Lieve Nijs,RN

University Hospitals Leuven, Belgium

Bedside scanning

Bedside Scanning a story

Not about barcodes …

… but patient safety

1. Introduction

• Medication errors are the main cause of

adverse events, they are repetitive and are a

continual risk for patients.

Marini (2009); Payne (2002); Brady (2009); Helmons (2009)…

1. Introduction

• The medication process in a hospital is

complex, which involves various people and

disciplines.

• Administering medication in a safe way,

without errors, is a challenge.

• The more complex medication therapy

needs our attention

Brady (2009); Folkmann (2010); Richardson (2012)…

1. Introduction

a. Medication errors

34%

6%4%

56% Prescription

Administration

Copy

Distribution

Based on Bates W, et al. Incidence of adverse drug events and potential adverse drug events,

implications for prevention. JAMA 1995;274(1):29-34

34% 62%

4%

CPOELarge impact of medication errors was

a determining factor to prioritize the

implementation of CPOE and BSS

1. Introduction

b. Types of medication errors– Prescription:

• Wrong patient, dosage, type, way of administring, time

• Unreadable

• Incomplete (posology, type, signature)

– Drug:• contraindication, allergy

• interaction, incompatibility

– Communication:• Oral orders

• No/too little information

In real Life….you’re not a number !

2. Reduce medication errors

a. Implementation of C.P.O.E

– Safe and readable prescription

– Monitor several interactions

(DD/DA/DP/DF/DD/DD)

From prescribing to C.P.O.E.

Visible for “everyone”…

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2. Reduce medication errors

b. Implementation of bedside scanning

– Registration of administration via bedside

scanning

– Final check on the “5 R’s”

The final check

bedside scanning

• Requirements

– Fully deployed CPOE

– Hardware and software

– Barcode on every single dose

Single Dose versus Unit Dose versus Nominative dose

BSS in practice …

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Dispensing

and ordering

Reconstitution

Administration

3. Advantages of CPOE and BSS

• A readable prescription

• Less reported medication errors

• Follow-up from a distance

• Paperless: billing, logistic process…

• Better packaging…

• Follow-up compliance possible!

4. Compliance BSS

• The introduction of BSS allows to map the

whole medication flow, to investigate the use

of BSS and to improve patient safety.

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4. Compliance BSS

– 4,973 prescriptions

– 25,487 medication orders

– 318,572 medication administrations

Lemaitre (2014)

4. Compliance BSS

(† p=0,11 ; ‡ p<0,000); ±

p=0,008)

Interactie type n (%) Alert Accept n (%)

Drug-Drug

Very serious interaction

Serious Interaction

4710 (94,71)

353 (7,50)

4357 (92,50)

2896 (61,49) †

61 (17,28) ‡

2835 (65,07) ‡

Drug-Allergy

Very serious interaction

Serious Interaction

239 (4,81)

49 (20,50)

190 (79,50)

142 (51,41) †

21 (42,86)±

121 (63,68)±

Drug-Pregnancy 24 (0,48) 10 (41,67) †

Total 4973 3048 (61,29)

4. Compliance BSS

• Scan rates

99.33% 99.84%98.75%

90.00%

91.00%

92.00%

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

100.00%

4. Compliance BSS

• Percentage deviations of the prescription

1.05%

1.35%

0.36%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

5. Results of prescription and administering

via bedside scaning

• Right drug

• Right patient

• Right dose

• Right route

• Right time (of administration)

+ • Prevention of interactions (drug-drug, drug-patient, drug-

food, drug-pregnancy)

• Prevention of identical prescriptions (drug duplication)

Real life : a case

A 45 year old patient was hospitalised for 5 days on intensive

care for a Vancomycineintoxication.

When the patient was stabilized, he came back to the

hospitalisation ward.

The physician made a prescription for the C.P.O.E. for

Vancomycine 1000 mg, dosage : 0 mg.

At that moment BSS was NOT implemented.

The nurse saw the prescription and administered the

medication 1000 mg.

Result: the patient went back to the intensive care.

This would not have happened with bedside scanning, because

zero doses are NOT ALLOWED.

Prescription and administraiting of zero

dosage

Conclusion

• CPOE and BSS contributes to a safer medication

administration

• Check in every phase of the process

• Bigger attention for the medication process

• Focus on effectiveness and positive effects

• We must remain alert for new errors

Is this how we like our meds … ?

Because in our day-to-day life we don’t

have these “medicinal” problems…

These are the meds we need…

Thank you for your attention