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BAR
CODING AND YOU
Nurses
should embrace rules for medication identification
”Nursing satisfaction studies done at our hospital pre
and post-implementation show that nurses are far more satisfied with
the BCMA system than without it-similar to the University of Wisconsin
findings. These studies also show that the longer the system is in
place, the more satisfied nurses are. Given some time to get through
the process change, nursing definitely understands and appreciates
the value of the system helping them to deliver safer patient care.”
- Wendy Wittwer, RN, BSN, St. Mary’s Hospital Medical Center,
Madison, WI; from the Proceedings Bar Code Medication Administration
Conference, Roundtable Discussion Summary.
Did you know there’s a new technology supported by the Food and
Drug Administration that may change how prescription drugs are prescribed,
dispensed and administered? Did you know it could impact the daily
workflow and efficiency of nurses?
In March 2003, the FDA published a proposed rule requiring bar code
identification for medication. Industry and public comments were accepted
until mid-June. In April 2003, the ALARIS Center for Medication Safety
and Clinical Improvement hosted a second conference where nationally
recognized experts from multiple disciplines, including nursing, came
together to focus on the benefits and challenges of bar code medication
administration (BCMA). The findings and conclusions, some of which
are presented here, were submitted to the FDA.
BCMA is one of the latest “smart technologies” in healthcare
that hold great promise for improving medication safety and efficiency.
It is a tool to be used by nurses to assure the “5 Rights”
of medication administration. With BCMA, medication, the patient and
the person administering the medication are scanned, reconciled, and
each dose is documented. Safety is improved by ensuring that the Right
patient gets the Right among of the Right drug at the Right time by
the Right route.
A study by Leape et al., found that serious medication errors are
most likely to occur at the ordering and administration stages. By
combining bar coding and bedside scanning, BCMA will drastically reduce
the percentage of administration errors. In fact, some are predicting
that medication administration will become virtually error-free with
BCMA.
Recent studies are revealing. For example, Veterans Affairs hospitals
have used BCMA with their pharmacy systems for years now. A study
of 67 cases at 163 centers showed that by using the BCMA system, an
estimated 380,000 medication errors were prevented over five years.
Similarly, implementation of BCMA by the University of Wisconsin Hospital
and Clinics reduced the rate of medication administration errors 87
percent, from 13,340 errors per year to 1,822 errors per year. Nursing
satisfaction data showed a 42 percent improvement post-BCMA.
BCMA implementation is very early in the adoption stage, with 2 percent
or approximately 300 hospitals, reporting the use of this technology
nationwide. Benefits of the technology for nurses include improved
speed and accuracy of communication, improved safety and error reduction
and reduced physical effort and redundancy of work. However, BCMA
will affect nurses’ work processes, and there can be new errors
associated with using it. It is also predicted that nurses will have
a difficult time understanding how BCMA will help them in their jobs.
BCMA is an important innovation that will greatly improve medication
safety in our institutions. At the same time, its implementation will
be challenging. The help overcome some of these challenges, nurses
need to be intimately involved in the design, selection, implementation
and evaluation of BCMA as it is incorporated into patient care and
into their facilities. Appropriate representation should include staff,
managers, administrators and opinion leaders in the nursing department.
More research and development must take place before BCMA is widely
used or becomes a legislative requirement. But one thing is for sure—the
technology will evolve. The next time you hear the phrase “BCMA”
or “bar code medication,” don’t shrink back in distrust.
Instead, step forward and influence its evolution.
--Written by Julee Payne and reprinted with permission from
Vital Signs Magazine – a Florida Sun-Sentinel bi-weekly publication
dedicated to providing nurses and allied professionals with industry
and recruitment information. Payne is the editor of Vital Signs.
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THERE'S
NO PLACE LIKE HOME FOR SOME HEALTHCARE WORKERS
More and more healthcare workers are discovering the joys of working
at home. Not their own homes, but their patients’ homes.
In 2000, roughly 6 percent of all private healthcare service employees
worked in home healthcare. But that number will soon mushroom, according
to the Bureau of Labor Statistics.
Employment in home healthcare services will grow by a breathtaking
68 percent between 2000 and 2010, predicts the BLS. In contrast,
employment in hospitals, the largest and slowest-growing industry
segment, will increase a mere 10 percent.
Earlier discharge of hospital patients continually boosts the number
of Americans coming home “quicker and sicker,” according
to Kathryn Christensen, executive director of Rush Home Care Network,
the nonprofit home care agency of Rush University Medical Center.
Founded in 1975, RHCN employs more than 50 home care providers,
ranging from registered nurses to home health aides.
In addition, advances in medical technology improve the survival
rate of severely ill and injured patients who need extensive therapy
and care, and new technologies enable the treatment of conditions
not previously treatable. Finally, the growing ranks of aging baby
boomers add to the demand for home services.
Approximately 7.6 million patients receive skilled nursing or medical
care in their homes, due to acute illness, long-term health conditions,
permanent disability or terminal illness, according to the National
Association for Home Care and Hospice.
Of the more than 20,000 agencies nationwide which provide home care,
7,000 are Medicare-certified. Most state-licensed and Medicare-certified
home health agencies offer six core services, as described by the
Illinois Home Care Council:
Nursing--By far, the greatest demand is for nurses, both RNs and
LPNs. An RN provides nursing care and treatments, develops a physician-authorized
plan of care and involves patients and their families in the care
plan. The RN coordinates other services provided by the home health
agency. Increasingly, this role is one of an educator, teaching
patients and family members how to manage an illness. While Rush
Home Care Network employs only RNs, other home care agencies also
employ LPNs.
Physical Therapy--Physical therapists relieve joint and muscle pain
and help restore function through exercises, massages, baths and
heat lamps. While state-licensed physical therapists need a master’s
degree or doctorate, physical therapy assistants and aides need
less education.
Occupational Therapy--These therapists help patients return to the
routine of daily living by providing instruction in self-care (bathing
and dressing) and homemaking. They help patients learn to live more
fully with a disability and suggest ways to adapt the home environment
to make living at home easier.
Speech Therapy--Speech therapists help with speech and hearing problems,
such as those caused by stroke.
Medical Social Work--These social workers help patients and families
cope with personal, family, work, financial and other problems that
can result from an illness or disability.
Home Health Aide--Under the supervision of an RN, home health aides
help patients with their daily routine, such as taking the proper
medications at the proper time and getting in and out of bed.
Because they function on their own and confront a wide range of
medical conditions, home care workers generally enter the field
with a measure of experience.
“Home care nurses have to know something about everything,”
notes Christensen. “In a single day, a nurse could go from
a cancer patient to a wound case and then see neurological, orthopedic
and diabetic cases.
“These nurses need a certain degree of comfort with their own
knowledge and skills sets,” continues Christensen, who spent
most of her nursing career in home care after beginning as a staff
nurse with the Visiting Nurses Association. At RHCN, frequent in-service
training sessions keep nurses up-to-date on the latest treatments,
products and technologies.
This field attracts independent individuals who appreciate the flexible
work environment. Superior communication skills are critical, because
while each home care provider works solo, they must coordinate their
role via phone and e-mail with other team members. Workers must
be computer savvy to maintain and share detailed records of patient
visits, and have excellent time management since they may see as
many as seven or eight patients in one day.
Managing paperwork and numerous patient records requires strong
organization skills, especially when your car is your office, notes
Margaret Carr, a physical therapist and clinical coordinator at
Rush Home Care Network.
For more information on jobs in home care, visit the NAHC at www.nahc.org
or the Illinois Home Care Council at www.ilhomecare.org.
For specialized positions, Carr suggests checking the Web sites
of specialty groups such as the American Physical Therapy Association
and the American Speech-Language-Hearing Association.
-- Cindy Mehallow
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