Jerry Fahrni

Tag: Barcoding

  • Using technology to advance pharmacy practice through education

    funny_tech_cartoonI found an interesting article in the October issue of the American Journal of Health-System Pharmacy. The article, titled Informatics in clinical instruction (Am J Health Syst Pharm. 2009 Oct 1;66(19):1694, 1699), gives a description of a software system designed by the authors that “allows students at one site to receive online and teleconference instruction from preceptors at multiple sites through remote, interactive discussion. It also allows “blogging” based on assigned videotapes, simulation modules, live patient cases, discussion questions, and primary literature review. In addition, the system facilitates clinical encounter documentation, including interviewing patients, taking physical assessments (e.g., blood pressure), taking medication histories, assessing for adverse effects (e.g., abnormal involuntary movements), and addressing potential or actual medication-related problems(MRPs).”
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  • Thoughts on creating a BCMA cross reference file

    zebra_barcode2Our 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 isn’t bar coded or won’t scan, then it won’t do the nurse much good at the bedside. We’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.
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  • Cool Technology for Pharmacy

    It’s not uncommon for our pharmacy to unit-dose liquid medications from a bulk bottle; 5mL Donnatal oral syringes, 20mL SMX/TMP and 15mL chlorhexidine unit-dosed cups, etc. Pulling up oral syringes and filling unit-dose medication cups is a manual and time consuming process.
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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.

  • 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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  • A couple of articles on medication errors worth reading

    The entire June issue of the British Journal of Clinical Pharmacology (BJCP)  is dedicated to medication errors. It’s worth your time to browse all the articles, but the two below were of particular interest to me.

    Agrawal A. Medication errors: prevention using information technology systems. British Journal of Clinical Pharmacology. 2009 ;67(6):681-686.
    The article covers all the usual suspects when it comes to reducing medication errors via technology. Technologies discussed include CPOE, barcoding, BCMA, medication reconciliation, personal health records, automated dispensing cabinets and decision support systems. No great amount of detail was presented, but the article is well referenced. The entire abstract can be found here.

    Cheung K, Marcel L. Bouvy, Peter A. G. M. De Smet. Medication errors: the importance of safe dispensing. British Journal of Clinical Pharmacology. 2009 ;67(6):676-680.
    The article discusses several strategies for reducing dispensing errors, including barcoding and automated carousels. For each strategy presented, the authors provide some level of support found in the literature. The article is worth adding to your collection. The entire abstract can be found here.

    One final item worth mentioning is a brief editorial written by J K Aronson, the President of the British Pharmacological Society. In it he states “Computerized systems can contribute to prevention as well as detection, but they are expensive and can generate their own forms of error. Simpler and cheaper methods are available and should be widely implemented. For example, error reporting is important in both detection and prevention, and pharmacovigilance has a role to play. However, chief among the preventive methods is education.” – I find this statement both insightful and accurate.

  • Cool Technology for Pharmacy

    I’ve decided to do something a little bit different this week. Below is a presentation I had to give following the completion of our pharmacy remodel and the implementation of our pharmacy barcode system. More images of the implementation can be found here.

    Barcoding Solution In Pharmacy

  • Barcodes on patient wristbands.

    wristbandbarcodeBarcode.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.


  • Cool Technology for Pharmacy

    zebra-r110xi-rfid-printer-encoderRadio-frequency identification (RFID) printers.

    RFID refers to small electronic devices that consist of a small chip and an antenna. They are capable of carrying quite a bit of information. To retrieve the information an RFID device must be scanned much like a barcode. While barcodes require a “line of sight” to be recognized by the scanner RFID labels can be scanned independent of position relative to the scanner and may be read up to 20 feet (or more) away.

    RFID is an interesting alternative to barcoding for medication tracking and administration. The advantages are their ability to carry increased amounts of information and the relative ease of scanning mentioned above. It is unclear why RFID hasn’t become more main stream, but one reason could be the relative cost when compared to a traditional barcoding system. RFID would certainly make tracking inventory a little easier.

    The printer pictured here is the Zebra R110Xi RFID Printer. For more information about Zebra RFID printers, as well as other RFID products, visit IDAutomation.com.