1. Clinton Hospital MAK Barcode Overrides
Telana N Fairchild, MSN, DNP candidate 2016
Maureen Wassef, PhD
University of Massachusetts - Worcester
Graduate School of Nursing
Residency Course
11/10/2018

2. Increase awareness of MAK Overrides occurring in the MSU
Objectives
Increase awareness of MAK Overrides occurring in the MSU
Discuss some common areas of concern
Review proposed intervention for nursing staff
Feedback about overrides and intervention
MAK Overrides
11/10/2018

3. The Institute of Medicine reports “To Err is Human” and “Crossing the Quality Chasm” have encouraged Health Information Technology to improve.
The Institute of Medicine report, “To Err is Human” established multiple deaths occur from errors in healthcare and they proposed targeting top issues to reduce the amount of errors caused by humans that lead to death. In the IOM report “Crossing the Quality Chasm”, Health Information Technology was established as one area to improve quality and effectiveness of healthcare. Congress passed the American Recovery and Reinvestment Act and thus the HITECH Act, which promotes improvements in the HIT. The government established meaningful use stages as a way to give institutions financial incentives to develop and improve their technology. One aspect of these stages was to develop an electronic system for documenting medication administration.
MAK Overrides
11/10/2018

4. For nurses on MSU between 12/14/ /14/2016 there were 109 overrides, the majority were medications.
MAK Overrides
11/10/2018

5. Of the 76% of the medicines are mostly daily and multidose, followed by antibiotics and prns.
MAK Overrides
11/10/2018

6. METHYLPREDNISOLONE SOD SUC(PF) SODIUM CHLORIDE 0.9% INSULIN ASPART
These are the medications that had four or more occurrences associated with each.
METHYLPREDNISOLONE SOD SUC(PF)
SODIUM CHLORIDE 0.9%
INSULIN ASPART
DILTIAZEM
FENTANYL CITRATE (PF)
METRONIDAZOLE
MAK Overrides
11/10/2018

7. These are a comparison of the override codes chosen
These are a comparison of the override codes chosen. Drug unidentifiable most frequent.
MAK Overrides
11/10/2018

8. Frequency of overrides per charted hour
Frequency of overrides per charted hour. Peak times line up with peak medications administration times.
MAK Overrides
11/10/2018

9. For nurses on MSU between 03/01/ /01/2016 there were 183 overrides, the majority were medications.
MAK Overrides
11/10/2018

10. METHYLPREDNISOLONE SOD SUC(PF) SODIUM CHLORIDE 0.9% INSULIN ASPART
These are the medications that had four or more occurrences associated with each.
METHYLPREDNISOLONE SOD SUC(PF)
SODIUM CHLORIDE 0.9%
INSULIN ASPART
DILTIAZEM
FENTANYL CITRATE (PF)
METRONIDAZOLE
MAK Overrides
11/10/2018

11. These are a comparison of the override codes chosen
These are a comparison of the override codes chosen. Drug unidentifiable most frequent.
MAK Overrides
11/10/2018

12. Frequency of overrides per charted hour
Frequency of overrides per charted hour. Peak times line up with peak medications administration times.
MAK Overrides
11/10/2018

13. ***ALWAYS verify 5 right of medication administration***
Using WOW, log into FMD, retrieve active medication list [one patient at a time]
At bedside, click on first med from active list and scan correlating med bar-code, ensure green check mark.
Continue with next med(s) due at this time, MAK will highlight next med, repeat scanning correlating med until all meds scanned correctly.
MAK Process: Workflow
MAK Process: Workflow
Once all meds are scanned, click ID Patient then scan patient’s bar-code. Ensure green check mark.
Since there were a high volume of just routine daily medications that were associated with an override. I wanted to first look at the work flow. Key here is that the staff realize they don’t have to individually click when giving group of medication, the system will automatically skip to the next in order for that time. Also, they have to look at the screen to verify they are getting a green check mark. If they don’t have green check mark they should stop and figure out why. I focused later on some common reasons for scanning errors. The most important point is that verifying the five rights of medication administration should still be followed. The system shouldn’t be relied solely on not making a medication error.
After verifying 5 rights, meds and patient are correctly scanned, administer meds. patient. Then click Chart and scan badge to take credit for med administration.
***ALWAYS verify 5 right of medication administration***

14. ALWAYS verify 5 Rights of Med Administration when using MAK
Right Patient
Right drug
Right dose
Right route
Right time
So to make sure the staff understand the 5 rights this slide was included with the interventions.

15. Trouble Shooting Barcode Errors
Medication Mismatch: If you have a red ‘X’ when scanning medication; first make sure highlighted medication matches the medication being scanned. If still getting red ‘X’, check if bar code is intact. Then make sure scanning MAK barcode (as some medications have multiple barcodes). If still red ‘X’, and true mismatch, then notify pharmacy so they can resolve issue.
Also, place information in log book for tracking of issue.
Verify 5 rights before overriding and administering medication
Patient Mismatch: If STOP sign appears when scanning patient, check patient name and DOB in MAK and verify with arm band and patient (if possible). Make sure no other facility arm band has barcode that would interfere with scanning. If admitted from MSU to GMPU or GMPU to MSU then obtain a new arm band for the correct unit.
Medication barcode partially missing, rubbed off, or unidentifiable: Pull another of the same medication and return med with barcode error to pharmacy utilizing the return bin. If it is multi-dose medication, then request a new label from pharmacy at earliest convenience (Action may require to wait until dayshift).
Also, place information in log book for tracking of issue.
Verify 5 rights before overriding and administering medication
This is the trouble shooting hand out. I will review each one closely.
Patient barcode partially missing, rubbed off, or unidentifiable: Obtain a new arm band. Verify with patient name and DOB and place on patient. Then remove old arm band.

16. Medication Mismatch If you have a red ‘X’ when scanning medication…
First make sure highlighted medication matches the medication being scanned.
If still getting red ‘X’, check if bar code is intact.
Then make sure scanning MAK barcode (as some medications have multiple barcodes).
If still red ‘X’, and true mismatch, then notify pharmacy so they can resolve issue. Also, place information in log book for tracking of issue.
Verify 5 rights before overriding and administering medication
We created a log book based on the feedback from nurse manager to keep track of medications with barcode issues. The log book will serve as a way to communicate with the care team. As these issues are resolved they will document. I will show example of excel spreadsheet included in log book.
MAK Overrides
11/10/2018

17. Patient Mismatch
If STOP sign appears when scanning patient, check patient name and DOB in MAK and verify with arm band and patient (if possible).
Make sure no other facility arm band has barcode that would interfere with scanning.
If admitted from MSU to GMPU or GMPU to MSU then obtain a new arm band for the correct unit.
I haven’t talked much about the patient barcodes due to the major concern was medication. However, since this is part of overrides we wanted to address the common issues. Often times for Clinton patient barcodes are problematic due to switching units. So when this occurs they will have to make sure to obtain a new armband for the correct unit. This would be similar to having another institution armband on patient. Just causes confusion when scanning patient arm bands. The other reason for this are the armbands get warn, from just normal wear and tear. These should just be replaced by verifying name and dob with patient.
MAK Overrides
11/10/2018

18. Barcode partially missing, rubbed off, or unidentifiable
Medication-
Pull another of the same medication and return med with barcode error to pharmacy utilizing the return bin.
If it is multi-dose medication, then request a new label from pharmacy at earliest convenience (Action may require to wait until dayshift).
Also, place information in log book for tracking of issue.
Verify 5 rights before overriding and administering medication
Patient-
Obtain a new arm band. Verify with patient name and DOB and place on patient. Then remove old arm band.
At night shift, the medication barcodes are unable to processed due to no pharmacist on site. These actions can wait until the dayshift but should be resolved at earliest convenience and tracked in log book until resolved.
MAK Overrides
11/10/2018

19. The log book will be placed in the medication room as method for communication for barcode issues for medications only.
Date identified problem
Medication Name
Dosage
Route
Describe Problem
Date Notified Pharmacy
Date Resolved
Solution
MAK Overrides
11/10/2018