Baystate Medical Center, a 653-bed hospital in Springfield, MA, made insulin safety a priority after rolling out its bedside medication bar coding program in September 2008. Staff members continued to see insulin as a problem medication when monitoring event reporting data on medication storage as well as scan rates of medications and patients. Direct observation on the nursing units validated that there were problems with the insulin administration work processes.
"The drug is dispensed as a vial, so it's traditionally handled multiple times for multiple doses," says Gary Kerr, MBA, PharmD, director of pharmacy services for Baystate Health. "There are several issues surrounding the scanning process—the vial can be left unsecured, on the automated dispensing cabinet (ADC) or in another area altogether. Nurses can travel with the vials in their pockets or not return them to the dispensing cabinets rendering the inventory tracking systems useless." The flawed process started with withdrawal of the multi-dose vial from the ADC, included movement through multiple patient rooms for administration of the medication, and ended with numerous temporary disparate storage locations.
Bar-coding at the bedside in itself is designed to manage down medication administration errors. However, in addition to complying with Joint Commission patient safety standards related to insulin, Baystate was struggling with:
To resolve the insulin safety problems, the pharmacy leadership team implemented a project to improve Joint Commission compliance, smooth nursing workflow, and reduce the number of potential medication errors associated with insulin.
"This style of approach to patient safety issues is what separates organizations that just want to 'pass' their accreditation survey with those that embrace the concept of ensuring safe patient care every day" says WendySue Woods, RN, MHSA, CSHA, senior consultant for The Greeley Company, a division of HCPro.
Kerr and his team investigated the possibility of affixing a small roll of scannable bar-coded labels to each vial of insulin to control some of the above mentioned issues. Baystate chose two nursing units to pilot test this plan. Both the pharmacy and nursing departments collaborated to come up with the best process for both parties.
The hospital aggressively measured and monitored the data surrounding this process starting in September 2008. After six months, the process was rolled out hospital-wide.
Current practice and results
Today, labels are generated in the pharmacy and then affixed to the vial. When nurses have to retrieve medication order from the ADC, they have everything they need in one place, says Kerr.
"The nurse basically prepares the patient dose at the cabinet, the syringe is labeled right there with the scannable label, and the vial is returned to the ADC, maintaining safety and appropriateness as a high-alert medication," Kerr says. "Then the nurse can go to the patient's bedside with the barcode-labeled dose-ready syringe in hand, knowing that he or she has the appropriate medication and dose."