursing. Neither are Bar-code Point of Care (BPOC), a.k.a. BCMA, systems or Computerized Provider Order Entry (CPOE). All these technologies are designed with the idea of improving patient safety through the reduction of hospital related medication errors. We’re going to have to look somewhere else for a solution. Just a thought.

Cool Technology for Pharmacy – NDC Translator

Jerry Fahrni — Fri, 02 Jul 2010 02:58:55 +0000

Last week I posted about some bar-coding troubles we were having. One of the comments regarding the information in the post was left by a pharmacist named Max Peoples. Max offered up some great information and mentioned a piece of software called NDC Translator from RxScan.

From Max’s comment: “One answer to the medication NDC # barcode scanning problem is to use the software called NDC Translator(TM) with your barcode scanners. Information at http://www.rxscan.com/rx.shtml

It intercepts the raw data coming from the barcode scanner, evaluates it’s content and if it contains the 10 digit NDC # (required to be there by law in a medication barcode) it converts the raw data into the 11 digit NDC # format and then sends the 11 digit NDC over to the application you are scanning into, in this case Jerry’s barcode labeling software.”

I’ve read about NDC Translator before and dismissed it because I couldn’t find enough information on the company’s website. However, secondary to last week’s mishap I’ve decided to re-evaluate my position and give NDC Translator another look. The concept is simple and straight forward, but what the software does behind the scene is not. The upside is tremendous as it has the potential to prevent mix-ups like those described in my previous blog post.

And to top it off the RxScan Kit with NDC Translator Software is very inexpensive. The website lists a single-scanner annual license fee of $399, which includes updates and technical support. Nothing in healthcare is that affordable, seriously.

I would really like to see the software in action. A video demonstration would be nice, but I tried searching YouTube and came up empty.

According to the RxScan website:

RxScan Kit with NDC Translator ™ is a combination of an RxScan barcode scanner and the NDC Translator software.

The NDC TranslatorTM is a software application that sits between your scanner and your pharmacy/BPOC/BCMA system and monitors information coming in from your scanner. When you scan a barcode, it performs its magic. This allows you to scan:

NDC number bar codes. Using the patented Instant NDCTMtechnology it automatically inserts the 11-digit NDC number into your application.

Rx and transaction number bar codes on labels

The NDC TranslatorTM software eliminates data entry errors and can be supplied as

a stand-alone product, configured to work with your existing scanners

as a kit, packaged with an RxScan scanner

An almost disastrous bar-coding mishap

Jerry Fahrni — Thu, 24 Jun 2010 02:57:38 +0000

At some point in the past few days it was decided that our technicians should re-label all injectable controlled substances with one of our “after market” flag labels. I’m not sure when or how the decision was made, but it was. When questioned about it, the rationale behind the decision was that the nurses were wasting unused medication at the ADCs and not taking the vial to the bedside. And apparently the solution was to use our flag labels because they offer a peel away section that can be taken to the bedside with the drug in a syringe for scanning and administration purposes.

A little bit of information on our labeling process may be in order. To generate a bar-code label with our software we have to enter the particulars of the drug into the application database. One piece of information, perhaps the most important piece, is a unique identifier. We’ve settled on the NDC number, which is often contained in the bar-code on the manufacturers product. With me so far? Good. So to make things easy we typically scan the bar-code on the medication package, which in turn automatically populates the unique identifier field. We do this to mimic the bar-code on the manufactured item as closely as possible; works great most of the time.

Now the problem. Take a look at the image below making sure to pay particular attention to the numbers beneath the bar-codes. Notice the similarities. The first 11 digits, highlighted in yellow, are the same for the drugs on the top and the bottom. The same is true for the first 11 digits on the second and third drugs, highlighted in green. Unfortunately these are completely different drugs. The second item is a 1mL vial of midazolam 5mg/mL injection and the third item is a 2mL ampule of fentanyl 50mcg/mL injection. No problem because the last five digits of the number in the bar-code are different, right? Sort of. Our labeling system truncates the information at 11 digits. So when the pharmacist attached these drugs to our cross-reference file the BCMA system couldn’t tell the difference. Doh! The solution was simple, but only after the mistake was caught. I won’t tell you how we caught the error, just know that it was caught.

The system broke down in several places and no blame is necessary. However there are some important lessons to take away from the experience: pay close attention to what you’re doing, be careful, check the product after you label it and before it goes out, and know the limitations of your technology.

Update (6/28/10):
Some people have asked me how we handled the bar-coding issue above. The issue is actually being handled from two different directions. The solution on my end was really quite simple. For items like those mentioned in the post I remove the first five digits from the unique identifier after scanning the bar-code information into our AutoLabel system. It just takes a second and eliminates the duplicates. See, I told you it was simple.

The second piece is coming directly from Talyst. Someone at Talyst read my blog post and shot me an email regarding the issue. I gave them a little more detail and they put me in contact with a couple of their engineers responsible for the labeling system. They’re currently working on a more technical solution.

“What’d I miss?” – Week of June 13, 2010

Jerry Fahrni — Fri, 18 Jun 2010 16:24:30 +0000

As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.

- The Karate Kid was #1 at the boxoffice last weekend with The A-Team coming in a distant second. My family and I took in The Karate Kid earlier this week. It wasn’t bad. Not great, but not bad. We plan on seeing The A-Team tomorrow. I loved that show when I was younger.

- For anyone that really cares, the Lakers won the NBA finals. All I can say is thank goodness basketball season is finally over. All that means to me is that football is right around the corner. Now if I can only make MLB go away forever things would be good.

- My family and I spent a few days in Oregon recently to attend my nieces graduation from Oregon State University (OSU), home of the Beavers. Besides the constant bombardment with Halloween colors, it’s a beautiful campus. Not quite as picturesque as UGA, but definitely nice. I took the opportunity to stop by the school of pharmacy, which turned out to be a single building near the library. I miss being on a college campus. However, I don’t miss it enough to go back to school.

- Following the trip to Oregon I am thankful for the Verizon network, the GPS on my DROID and MP3 players. Without these things I may have never made it home.

- I took hundreds of photos during our trip to Oregon. I posted a few of them here if you’re interested.

- John Poikonen posted a very interesting graphical representation of pharmacy informatics at RxInformatics.com. I’ll have to get John to explain it to me because the whole thing went right over my head.

- Check out this video from iLink Systems using Microsoft Surface in conjunction with Microsoft HealthVault and Microsoft Amalga. Amazing! This is what healthcare should look like with the patient and physician interacting side by side with all information available at their fingertips in an easy to use framework.

- The Android market is heating up. Verizon has information on the new DROID X, which is very exciting. There are some great pictures and video at Engadget if you’re interested.

- Technologizer: “I see only one possibility here: HP’s Windows slate PC is dead. Doesn’t mean that there won’t be some sort of Windows-powered HP tablet someday, but this one isn’t happening.” Looks like another great tablet device will never see the light of day. I can’t believe what’s going on in the tablet market at this point in history. None of it is good.

- Engadget has created a Dell Streak hub where one can find all the information you would ever want on this slick little device. I’m really looking forward to the Streak hitting the US market. No question about it, the Streak is on my wish list.

- Here’s some science I can sink my teeth into; sorry had to do it. “Potato Chip Science turns empty chip bags, tubes, and lids—plus spuds and chips—into a whole brain grab bag of experimental fun.”

- Microsoft Office 2010 is here. I’ve been using the Office 2010 beta for a while now and have been impressed by the features, especially on the tablet.

- In addition to the Office 2010 rollout, Microsoft is now offering their office suite as part of Windows Live in conjunction with Skydrive. For those of you that don’t know what this is I highly recommend you check it out. It’s basically a stripped-down version of Microsoft Office for the desktop, but still plenty robust enough for your day-to-day needs. In addition, the Microsoft Skydrive offers 25GB of free storage in the Microsoft cloud. And all for free. I’ve heard rumors that Microsoft has plans to decrease the storage to 2GB, but I’m really hoping they don’t do that. The 25GB of storage is what separates them from the rest of the players in this area. Walt Mossberg has a quick and dirty review of the new Microsoft Office for the web, including a video that I’ve placed below.

- I’ve also been using Windows Live Sync. It’s functional, but there’s a lot of room for improvement. Live Sync has a long way to go to catch up with the likes of applications like Dropbox. Why didn’t Microsoft build its Office Live and Skydrive on top of its Live Mesh platform? That would seem to make a lot more sense. I’m just sayin’.

- NewTeeVee: “Up until now, if YouTube users wanted to combine multiple clips into a single video, they had to use offline editing tools. But YouTube today rolled out cloud-based video editing tools, giving users a whole new way to remix their existing video assets online.” – I’m a relative newcomer to the age of YouTube videos, but have been doing a little experimentation over the past several months. This is exciting news indeed.

- Barcode.com: “Interestingly enough, the first retail application for barcodes was developed for the grocery industry in the l960’s and is now present in all types of retail businesses. Although we seldom give it a second thought, the barcode has completely revolutionized retail.” - The article goes on to give some reasons to support the statement above. I’ve said it before and I’ll say it again, we’re twenty years behind the consumer industry when it comes to making good use of technology. Will we ever catch up? Who knows.

- I found this over at 9 to 5 Mac. Sad and funny all at the same time.

- I continue to be impressed with Google Buzz. The ability to go beyond 140 characters, add comments, photos, video, etc, and carry on a conversation is promising. It really is a cross between Google Wave, GMail and Twitter. I’m not sure exactly where it fits in the whole scheme of things, but I find it interesting.

- There is a an article at the For The Record website that offers an interesting perspective of healthcare technology. What’s most interesting is that the article is over a year old and is still relevant. “The [healthcare] industry has historically placed a high priority on improving patient safety and reducing preventable errors. The introduction of technology into the mix has not altered that focus, although it has added new layers of complexity.” Yep, it’s like playing Jenga. Healthcare continues to build these complex towers of technology without creating a solid foundation. And we all know how a Jenga games end.

Father’s day is Sunday. Just in case you don’t know, it’s good to be a dad. Have a great weekend everyone.

Cool Technology for Pharmacy – RxVerify

Jerry Fahrni — Fri, 18 Jun 2010 02:05:36 +0000

While reading through a pharmacy listserv I came across a seemingly simple piece of software that fills an important gap in the pharmacy distribution process. RxVerify, by Pharmacy Ideas, is a bar-code verification system used during the medication restocking phase for code boxes, anesthesia trays, transport boxes, etc.

The concept is simple and goes something like this:

1) Place labels containing the drug name and associated bar-code on the pockets of your code boxes, anesthesia trays, transport boxes, etc.

2) Pull items that need to be placed in these trays/boxes from pharmacy stock.

3) Scan the bar-code on the pocket followed by the bar-code on the medication. If the bar-codes match you get a stamp of approval and proceed to enter the lot number and expiration information found on the medication for tracking. If the bar-codes don’t match the software gives you a rude warning in the form of a visual queue that says “No Match!” in big red letters. In addition to the “No Match!” warning, a pop-up window appears that prevents the user from continuing.

Pretty simple, but effective if used properly.

In addition to the safety features offered by RxVerify, the system offers various reports for tracking and record keeping purposes. The ability to track lot number and expiration dates is a big plus. One of the reports that is of particular interest to me is the “Med Error Prevention Report”. This report identifies what I like to call “bad scans”. Basically it tracks potential errors caught by the system. Of course not all the bad scans would result in a drug error, but the information can be useful nonetheless.

You can watch a video overview of RxVerify here. The video contains information on more than one product, but the the section specific to RxVerify begins at around the 12 minutes mark and runs through about 18:45.

Simple, yet cool.

From the RxVerify website:

RxVerify© (Prevent pharmacy restocking errors with a proven and effective control measure: The medication barcode!)

RxVerify© is software which uses the medication barcode to ensure quality assurance for the restocking process. The medication barcode is a proven and effective control measure for preventing medication restocking errors. This software is commonly used by pharmacy technicians for accurately restocking the following medication storage location types:

Anesthesia/surgery Medication Trays
Code Cart Med Trays
Emergency Med Boxes
Med Transport Kits
Surgery Med Carts
Any medication storage kit/box

RxVerify© not only provides quality assurance for medication selection, but it also prevents medications which are expired or nearly expired from being used for restocking.

Bar-code musings

Jerry Fahrni — Thu, 17 Jun 2010 04:42:43 +0000

Bar-code verbiage
Last week I posted some examples of difficult bar-codes. The post was well received and generated a fair number of comments; for me anyway. One of the commenters, John Nachtrieb of Fotel, had this to say: “Jerry: Another comment–The ASHP Statement on Barcode Verification (If I’m reading it accurately) speaks about using a barcode to verify that the medication is correct, which is a different usage of the term “verify” than I think you are using. Barcode pro’s use “verify” the same way you do–making sure the symbol is “legible” to the scanner. Then there is the issue of “validation” which, in the parlance of barcode professionals, refers to making sure the barcode correctly identifies the product it’s on.”

I had no idea that there was a clear-cut difference in the usage of validation and verification. I reached out to Mark Neuenschwander of the Neuenschwander Company and co-founder of the unSUMMIT for clarification. I figured he would know what the difference was, and he did. In a nutshell validation is the quality assurance process while verification is the measuring and grading of the printed bar-code. He referred me to the GS1 website for clarification. He also indicated that the term ‘verification’ is used differently in healthcare than in manufacturing.

Confusing, no? Yes. Well, it is to me anyway. Ultimately Neuenschwander said the most important thing was to get the labeling right. I can live with that.

Microsoft Tags
I was discussing the fate of Microsoft Tags with a colleague the other day. It’s hard to imagine that these little beauties will survive in a world where other types of bar-codes are already well established. The one thing that Microsoft Tags offer over other bar-codes is color. I find my eyes drawn to them over their black and white counterparts. This is true even when the Microsoft Tag is located near the bottom edge of the page. The other thing I like about Microsoft Tags is the ability to look at usage analytics. That’s pretty cool.

For an interesting view on Microsoft Tags and healthcare check out The Medical Quack.

Individual medication bar-codes
One bar-coding problems we’re having is with multiple unit-dosed items packaged together in a single package. Examples of medications like this include levalbuterol and budesonide unit-dose inhalation. The unit-dose inhalations are not individually bar-coded. Once the package is open you’re left with several unit-dose inhalations without a bar-code, which means there’s nothing for the nurses or respiratory therapists to scan.

We’ve solved the problem by placing pre-printed bar-code labels in the Pyxis units with the unit-dose inhalations. I don’t care for this solution as it creates new opportunity for error with labels attached to the wrong unit-dose package or loose bar-code labels floating around the nursing units. Our wholesaler has some respiratory medications like albuterol and ipratropium in ready to use unit-dose packaging. Unfortunately levalbuterol and budesonide aren’t currently available this way.

Barcoding End-to-End Solutions: From Pharmacy to Bedside Webinar
Available dates and times:

June 17, 2010 12:00 pm, Central Daylight Time (Chicago, GMT-05:00)
June 17, 2010 1:00 pm, Eastern Daylight Time (New York, GMT-04:00)
June 17, 2010 11:00 am, Mountain Daylight Time (Denver, GMT-06:00)
June 17, 2010 10:00 am, Pacific Daylight Time (San Francisco, GMT-07:00)

Information on this webinar can be found here.

The slide set can be downloaded here (PDF).

OTC drug interaction analyzer for smartphones

Jerry Fahrni — Tue, 15 Jun 2010 04:16:27 +0000

Medilyzer is a smartphone application designed to provide mobile information and drug interaction checking for various over-the-counter (OTC) medications. The application is available for both the iPhone and Android smartphones, and according to the Medilyzer website a BlackBerry edition is on its way.

iPhone version

Created with consumers in mind, the iPhone application delivers information about OTC products using the barcode located on the medication package. Users simply type in the numbers on the barcode and receive a picture of the medication along with important drug facts.

By simply touching the picture of the medication, a screen will appear where users can view the medicine’s active ingredients, warning, dosage information, and comparable generic products.

To compare multiple medications users can touch “Check Interaction” located on the main screen. A green check means the OTC medications are ok to take at the same time; a red stop sign means you should not take the medications together and consult with a pharmacist.

Android OS version

The Medilyzer Android Application is very intuitive and easily navigated. To enter anOTC medication, simply touch the “Scan Medication” button. This button activates the camera and the barcode is captured using an easy point and shoot method.

When the product barcode correctly appears in the window, the phone will blink green then display the name of the scanned medication. Users can view information such as product warnings and comparable generic products.

To check OTC drug interactions simply touch “Scan Medication” once more to learn if two OTC can be taken at the same time.

I find it interesting that you can scan the bar code image on the Android version of the software, but have to manually enter the UPC code on the iPhone. I wonder if it has anything to do with the quality of the cameras on the devices or if it is an issue with actual operating system? Anyway, I loaded both my DROID and iPhone with Medilyzer and took it for a test run.

The Android version had difficulty scanning bar codes on any surface other than the flat side of a box. In other words I couldn’t get it to scan bar codes on bottles. When it did pick up the bar code image the software worked as advertised. On the iPhone everything went smoothly. The only issue I have with the iPhone version is the need to manually enter the UPC.

In theory Medilyzer is a great application and has tremendous potential for consumer safety, but I can’t recommend it for Android devices because of the extreme difficulty I had getting a clean scan off surfaces that weren’t completely smooth and flat. The iPhone version works fine if you don’t mind entering the UPC code by hand.