Which barcode system is right for you?
When it comes to choosing the right barcode medication administration system, industry experts advise prospective customers to take a close look at what electronic medical record they select.
"You will likely go with the barcode medication administration system that your EMR has," said Paul Hess, research director at KLAS and author of a recent report titled, "Medication Cabinets, Carts, & BCMA 2014: Technology's Impact on Nurse Efficiency and Patient Safety."
"It's the EMR vendor that providers will likely go with for their barcode scanning tools," said Hess.
Of the EMR vendors represented in the report, Allscripts had the lowest percentage of customers who were using their own EMR vendor BCMA. PatientSafe Solutions is a small best-of-breed BCMA vendor that has a number of Allscripts EMR customers.
These days, Hess said that it's unusual for a hospital to choose a stand-alone barcode offering or a system that's not part of the EMR-vendor's product.
KLAS's report, released in April, surveyed 177 nurses and focused on how medication cabinets, carts and BCMA affect nursing efficiency and enhance patient safety.
"We asked the impact on patient safety barcode scanning in this report," said Hess. "There was no question it provides a whole new level of patient safety. That's not up for debate really it clearly helps patients."
Respondents were asked what impact BCMA had on nursing efficiency for the report and the overwhelming response was that it does help nursing efficiency. This is noteworthy, said Hess, because it is generally accepted that BCMA slows nurses down.
"What that suggests is that there is a difference between nursing efficiency and a nurse’s ability to just go fast," he said. "You can decide which is better, efficiency or speed?"
As the report states: "The most vulnerable step in the medication administration process is the last 50 feet."
According to the KLAS, more organizations consider purchasing a new BCMA system or expanding their existing one as their top priority.
The next-highest priority was acquiring mobile point-of-care devices that consolidate the nurse tool belt (e.g. wireless communication, BCMA, secure messaging, specimen collection, blood administration). Cerner, Epic, and PatientSafe Solutions offer devices with more than just BCMA, but to date, adoption has been minimal.
Hess said nurses were asked in the report where they feel most vulnerable in the medication administration process. They said that they feel most vulnerable when they don't use barcoding.
But barcoding is not always utilized, said Hess. For instance, it's not used it if there's an emergency and nurses have to administer medications quickly. In that case, they don’t feel that they can stop and scan like they normally would.
He said that there are also times when nurses just don’t use it because it is a different workflow than what they are used to and they haven't fully adopted it yet. In those cases they will often have what they call a "workaround" for it.
"My takeaway from that is that there is still some work that needs to be done with BCMA," said Hess. "We know that there are still some bugs where a nurse isn’t able to scan a barcode when they should and the level of adoption isn't quite where it should be."
Hess said that when shopping for a barcode features, you want a system that has 2D barcodes, the square barcodes made up of square dots, versus the 1D barcodes, that you often see in retail with the straight up-and-down black lines.
2D barcodes can have more data tied to them than 1D. With 2D, in addition to the name of the drug you can also have the drug expiration dates, drug batch numbers, etc. In some cases it can also be easier to image a 2D barcode versus scanning a 1D. If the barcode is wrapped around a small vial, for example.
Hess pointed out that there are barcode scanners vs. imagers. The scanners are typically used for 1D barcodes while the imagers actually take an image of the 2D barcode.