Socket announces latest Bluetooth barcode scanner

chs7xscannermobihealthnews: “Socket Mobile announced this week the availability of its latest Socket Bluetooth Cordless Hand Scanner (CHS) Series 7, a barcode scanner with medical applications which has been Apple-certified as a “Made for iPad, iPhone, iPod” accessory.

“This is the best performing barcode scanner for developers who are creating applications incorporating barcode scanning for the Apple iOS,” stated Samantha Chu, data collection product manager at Socket Mobile, in a press release. “There are numerous applications that stand to benefit from barcode scanning in a range of vertical markets, and we believe the CHS 7Xi provides the Apple developer community with a level of control and data integrity that didn’t exist previously.”

I’ve mentioned the CHS Series 7 scanners before. They really are neat little devices; small, quick and accurate.

Another scanner worth mentioning in this category is the Koamtac KDC200. I’ve used the KDC200 and it’s a pretty slick scanner as well.

The weakest link in building a safer medication use model

I’ve just spent four days at the ASHP Summer Meeting in Denver, CO. The meeting offered a nice variety of topics, but seemed to focus on medication safety and informatics more this year than in the past. In fact, this is the first year that ASHP has offered a medication safety tract at one of their meetings.

I avoided the more traditional sessions on therapeutics, choosing instead to focus on the informatics and medication safety sessions. Based on the information presented it was obvious to me that these two disciplines are intimately linked. After all, the idea behind much of the technology we use in healthcare today is to improve patient safety.
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Smart Pump integration with EHR and auto-programming [Video]

The integration of smart pumps with an EHRs, and the use of auto-programming isn’t common place in healthcare, but it should be. I’ve only come across a couple of facilities that have done it “successfully”. In addition I’ve heard a couple of presentations on the subject matter; one at ASHP a couple of years ago and one at the unSUMMIT last year.

The video below talks about the integration of smart pumps with Cerner at WellSpan Health in New Jersey. Interesting stuff.

Data visualization and dashboards

A wise colleague of mine once told me that lots of people collect data, but few people know what to do with it. I didn’t understand what he was talking about at the time, but I’ve come to have a better understanding over the years. It basically boils down to the difficulty that many of us experience when it comes to the best way to handle information. Our brains do some amazing things, but fail to “see” things when the perspective is all wrong.

Data surrounds us. It’s in everything we do, from the bank statements we receive in our personal life to the mountains of data collected by every healthcare institution. Regardless of the data collected, there are basically three things that can be done with it. Data can be ignored, it can be archived or it can be used. Unfortunately only one of those three things is truly useful; using it. Many people chose to ignore or archive data not because the information isn’t valuable, but because they are overwhelmed with the amount of information they receive and the way that the information is presented.
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unSUMMIT 2011 Presentation (#unSUM11)

I uploaded the presentation I gave Thursday at the unSUMMIT in Louisville, Kentucky. You can see it below, although some of the slides came out a little rough when I uploaded it to slideshare. It looks like it may have something to do with the font I used. If I find time I’ll correct it later.

The presentation focused on the often overlooked things that need to be done following implementation of something like BCMA. Healthcare systems have a bad habit of not providing enough resources, both labor and monetary, to maintain and optimize technology once implemented. I simply suggested five things that healthcare systems could do post-implementation to make sure their BCMA implementation didn’t crumble right before their eyes.

And now that the unSUMMIT presentation has been delivered I am officially retiring from the role of presenter. Unlike some people I know, it takes me a concerted effort and a fair amount of time to put one of these things together, and I just don’t feel like doing it again. Enjoy.

Preparing for the unSUMMIT (#unSUM11)

I’m sitting in a hotel bar in Louisville, Kentucky having a salad as I prepare to register for the unSUMMIT. This is the second year in a row I’ve made the trek to the unSUMMIT. I felt that the experience I had last year was definitely worth a second look.

From the unSUMMIT website:

Conventional summits deliver a something-for-everyone survey of the landscape with little or no depth on any given topic. This warp-speed flight provides only a 30,000-foot view of the terrain below. Nurses, pharmacists, and IT professionals return to the trenches of their own hospitals no better equipped to dig in and implement change.

The unSUMMIT is different. It delivers a steadfast focus on barcode point-of-care technology. Attendees are outfitted with practical tools, insight, and inspiration for leading their institutions to carefully select, implement, and harness the quality-improvement power of BPOC systems.

Truly an unconventional convention, The unSUMMIT is designed to get you out of the clouds and into the weeds, where the union of technology and practice can be more easily realized through the shared expertise of your experienced colleagues.

I think most people believe that the unSUMMIT is nothing more than a bunch of people sitting around talking about BCMA, but it actually goes beyond that. Last year I heard presentations on not only bar-coding medications, but integrations of smartpumps into eMARs, the use of RFID tags, how to conduct observational studies and so on.

This year looks to provide a similarly broad scope of information. While reviewing the list of presentations I saw topics on mobile technology, accountability, technology roadmapping, workflow design and of course a lot of stuff on bar-coding medications.

The unSUMMIT begins officially tomorrow morning. I will be presenting on Thursday, April 28 at 2:00pm. I haven’t decided if I’m going to post the presentation here or not. I’ll let you know.

If you’d like to know what’s going on during the conference you can follow the Twitter stream at #unSUM11.


Cool Pharmacy Technology – Codonics SLS Safe Label System

Labeling syringes has always been difficult for anesthesiologists in the OR. It must be because they never seem to get it right. If you don’t believe me, just look at the image below. These drugs were found during routine inspection of an OR suite. Well that’s all changed now with the Codonics SLS Safe Label System.
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How not to design an application for pharmacy

I’ve used Pyxis PARx before, but only in combination with a carousel storage system. I recently had the opportunity to play with the standalone version of PARx and all I have to say is yikes!

The system utilizes an older version of Windows Mobile on a clunky Motorola handheld. To get from log-in to a useful place in the application required me to go through no less than four screens. The touch screen was unresponsive and difficult to use, the device was painfully slow and the connectivity was lacking.

So, to sum up my experience with PARx – used with carousel technology it’s great, but try to use the standalone product and you might find yourself spewing profanity.


FMEA and BCMA, two acronyms that work well together

During my time as an IT pharmacist I was fortunate enough to be part of two Failure Modes and Effects Analysis (FMEA) groups; one for CPOE and another for BCMA. The FMEA process is labor intensive and time consuming, but well worth the effort in my opinion. In both the CPOE and BCMA instances several important pieces of information were discovered that may have otherwise gone unnoticed.

I don’t often see articles that talk about using FMEAs, which is a real shame secondary to their value. So it was a pleasant surprise to see a recent article in Pharmacy Purchasing & Products on the use of an FMEA post BCMA implementation. I’m not familiar with using an FMEA after the fact, but it makes more sense to me now after reading the article.

According to the author, they “had conducted an FMEA prior to initially employing BCMA; however, we never performed any post implementation follow-up on the system.” An all too common occurrence in healthcare, i.e. implement and forget. We did something similar at Kaweah Delta when I worked there, but we referred to the process as a gap analysis rather than calling it an FMEA. Regardless of the verbiage, the results were similar.

The reason cited for the second FMEA was an increase in errors associated with the BCMA system. “Errors were primarily due to unscannable bar codes, mislabeled medications, the wrong medications being dispensed, and most commonly, nursing staff’s failure to scan.” This sounds familiar. The errors cited are simply side effects of the implement-and-forget mentality. Regardless of the system in place, humans inevitably develop bad habits and workarounds. We need to be constantly reminded to do the right thing. Implementation is only a small part of the work involved with any new system. Follow-up, maintenance and optimization is when the real work begins.

And the results of the second FMEA? “Three months after completing the FMEA, the team compared the before and after scan rates. We found significant improvements in the scanning of both the patients and the medications throughout the system. In addition, we have witnessed a culture change: nurses now become anxious if they cannot scan a product.” Not bad.

Read the article, it contains some good information.

BCMA Technology: Characterization of Med Triggers and Workarounds (Article)

There’s an interesting article in the February 2011 issue of The Annals of Pharmacotherapy dealing with BCMA and what the author describes as “clinical workarounds”.1


BACKGROUND: Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors.
OBJECTIVE: To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR).
METHODS: Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted.
RESULTS: Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time.
CONCLUSIONS: BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology.

The study described in the article utilized a combination of retrospective analysis and direct observation to identify alert triggers generated by a BCMA system. In addition the study looked at various workarounds utilized by nursing as well as pharmacy. The article is a much more limited version of the one by Koppel in 2008.2

The Annals article identifies some disturbing trends at the Medical University of South Carolina (MUSC) where the study took place. Examples include failure to document override reasons for 77% of alert messages and 468 directly observed workarounds during 121 administration attempts over a 6 hours period. Those number are a sure sign of a poorly designed system and lack of institutional oversight. It certainly has nothing to do with BCMA and the overall effectiveness of the technology. Sounds like some disciplinary action is in order.

One other thing I found unusual in the article was the classification of pharmacy workarounds. “Specific pharmacy workarounds included duplicate orders, lack of medication order verification, medications within the incorrect section of the eMAR (prn vs standard administration time), and incorrectly timed medications causing administration too late/early for the nursing staff.” I’m not sure how you see this, but a duplicate order isn’t a workaround, it’s an order entry error. Same goes for entering an order as PRN instead of SCH. Not sure what the author had in mind when he made the decision to classify these as workarounds. Weird.

  1. Daniel F Miller, Christopher R Fortier, and Kelli L Garrison Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds Articles Ahead of Print published on 1 February 2011, DOI 10.1345/aph.1P262. Ann Pharmacother ;45:162-168.
  2. Koppel R, Wetterneck T, Telles JL, et al. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008;15:408-23.