Paul Davern RE: Bar Code Medication Charting on Pediatric and Adolescent Units

Hello to my medication safety colleagues --- this may sound like an unusual request however please bear with me.

At St. Francis Hospital we are progressing through the roll-out of bar code medication charting and actually the process is going quite well with most of the patient care areas implemented. The units to go up next are our adult, adolescent and child behavioral health units. The adult units are not an issue however there is an issue with the adolescent and child units. Historically the patients on these two units do not use identification wrist bands for a number of reasons including:
1. they will remove them on a regular basis
2. they will harm themselves with the wrist bracelet, especially the hard plastic ones
3. the patients go out for field trips off the units and the wrist bracelets might ID them as patients to the outside world - not desirable

Currently the RNs utilize photos of each patient for ID before med. administration.

Basically our question is as follows:

For the organizations that have implemented (or are implementing) bar code medication charting what do you do for the pediatric population:

1. require wrist bracelets regardless
2. did not implement on pediatric units
3. use a patient bar code that is not ""attached"" to the patient for bar coding
4. use a photo with a bar code attached
5. other --- please elaborate

I realize all of the selections listed above have their own issues that do not make them attractive choices.

A second problem also arises once we have gotten past the patient identification part of bar coding, that is: How do you get the medications to the patients? The young patients usually are in playrooms in a group and if you bring a mediation cart with scanner to them, you run the risk of a non-intended patient taking something off of the cart, spilling water, etc. If you want the patient to go to a med room or med area to get their medications, they don't want to comply, want to continue playing with their friends etc. What is a good way to overcome these obstacles and accomplish our mission?

Currently our nursing leadership is reluctant to institute bar coding on these units. Our plan is to provide them with at least some ideas since we feel that bar code medication administration should be utilized for all patients.

I realize that many of you do not have to deal with these issues (lucky you) however for the few of you that do your responses are appreciated. The opinions of folks that do not have to deal with this issue are obviously also welcome.

Thanks much,
paul

Paul F. Davern, R.Ph., MBA
Medication Safety Officer
Pharmacy Department
Saint Francis Hospital and Medical Center
114 Woodland St.
Hartford, CT 061005
e-mail: pdavern@stfranciscare.org
phone: 860.714.5048
pager: 860.720.1396
fax: 860.714.8010