7/18/2016 BEDSIDE TELEMETRY MONITOR SCANNING. PROBLEM Monitor never called into central station. SETTING 23 Bed Combined ICU/PCU

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Lessons Learned Success Story BEDSIDE TELEMETRY MONITOR

ICU/PCU 15 Bed Surgical Specialty Unit PROBLEM Monitor

patient Cardiac Prefense (Vital Signs) 24 Bed Medical

(Vital Signs) Prefense (Vital Signs) 13 Bed Observation

1 Lessons Learned Success Story BEDSIDE TELEMETRY MONITOR SCANNING STEVEN MCPHERSON, BSN, RN SETTING 23 Bed Combined ICU/PCU 15 Bed Surgical Specialty Unit PROBLEM Monitor never called into central station Wrong monitor on wrong patient Cardiac Prefense (Vital Signs) 24 Bed Medical Specialty Unit Centralized Monitoring Station Prefense (Vital Signs) Prefense (Vital Signs) 13 Bed Observation Unit Cardiac added/removed without communication Failure Mode and Effects Analysis 1

IDEA Bedside verification Barcode scanning

specific monitor asset number assigned to each

2 IDEA Bedside verification Barcode scanning Inventory management ASSIGNING MONITORS Physician order generates notification Monitor scanned into electronic intervention in EMR One specific monitor asset number assigned to each patient for their entire stay ASSIGNING MONITORS ASSIGNING MONITORS 2

MONITOR BROUGHT TO BEDSIDE CAPTURING INFORMATION

Cardiac Rhythm Scanning Activity Monitor Channel/

Discontinuation Readiness Order Management Patient

3 MONITOR BROUGHT TO BEDSIDE CAPTURING INFORMATION REPORTS Functions Handoff Demographics Current Orders Cardiac Rhythm Scanning Activity Monitor Channel/ Asset # Inventory/ Handoff Reports Inventory Discontinuation Readiness Order Management Patient Logistical Data Repository Decrease Monitoring Errors Acuity/Census Trends 3

DOWNSTREAM EFFECTS Ideal Future State Reports Grant Facility Wide View of Monitored Patients Promote Charge Nurse Auditing and Conversations with Primary Nurses Discontinued

Charge Nurse and Leadership Auditing for Decreased Monitored Days Reducing Cost and Promoting Patient Safety (Benjamin, Klugman, Luckmann, Fairchild, & Abookire, 2013) Breakdowns

4 DOWNSTREAM EFFECTS Ideal Future State Reports Grant Facility Wide View of Monitored Patients Promote Charge Nurse Auditing and Conversations with Primary Nurses Discontinued Faster/Patients Downgraded More Timely Decrease Divert Hours and ED Holds Reduce Staff Time and Efforts 100% Scanning At Control Center 100% Immediate and Routine Bedside Scanning Charge Nurse and Leadership Auditing for Decreased Monitored Days Reducing Cost and Promoting Patient Safety (Benjamin, Klugman, Luckmann, Fairchild, & Abookire, 2013) Breakdowns In Process Patient Safety Documentation Accuracy and Scanning Versus Manual Entry Staff Responsibilities Documentation Lack of Auditing More Strict Documentation Parameters Workarounds 4

WORKAROUNDS SCANNING COMPLIANCE A mixed method study performed at a 470 bed Midwestern academic tertiary

These workarounds related directly to ones formed around telemetry monitor scanning (Koppel, Wetterneck,

Steps Original Captured Query Scanner as an Input Device Entered Query Requested Value Apparent to End

5 WORKAROUNDS SCANNING COMPLIANCE A mixed method study performed at a 470 bed Midwestern academic tertiary hospital identified 15 workaround types performed by nurses during barcode medication administration. These workarounds related directly to ones formed around telemetry monitor scanning (Koppel, Wetterneck, Telles, & Karsh, 2008) Steps Performed Out of Sequence Unauthorized Process Steps Omission of Process Steps Original Captured Query Scanner as an Input Device Entered Query Requested Value Apparent to End User Verified Scanned Bedside Not Necessary to Complete Required Fields GETTING CREATIVE BACKED INTO A CORNER 5

BARRIERS TO EFFECTIVE PROCESSES Primary Nurses Not Scanning Initially and Every Shift HOW IS THIS FIXED?

Engagement in the Process and it s Effect on the Patient False Sense of Security Decreased Patient Safety related to Non Case Studies Formal New Hire

that the process increases patient safety A descriptive study performed in 2013 at a facility implementing barcode medication administration, gauged nursing

6 BARRIERS TO EFFECTIVE PROCESSES Primary Nurses Not Scanning Initially and Every Shift HOW IS THIS FIXED? Real Time Auditing and Rounding Posted Ideal Workflows Charge Nurses Not Rounding to Audit Monitor Technicians Not Following Proper Procedure Low Staff Engagement in the Process and it s Effect on the Patient False Sense of Security Decreased Patient Safety related to Non Case Studies Formal New Hire Training PERCEPTION Positive Outcomes related to safety, reduced costs, and patient satisfaction Lessons Learned Success Story with process steps Belief that the process increases patient safety A descriptive study performed in 2013 at a facility implementing barcode medication administration, gauged nursing satisfaction before and after the technology implementation. The nurses studied agreed that the extra time was well spent to ensure patient safety and medication verification (Voshall, Piscotty, Lawrence, & Targosz, 2013). 6

7 REFERENCES Benjamin, E. M., Klugman, R. A., Luckmann, R., Fairchild, D. G., Abookire, S. A. (2013). Impact of cardiac telemetry on patient care and cost. American Journal of Managed Care. 19(6):e225 32, 2013 Jun. Retrieved from b/ovidweb.cgi?&S =OPAGFPMPHBDDPGHPNCJKADLBOECIAA00 &Complete+Reference=S.sh.21%7c6%7c1 Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association. 14(4), Voshall, B., Piscotty, R., Lawrence, J., & Targosz, M. (2013). Barcode medication administration work arounds. The Journal of Nursing Administration. 43(10),

BAR CODE MEDICATION ADMINISTRATION: A STRATEGIC TECHNOLOGY INTERVENTION FOR REDUCING HOSPITAL S MEDICATION ERRORS

Vol. VII No. 2 2016 ISSN : 2087-2879 BAR CODE MEDICATION ADMINISTRATION: A STRATEGIC TECHNOLOGY INTERVENTION FOR REDUCING HOSPITAL S MEDICATION ERRORS Faculty of Nursing, Syiah Kuala University E-mail: