Proposed FY25 BCMA m

Quality Compliance goal for Licensed Nurses regarding Barcode Medication Administration

BCMA

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Created by: Pamela Bull, MSN, RN, CPEN

Updated 2/2024

Review the five rights of safe medication administration practices

Identify the key elements of the five rights of safe medication administration practices to minimize medication errors

Identify safe medication administration practices

Objectives

There are 5 key rights to safe medication administration. Click on each one to learn more.

Rights of Medication Administration

RightTime

RightDose

RightRoute

RightPatient

RightMedication

RIGHT Patient

PATIENT IDENTIFICATION

The active process of correctly matching a patient through the use of two approved patient identifiers and/or sources to verify the individual is correctly matched to the care, treatment, or service.

RIGHT Patient

APPROVED IDENTIFIERS

Patient Name
Date of Birth
Medical Record Number
Last four digits of Social Security Number
Government-issued photograph identification (e.g. driver's license)

RIGHT Patient

PATIENT ARM BAND

The identification/arm band is one form of patient identification, used to match the patient with the care, treatment, or service.Placed the patient arm band on the wrist or ankle of admitted patients.

RIGHT Patient

ADDITIONAL CONSIDERATIONS

If the patient's medical condition does not allow for the arm band to be place on the patient's extremity (wrist or ankle), the identification band is attached to a visible part of the patient's body using tape appropriate to the patient's condition/allergies.

RIGHT Patient

Administering Medications

Always scan the patient arm band firstOnly pull medications for one patient at a timeReturn unused medications to the Omnicell

Only scanning the patient's arm band is a safe form of identifying the patient.

QUESTION 1-1

False

True

correct

Verbal identification of the patient with 2 patient identifiers is best practice.

A patient with thin skin and edematous arms did not have their patient ID armband on their wrist. The RN scanned the armband hanging on the IV pole, then scanned the medication and administered it to the patient in the bed.

QUESTION 1-2

SafePractice

UnsafePractice

Unsafe practice

The armband hanging on the IV pole belonged to a different patient, and so did the medication. The patient in the bed was never intended to receive the medication they were given.

An RN pulled medications for two patients and placed both patients' medications on top of the WOW. The RN scanned the medications for one of the patients, then began talking to the patient while opening the medications.

QUESTION 1-3

SafePractice

UnsafePractice

Unsafe practice

The nurse ended up opening all of the medications on the WOW, and administered them to the patient.The patient ended up taking medications which were not ordered for them.

write The Number down Below. you will need to enter it in at the end of the presentation.

There are 5 key rights to safe medication administration. Click on each one to learn more.

Rights of Medication Administration

RightTime

RightDose

RightRoute

RightPatient

RightMedication

RIGHT Medication

inspection

Human inspection of medication labels and all medication components is a key element to catching errors downstream in the medication use process

RIGHT Medication

anticipate

Anticipate that failures can occur and inspect the medication label, pharmacy label, dilution fluid, and any auxillary labels.

RIGHT Medication

Verbal orders

Verbal orders should be written down and repeated back to the provider.Verbal orders and Omnicell overrides should be limited to urgent/emergent situations only.

Pharmacy dispensed an ADDvantage bag labeled ceftriaxone for a patient. The nurse scanned the patient, then scanned the medication, and no error warning popped up in eStar.Did the nurse miss any critical steps?

QUESTION 2-1

Yes

yes

The nurse did not visually inspect the medication. This resulted in ampicillin reaching the patient rather than the ordered ceftriaxone.

During a cardiac arrest in the ICU, a bag of norepinephrine was requested by verbal order. A clinician accessed the medication on override per provider direction and the urgent/emergent need. Once removed, the medication was directly handed to the medication nurse. Were any safety steps missed?

QUESTION 2-2

Yes

yes

The clinician had inadvertantly grabbed a bag of phenylephrine from the Omincell rather than the intended norepinephrine.The clinician did not double check the label on the medication bag prior to handing it to the medication nurse.

write The Number down Below. you will need to enter it in at the end of the presentation.

There are 5 key rights to safe medication administration. Click on each one to learn more.

Rights of Medication Administration

RightTime

RightDose

RightRoute

RightPatient

RightMedication

RIGHT dose

Verification

Verify the ordered dose is the same as the dose being givenIf applicable, verify the medication concentration is correct. Is the ordered dose appropriate for the patient/situation?

RIGHT dose

Amount

Always scan the patient BEFORE scanning medicationsIf appropriate, calculate the dose and verify with a second RNDraw up the medication in the intended or appropriate device

RIGHT dose

Pill splitters

Pill splitters and pill crushers are single patient use only (place a patient labeled on the device and store it in the patient-specific bin in the Omnicell).Clean pill splitters with alcohol after each use. Send them home with the patient upon discharge or discard it in a sharps container.

Medications were pulled and scanned for a patient. The nurse clicked through all pop-up boxes on the WOW. The RN then opened all medications and administered them to the patient.

QUESTION 3-1

SafePractice

UnsafePractice

Unsafe practice

One of the medications was a partial dose. The RN forgot to split the ordered partial dose prior to administering. SAFE PRACTICE - Scan, verify, split (if needed), then place in medicine cup, each medication individually. Partial doses will never be missed.

The nurse grabbed a thin/small syringe to draw up insulin. The order was for 1 unit per sliding scale order with an insulin syringe. The nurse drew up the insulin to the first line and administered the medication. Did the nurse miss anything?

QUESTION 3-2

Yes

yes

The nurse had grabbed a TB syringe, rather than an insulin syringe. They drew up to the first line, which on a TB syringe is 0.1 ml. This equals 10 units in an insulin syringe, rather than the ordered 1 unit.

write The Number down Below. you will need to enter it in at the end of the presentation.

There are 5 key rights to safe medication administration. Click on each one to learn more.

Rights of Medication Administration

RightTime

RightDose

RightRoute

RightPatient

RightMedication

RIGHT time

Double Check

Verify the frequency of the medicationDouble check that you are giving the medication at the correct time.

RIGHT time

Double Check

Review the order comments and administration instructions for time information.Confirm when the last dose was given.

A diabetic patient has an order for insulin lispro 10 units SQ TID with meals, and the doses are scheduled for 0700, 1200, and 1800.The patient's dinner tray arrived at 1700. The insulin lispro was given at 1800. Did the nurse forget to check anything?

QUESTION 4-1

Yes

YEs

The order for the Lantus stated to be given TID with meals. In this scenario, the Lantus was NOT given with the meal, but after it.

A dialysis patient has an order for midodrine 10mg PO 'once with dialysis', scheduled for 0800. The medication was administered on time, but the patient did not go to dialysis until 1300. Did the nurse forget to check any part of the order?

QUESTION 4-2

Yes

YES

The nurse forgot to check the administration comments as they stated to 'give 30 minutes prior to transport to dialysis'. Instead, the patient received the medication approximately 4.5 hrs early.

write The Number down Below. you will need to enter it in at the end of the presentation.

There are 5 key rights to safe medication administration. Click on each one to learn more.

Rights of Medication Administration

RightTime

RightDose

RightRoute

RightPatient

RightMedication

RIGHT route

verification

Verify the ordered route is the route being used for administration. Verify the route is correct based on the medication/patient/situation**REMEMBER-the absorption rate depends on the administered route

RIGHT route

label

Label a medication container as soon as it is prepared, unless it is immediately administered. Label one medication at a time (e.g. prepare and label the first medication, then prepare and label the second medication)

RIGHT route

Discard

Immediately discard any unlabeled or partially labeled medications in the designated waste container.

The patient had IV furosemide and subQ Lantus due at the same time. The RN drew them both up, turned, and administered them to the patient.

QUESTION 5-1

SafePractice

UnsafePractice

Unsafe practice

ln this scenario, the nurse gave the furosemide subQ and the Lantus IV. Had they only drawn up one medication at a time and administered, the correct route would have been double checked.

A patient has promethazine ordered. The nurse drew up the medication, scanned everything, and gave the medication IV push. Did the nurse miss any steps?

QUESTION 5-2

Yes

The nurse did not double check the route. The promethazine was ordered to be given IM, however, nurses over the past several shifts had been giving the medication IV push.

A patient has medications ordered to be given through a feeding tube. The nurse takes all of the patients oral medications, crushes them, and administers them all through the feeding tube. Did the nurse miss any steps?

QUESTION 5-3

Yes

yes

When crushing medications, it is essential to check the 'DO NOT CRUSH' list. In this scenario, the nurse ended up crushing a medication that should not have been crushed, which will alter the absorption of the medication.

write The Number down Below. you will need to enter it in at the end of the presentation.

There are 5 key rights to safe medication administration. Click on each one to learn more.

Rights of Medication Administration

RightTime

RightDose

RightRoute

RightPatient

RightMedication

ENTER THE NUMBERS YOU WERE GIVEN AS YOU COMPLETED THE MODULE

_ _ _ _ _

HINT: PATIENT

* _ _ _ _

HINT: DRUG

ENTER THE NUMBERS YOU WERE GIVEN AS YOU COMPLETED THE MODULE

* * _ _ _

HINT: DOSE

ENTER THE NUMBERS YOU WERE GIVEN AS YOU COMPLETED THE MODULE

* * * _ _

HINT: TIME

ENTER THE NUMBERS YOU WERE GIVEN AS YOU COMPLETED THE MODULE

* * * * _

HINT: ROUTE

ENTER THE NUMBERS YOU WERE GIVEN AS YOU COMPLETED THE MODULE

BCMA Tips

TIP 1

Always scan the PATIENT first, THEN scan the medication

BCMA Tips

TIP 2

In a procedural/testing area, or don't have a computer in your room?Ask/find a WOW or use the ROVER app on the Mobile Heartbeat phone so you can perform BCMA

BMCA Tips

TIP 3

Is a WOW/ROVER unavailable?Is it downtime?Take extra care to ensure the rights of medication administration

GOAL

WHAT IS OUR BCMA COMPLIANCE GOAL?

>/= 95%

References

Adams, L. (2023, September). Medication Administration. PolicyTech. Retrieved February 28, 2024, from https://vanderbilt.policytech.com/dotNet/documents/?docid=35215Hasselblad, M. (2021, October). Patient Identification. PolicyTech. Retrieved January 31, 2024, from https://vanderbilt.policytech.com/docview/?docid=28398

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You have successfully completed this module on Bar Code Medication Scanning

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