Offering a variety of services, including preventative testing and treatment, community outreach activities, and partnerships with local health care providers, T.J. Samson Community Hospital is a 196-bed acute care facility serving the communities of Glasgow, Kentucky. With centers devoted to the heart, cancer treatment, kidney care, family medicine, and sleep disorders, T.J. Samson provides numerous health care specialties. As a full-service hospital pharmacy, we are often required to develop bridges between the various technological systems that we are running, while still allowing for future expansion of these systems. With the common goal of providing ever-better patient care, it can sometimes be a challenge to find the right bridge. This was the case following the implementation of our new eMAR system, which resulted in a high number of unsuccessful scans of medications on the floor.
Improving Existing Systems
After initially instituting an eMAR system that positively identified drug and patient using point-of-care bar code technology, we began to realize the limits of the standard symbol scanners we were using with the system. These scanners had no modifications for scanning medications. When using standalone scanners we found the programming manipulations available for recognizing medication bar codes to be limited and relatively simple. Since medication bar codes come in hundreds of different formats, reading the true 11-digit national drug code (NDC) numbers was often impossible without either creating a new bar code in-house or resorting to repeatedly programming a “new bar code” into our eMAR system as it came from the manufacturer. In our eMAR system, we were able to input the different acceptable codes that the system might encounter for a particular bar code; however, this process required a substantial amount of time and manpower. Additionally, there was always the risk of human error when manually entering in the acceptable codes. This laborious process led us to seek out a software application that could help us bridge the gap between our eMAR system and properly decoded medication bar codes.
Implementing the New System
RxScan’s NDC Translator software translates the raw data from an NDC bar code into an NDC number format that is identifiable within our eMAR system. The software also is compatible with the existing scanners we had in place, simplifying the implementation process. Effectively a bridge between our scanners and our eMAR system, our IT department was able to easily load the program and reconfigure the scanners to run data through the software.
After reviewing the raw data in the bar code, the NDC Translator finds an NDC number and sends it to the eMAR in the 11-digit output format we prefer. The software also can output lot number and expiration date when that information is originally included in the bar code, and will alert the user if a medication has passed its expiration date.
Departmental Use and Acceptance
At T.J. Samson, we use the NDC Translator software exclusively in our nursing administration process, making the nursing staff the primary users of the software, although this is largely unknown to them. Once loaded and configured, the software runs automatically, thus no training is necessary for the user. The nurses simply scan the bar code as they normally would, and the software processes out the NDC number. Previously, nursing would often complain that the eMAR system was not working properly, as they knew they had the proper drug, but due to additional information embedded into different bar codes in different forms, the eMAR system would become confused and indicate that the wrong drug was being scanned. Implementing this software has elicited an enthusiastic response from nursing due to the significant increase in “good” or successful scans.
Since full implementation of the software in all our scanner-to-eMAR applications, we have realized a 90% decrease in our failed scan reports. By eliminating the bulk of our missed or bad scans, we have greater confidence in our ability to provide superior patient safety, and have improved efficiency by greatly reducing the amount of time spent reconciling mis-scanned bar codes.
Kevin Adams, PharmD, MHA, is director of pharmacy at T.J. Samson Community Hospital in Glasgow, Kentucky. Kevin previously served as clinical pharmacy coordinator and as a clinical staff pharmacist at T.J. Samson. Kevin received his BS in pharmacy, and his doctor of pharmacy from the University of Kentucky, College of Pharmacy. He also attained a master’s degree in health care administration from Western Kentucky University’s College of Public Health. Kevin’s professional interests have expanded from working on oncology and infectious disease management to pharmacy management and patient safety initiatives through technological advancement.
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