Our facility is gearing up to implement bar code medication administration (BCMA) in February 2010. Part of getting ready is making sure that all the medications dispensed from the pharmacy are bar code ready. If the medication isnâ€™t bar coded or wonâ€™t scan, then it wonâ€™t do the nurse much good at the bedside. Weâ€™re in pretty good shape secondary to our carousel install in February of 2008. Everything that gets stored in the carousel is already bar coded. I had hoped that the file stored in our AutoPharm, i.e. carousel, cross reference file could simply be dropped into our Siemens Pharmacy cross reference file, but that would have been too easy. Siemens refused to play nicely with the data.
Anyway, Iâ€™ve spent the better part of the last two weeks walking the shelves and adding all our medication bar codes to the pharmacy system. Some things Iâ€™ve noticed include:
– Manufacturerâ€™s bar coding practices are not consistent. Some use linear bar codes, while others use 2D or stacked bar codes. We need a standard.
– Linear bar codes appear to be tied to the NDC number, while 2D and stacked bar codes appear to contain â€œextraâ€ information.
– Donâ€™t scan the packaging or overwrapping for a medication. Scan the product directly if at all possible.
– IV bags, i.e. piggybacks, large volume parenterals, etc, that use white printing for their bar codes are difficult to scan. I have a request for the manufacturers that do this; stop it. I look like Iâ€™m performing a voodoo ritual every time I try to scan one of these bags. I guarantee you the nurses wonâ€™t like it.
– Every item Iâ€™ve added to the cross reference file will have to be verified by someone else. The â€œhuman factorâ€™ guarantees that something will be attached to the wrong drug. It happened with the carousel install, and it will happen with BCMA.
– Speaking of the human factor, I found some mistakes in the pharmacy formulary while walking the shelves to create the cross reference file. Maybe we should check every item on the shelf at some predetermined interval, i.e. quarterly, yearly.
– This process is very time consuming. It would be nice to see wholesalers catalog the product bar codes as they come in and supply them in a downloadable format to the customer.
– Completely unrelated, but sevoflurane now comes in a plastic bottle. Iâ€™m not sure when it changed, but I remember when it came in a glass bottle. I always wondered what would happen if we dropped one and broke it in the pharmacy. I did drop and break a bottle of albumin once. It was like trying to clean up egg whites.