Requiring two nurses at bedside verification

[estiner]

We are looking at instituting barcode scanners at the bedside and my vendor is telling me we no longer need to have two nurses at the bedside verification of units for transfusion.  What are others doing with this?  Are you eliminating that second nurse requirement if the unit and armband are scanned?

[tbostock]

This is true, regulations state that the barcode scanner can take the place of the second nurse. Make sure it is an FDA approved system, and of course fully validate it.  Then it will be your institution's decision whether they want to keep the second nurse or not. 

[David Saikin]

Terri is correct!

[MAGNUM]

Yes it may very well be noted that the scanner can be used as the second signature, but there is relief on my part in knowing that besides myself and the nurse reviewing the unit in the blood bank prior to issue, there are two others reviewing at the bedside.

[Marilyn Plett]

It's been my experience that two nurses do the "bedside check" at the nursing station, i.e., they review the paperwork but not the patient ID. A family member was in the hospital recently. I had more confidence in the computer scans of the wristband and the medication than in any human "verification".

[Malcolm Needs ☆]

I agree 100% Marilyn.

Numerous studies have shown that multiple checking leads to more errors. This is because human nature, either as a matter of fact or maliciously, leads to checks being done badly (not at all) because there is a "feeling" that, well, if I miss something, the next person will pick it up, or, conversely, well, there can't be any errors, because they would have been picked up by the person who checked before me. On top of that, of course, there are checks that are done under great pressure of work, or when very tired, when a genuine error is made because of the circumstances.

The great thing is that, if computer programmes are written properly (and it is an "if"), computers do not feel either "pressure of work of circumstances" or cannot make mistakes because "they are tired".

Take the human out of it, and it is normally better; that's why electronic issue (under "normal" circumstances) is safer than a serological cross-match.

[SMILLER]

And then there's the practice of keeping all the patient's barcodes on the chart at the nursing station, so that things get barcoded away from the bedside anyway, regardless of the scanner. 

 

I am afraid we have seen alot of specimens mislabled because of this practice.  (Not bloodbank though, only Lab phlebots draw those!)

 

Scott

[Malcolm Needs ☆]

True SMILLER, but, if the system forces you to scan the patient's arm/ankle band, so that there is bedside printing (or whatever) it more difficult to fool the system (although, I am absolutely certain, not impossible - human beings will find ANY way of getting around things). There is a lovely saying, "This system is fool proof, but it is not idiot proof"!

[BankerGirl]

And then there's the practice of keeping all the patient's barcodes on the chart at the nursing station, so that things get barcoded away from the bedside anyway, regardless of the scanner. 

 

I am afraid we have seen alot of specimens mislabled because of this practice.  (Not bloodbank though, only Lab phlebots draw those!)

 

Scott

 

We had problems with the nurses scanning the MAR instead of the armband for POC testing, so our IT department added a check digit to the armband.  When we started using bedside patient verification for blood transfusions, the scanners were already set up to require that check digit.  If they try to scan any other barcode they will receive an error.  This has helped tremendously!

[MAGNUM]

 

We had problems with the nurses scanning the MAR instead of the armband for POC testing, so our IT department added a check digit to the armband.  When we started using bedside patient verification for blood transfusions, the scanners were already set up to require that check digit.  If they try to scan any other barcode they will receive an error.  This has helped tremendously!

 

I like the check digit part.

[aafrin]

True SMILLER, but, if the system forces you to scan the patient's arm/ankle band, so that there is bedside printing (or whatever) it more difficult to fool the system (although, I am absolutely certain, not impossible - human beings will find ANY way of getting around things). There is a lovely saying, "This system is fool proof, but it is not idiot proof"!

I fully concur Malcolm; for I have noticed it many times that ---

"Foolproof systems do not take into account the ingenuity of fools."

[aafrin]

I fully concur with you Malcolm; for I have noticed it many times that ---

"Foolproof systems do not take into account the ingenuity of fools."