Best Practices for Health-System Pharmacy During COVID-19 - Episode 8
Practice Pearl 2: Infection Control Challenges Due to COVID-19—Barcoding Practices
Estela Trimino, PharmD, BCPS, leads a discussion on changes in barcoding practices to address infection control challenges caused by COVID-19.
Madeline Camejo, PharmD, MS: Esty, one of the questions I wanted to ask you was, barcoding practices changed during COVID-19, and I’m sure for you Michael, especially when we created the pumps. Having to bring the pumps out of the room and trying to protect the nurses with the PPE [personal protective equipment] shortage so they didn’t have to go in and out of the room. Talk about the barcoding that we normally would do by the bedside, how did that change during COVID-19 in your institutions?
Estela (Esty) Trimino, PharmD, BCPS: When we went to the pump outside of the room, we found there were a lot of titrations for these patients, and nurses would be going into the ICU [intensive care unit] often. Multiple times the nurse would be going in and out of the room to barcode scan the patient with each titration. When we looked at this and at the patient loads for our nurses, we deviated from our usual process of barcode scanning at bedside to having a duplicate armband with a double check at the door in our ICU. That was during the height of our surge, and it was only allowed in our ICU unit. That’s where we deviated from usual practice. Then there were a lot of things that came out from New York from ECRI [the Emergency Care Research Institute] and from some of the ISMP [Institute for Safe Medication Practices] reports about the challenges during this crisis mode, saying it is beneficial to continue to use barcode scanning at the bedside.
Now that our [COVID-19] numbers are coming down, we’ve reverted back to having barcode scanning at bedside and those titrations, even though the pumps are outside of the room. So there was some deviation from our usual process of barcode scanning in those early times in relation to any drip that is titratable in the ICU.
Madeline Camejo, PharmD, MS: What about you Michael? How were the barcoding challenges in your institution?
Dr. Michael Epshteyn: When it comes to barcoding, we have been hardwiring the need to scan barcodes over the years. When we originally rolled out barcode scanning for patient wristbands and barcode scan on the medication, the initial numbers were in the 60th or 70th percentile. And now we are continuously close to 100%. We didn’t want to roll back on that at all, and so our barcode scanning requirements and process did not change during that time. We did make sure that our nurses had appropriate PPE to go into the patient rooms, and we have computers in the nursing units and in each of the patient rooms. The barcode scanning continued as before. We really didn’t make any adjustments to that. We felt that we could sustain barcode scanning, and it was important to keep some things consistent since we were dealing with so many other challenges.
We do have a medications safety committee that reviews barcode scanning rates and any gaps or issues with medications that don’t scan. We review that information monthly, and we did not see any decline in barcode scanning, which made me very happy because we were using new medications and moving patients around depending on their isolation status. And so, I felt that barcode scanning had to remain in place as a second layer of protection and the final double check. We didn’t make any changes; that was one of the few things that remained the same.
Transcript edited for clarity.