One of the questions marks surrounding BCMA, known as MAK in Siemens language, is how to label pediatric oral syringes. Unlike most adult unit-dosed medications, pediatric dosages come in a variety of sizes. Where an adult patient may receive 25mg of captopril, a pediatric patient may receive a range of doses based on weight (0.15-0.3 mg/kg/dose for infants). The captopril tablet used by adults is barcode ready from the manufacturer. The pediatric dose, on the other hand, is not. For pediatric patients we compound a 0.75mg/mL oral suspension and pull the doses into oral syringes based on the provider’s order. Captopril is only one example as we do the same for hydralazine, spironolactone, propranolol, sildenafil, etc.
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Category: Barcoding
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Pediatric labels for bar code medication administration (BCMA)
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Is bar code scanning really safer for pharmacy?
This is a great questions and one that I previously would have said is a no-brainer. I believe a bar coding system for medication dispensing from the pharmacy is an improvement in patient safety, but I would be hard pressed to prove it. A colleague of mine (John Poikonen at RxInformatics.com) is fond of saying that there is no evidence to support the use of bar coding. Here’s a quote from John: “The pharmacy profession is drunk with the notion that BCMA works for patient safety, in the face of little to no evidence.“ He has a point.
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A little assistance for choosing the right barcode reader
barcode.com: “With all of the data capture solutions on the market today, choosing a barcode scanner may seem overwhelming. However, after analyzing all of your needs, making the right choice should come easily. It’s important to analyze both the requirements of your business and what your budget allows. First and foremost, ask yourself, “what barcode symbology will I need to be scanning?†While laser scanners are a cost-effective option, they aren’t able to scan 2D barcodes (aside from the PDF-417, a 2D-like symbology), which digital imagers can. With the use of 2D barcodes on the rise, it may be wise to invest in a digital imager so that it will better accommodate future progressions in technology. On the other hand, digital imagers can decode 2D barcodes, which can be encoded with a significantly greater amount of information than their 1D counterparts. In addition, imagers allow for omni-direction barcode reading, eliminating the need to accommodate the scanning device. Area imagers can even read Direct Part Marking (DPM), a method of permanently marking a product, allowing the product to be tracked throughout its life.†– Our facility uses a combination of barcode scanners in the pharmacy, and I can honestly say choosing the right one can make all the difference. I have personal experience with a few barcode scanners from Code Corporation and Honeywell (previously Handheld). In my opinion the Honeywell products are better. They are easy to use and very forgiving when it comes to scanning medication barcodes. The Code scanners require a little manipulation and better aim, which can be frustrating when you’re in a hurry.
For more information on barcode readers, try barcode.com, barcoding.com or idautomation.com.
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Integration and standardization are still stumbling blocks in healthcare
I spent a good chunk of my morning in meetings and workgroups for the implementation of our barcode medication administration system (BCMA). Most of these sessions are dominated by nursing as many consider BCMA a nursing system.
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A failure modes and effects analysis on bar code medication administration
Over the past several months I’ve been involved with a committee tasked with performing a failure modes and effects analysis (FMEA) on our bedside scanning initiative. An FMEA is a procedure for analyzing potential failure modes within a system and classifying those potential failures by frequency and severity. The failure modes can be actual or potential. It’s a way to plan for holes in the system before they actually develop, and can be quite useful in creating possible solutions for future problems. Being proactive is always easier than being reactive, I think.
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New barcode technology coming out of MIT
Engadget: “Since barcodes are the sign of the devil (must be true, we read it on the interwebs) it’s no surprise thateveryone wants to replace ’em. QR codes have been quite popular, allowing people and companies to tag their stuff with colorful decals filled with bits and bytes, and of course RFID tags are still going strong, but a team of researchers at MIT has come up with something better: Bokode. It’s effectively a tiny little retroreflective holograph that is just 3mm wide but, when a camera focused to infinity sweeps across it, the Bokodes become clear and appear much larger, captured in the video below. In this way they can contain “thousands of bits” of data and, interestingly, show positional information too, meaning the camera knows where in 3D space it is in relation to the tag. This, of course, has hundreds of potential applications ranging from grocery shopping to augmented reality, and should lead to new and exciting ways for scholars to interpret/misinterpret Revelations.” – I first saw this information yesterday in a link to a BBC News article that was floating around Twitter. I can see use for such barcode technology in pharmacy. In the BBC article, Dr. Mohan (one of the MIT researchers) makes a comment that while standing in front of thousands of books “You could take a picture and you’d immediately know where the book you’re looking for is.” Now, replace the word ‘book(s)’ with ‘drug(s)’ and you will understand my interest. More information can be found here.
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RFID vs. barcode
Barcode.com: “RFID, or radio frequency technology, uses a tag applied to a product in order to identify and track it via radio waves. The 2 parts that make up the tag are an integrated circuit and an antenna. While the circuit processes and stores information, the antenna transmits signals to the RFID reader, also called an interrogator, in order to interpret the data in the tag. In contrast, a barcode is an optical representation of data that can be scanned and then interpreted. The data is represented by the width and spacing of parallel lines, and are often used in POS applications, in addition to tracking objects throughout the supply chain.” – The article goes on to give the advantages of both technologies. The more I read about RFID technology, the more interested I become. While the technology hasn’t really caught fire in health care, I think the utility of RFID demands further investigation.
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Barcodes on patient wristbands.
Barcode.com: “Often times, information that Hospital administrators would like to include in the barcode is far too much in relation to the wristband space. While 1-D barcodes cannot always fit all of the information, they can be scanned by all types of barcode readers, unlike 2-D barcodes which can fit more information, but require a 2-D capable scanner. In addition, when the end of the barcode curve around patients wrists, it is difficult to scan, thus, it is necessary to choose a barcode symbology that will fit on the flat part of the wristband, but also hold all of the necessary information. Rather that choosing a UPC code, which is commonly used in retail applications, it would be wise to choose a dense barcode symbology, such as Code 128, which can hold a lot of information in a small amount of space.“ - Wristbands are a popular item for discussion in any barcode medication administration (BCMA) project. They’re just not user friendly. Even though 2-D barcodes require an upgraded scanner, I prefer them because of their small footprint. Their size allows multiple copies of the same barcode to be placed on the wristband in several strategic locations for easy access. The difficulty associated with scanning a patient wristband is one more reason why RFID may be worth a second look.
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Barcode scanning technology continues to improve patient safety.
Am J Health Syst Pharm (2009;66 1110-1115): “A total of 1465 medication administrations were observed (775 preimplementation and 690 postimplementation) for 92 patients (45 preimplementation and 47 postimplementation). The medication error rate was reduced by 56% after the implementation of BCMA (19.7% versus 8.7% , p < 0.001). This benefit was related to a reduction associated with errors of wrong administration time. Wrong administration time errors decreased from 18.8% during preimplementation to 7.5% postimplementation (p < 0.001). There were no significant differences in other error types. Conclusion. The implementation of BCMA significantly reduced the number of wrong administration time errors in an adult medical ICU.” – I’ve touched on this before. In a pre-barcode era mistakes at the bedside weren’t caught and patients suffered the consequences. Barcoded medication administration has tremendous potential. I am hopeful that hospitals will continue to develop its potential in this age of technology, and in doing so drive medication administration errors to zero.
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Barcodes ‘help face recognition’
BBC News: “Faces are made up of “barcodes” which help us recognise each other, according to scientists. The researchers at Stirling University and UCL manipulated the faces of celebrities such as Marlon Brando and George Clooney for their study. Their results suggested that most of the information needed to identify someone could be found in the lines formed by the eyebrows, eyes and lips. They hope their research will help improve face recognition software.” – Just when I thought I had heard about every use for a barcode someone goes and barcodes my face.Â