Bar Code Resource Office BCRO Update VEHU Class 248

1. 1 Bar Code Resource Office (BCRO) UpdateVEHU Class 248 Nancy Smestad Ron Schneider

2. 2 HOUSE KEEPING This is 1.5 hours class Restrooms are located� Cell Phones Please turn off or change to vibrate If you must answer a call, please leave the room. Before we get started we need to take care of some Housekeeping issues. Restrooms are located.. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.Before we get started we need to take care of some Housekeeping issues. Restrooms are located.. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.

3. 3 HOUSE KEEPING Please, No questions during the presentation. Questions written on the 3X5 card will be answered at the conclusion of the presentation. For questions not answered, the question and the answer will be available on the web. Before we get started we need to take care of some Housekeeping issues. Restrooms are located.. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.Before we get started we need to take care of some Housekeeping issues. Restrooms are located.. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.

4. 4 Bar Code Resource Office (BCRO) VHA Office of Information Chief Health Informatics Officer Dedicated to point of care bar code technologies Bar Code Medication Administration Bar Code Expansion Located in Topeka, Kansas Most staff virtual I work for the Bar Code Resource Office, formally known as the BCMA Program Office. You are a part of VHA Office of Information directly reporting to the Chief Health Informatics Officer. The office is dedicated to supervise all point of care bar code technologies within VA. That includes Bar Code Medication Administration and the Bar Code Expansion Project. The main office is located to Topeka, Kansas where BCMA started but many of our staff are virtual located at many medical centers across the country.I work for the Bar Code Resource Office, formally known as the BCMA Program Office. You are a part of VHA Office of Information directly reporting to the Chief Health Informatics Officer. The office is dedicated to supervise all point of care bar code technologies within VA. That includes Bar Code Medication Administration and the Bar Code Expansion Project. The main office is located to Topeka, Kansas where BCMA started but many of our staff are virtual located at many medical centers across the country.

5. 5 BCRO Staff Director Nurse Consultants Pharmacist Consultants Laboratory Consultants Administrative Assistant

6. 6 BCRO Activities BCMA equipment standardization BCMA National calls Bar Code Quality Directive Closed Loop Verification Program BCRO web site Annual Bar Code Conference Help (if we can) Spreading the word International bar code participation FDA Bar code manufacturers Exactly want does our office do. This is a list of some of the functions of our office, it is not all inclusive. We have set standard testing guidelines for all new products to be used with BCMA. No VA should purchase any product that is not on our approved equipment list which is constantly being upgraded as new products come on the market. We have National BCMA calls every other week. Soon one call each month will involve BCMA and the other call will be for BCE. The BCRO monitors, tabulates and analyses the quarterly Bar Code Quality Directive. We have a Closed Loope Verification Program to report problematic bar codes. I will talk about this more later. We have a web site and a BCMA C sharePoint which contacts much information needed for BCMA. We have an annual Bar Code Code Conference where we share lessons learned and ways to improve BCMA. We are here to help you with any problem related to bar code point of care technology. If do not know the answer, we will find someone who does. You use the software every day, so we have a great expert pool to assist us. We are spreading the word about the great work that you do. We are contacting by other medical centers, we do presentations and publish article praising the great work you do. You do not realize how envious other people are of what we have accomplished. We have been invited to participate on international bar code user groups trying to standardize bar coeds in the industry. We have contacts at the FDA that we report non compliant products to. The manufactuer may think they are in compliane with the bar code regulation and we may not, so we have the FDA be the final arbitrator. We are constantly contacting manufacturers on your behave about problematic bar codes. We have there attention as you will lran later in our presentation.Exactly want does our office do. This is a list of some of the functions of our office, it is not all inclusive. We have set standard testing guidelines for all new products to be used with BCMA. No VA should purchase any product that is not on our approved equipment list which is constantly being upgraded as new products come on the market. We have National BCMA calls every other week. Soon one call each month will involve BCMA and the other call will be for BCE. The BCRO monitors, tabulates and analyses the quarterly Bar Code Quality Directive. We have a Closed Loope Verification Program to report problematic bar codes. I will talk about this more later. We have a web site and a BCMA C sharePoint which contacts much information needed for BCMA. We have an annual Bar Code Code Conference where we share lessons learned and ways to improve BCMA. We are here to help you with any problem related to bar code point of care technology. If do not know the answer, we will find someone who does. You use the software every day, so we have a great expert pool to assist us. We are spreading the word about the great work that you do. We are contacting by other medical centers, we do presentations and publish article praising the great work you do. You do not realize how envious other people are of what we have accomplished. We have been invited to participate on international bar code user groups trying to standardize bar coeds in the industry. We have contacts at the FDA that we report non compliant products to. The manufactuer may think they are in compliane with the bar code regulation and we may not, so we have the FDA be the final arbitrator. We are constantly contacting manufacturers on your behave about problematic bar codes. We have there attention as you will lran later in our presentation.

7. 7 BCMA Coversheet Reports Enhancement Nancy R. Smestad, MS RPH Fargo VAMC July 2008

8. 8 Coversheet Objectives Organize a team to evaluate and implement new BCMA functionality Delineate the BCMA reports enhancement utilization Develop performance improvement reporting Our medication safety team evaluated the new reports functionality and determined a subgroup consisting of 4 individuals should critically review the new reports functionality. The subgroup consisted of the BCMA coordinator, patient safety coordinator and 2 nurses. The team reviewed the SRS(Software Requirements Specifications) from the BCMA development team. The subgroup discussed utilization of the reports enhancement relative to the daily activities on each nursing unit. The subgroup was challenged with development of performance improvement reporting parameters.Our medication safety team evaluated the new reports functionality and determined a subgroup consisting of 4 individuals should critically review the new reports functionality. The subgroup consisted of the BCMA coordinator, patient safety coordinator and 2 nurses. The team reviewed the SRS(Software Requirements Specifications) from the BCMA development team. The subgroup discussed utilization of the reports enhancement relative to the daily activities on each nursing unit. The subgroup was challenged with development of performance improvement reporting parameters.

9. 9 Objectives Cont. Review the Coversheet functionality Review the Coversheet Reports Tips for implementing Coversheet Reports Performance Improvement reporting utilizing new reports The subgroup reviewed all aspects of the CoverSheet functionality in detail. The team reviewed the reports and determined how the reports could be utilized by nursing staff and delineated the reports which would assist unit managers, patient safety coordinator and the BCMA coordinator. The subgroup reviewed each report in detail for implementation on the nursing units They developed usability criteria for nursing and nurse managers. The subgroup looked at development of performance improvement criteria.The subgroup reviewed all aspects of the CoverSheet functionality in detail. The team reviewed the reports and determined how the reports could be utilized by nursing staff and delineated the reports which would assist unit managers, patient safety coordinator and the BCMA coordinator. The subgroup reviewed each report in detail for implementation on the nursing units They developed usability criteria for nursing and nurse managers. The subgroup looked at development of performance improvement criteria.

10. 10 Coversheet Enhancements Pit Falls Establish nursing unit usage Enhanced functionality Applicability to daily work The subgroup reviewed the specific requirements delineating the pit falls and useability. Nursing time and time to access the reports was critically evaluated. The enhanced functionality was scrutinized to insure appropriate use. The subgroup determined that feedback from the nursing staff and managers was critical to utilizing the reports.The subgroup reviewed the specific requirements delineating the pit falls and useability. Nursing time and time to access the reports was critically evaluated. The enhanced functionality was scrutinized to insure appropriate use. The subgroup determined that feedback from the nursing staff and managers was critical to utilizing the reports.

11. 11 The subgroup reviewed the Coversheet enhancements including the appearance of the order flag, prominence of STAT and NOW orders as well as the route expansion. The team determined the enhancements provided nursing staff with user friendly information in one location. The concerns by the nursing staff was the amount of information and the lack of nursing time. Nursing staff felt the off tours would benefit from the enhancements since time would allow the staff to review the information. Nursing expressed time constraints for the day shift.The subgroup reviewed the Coversheet enhancements including the appearance of the order flag, prominence of STAT and NOW orders as well as the route expansion. The team determined the enhancements provided nursing staff with user friendly information in one location. The concerns by the nursing staff was the amount of information and the lack of nursing time. Nursing staff felt the off tours would benefit from the enhancements since time would allow the staff to review the information. Nursing expressed time constraints for the day shift.

12. 12 The subgroup reviewed the order flag functionality and nursing staff felt this enhancement was very helpfulThe subgroup reviewed the order flag functionality and nursing staff felt this enhancement was very helpful

13. 13 New Reports Medication Report Overview Usage Nursing Usage Managers Improving Patient Outcomes The complete functionality of the medication overview report was reviewed. The team dissected the report critically evaluating the use for nursing staff on a daily basis. The subgroup evaluated usage by nursing managers and the methodology whereby the use of the report could be utilized to improve patient outcomesThe complete functionality of the medication overview report was reviewed. The team dissected the report critically evaluating the use for nursing staff on a daily basis. The subgroup evaluated usage by nursing managers and the methodology whereby the use of the report could be utilized to improve patient outcomes

14. 14 Medication Overview Report The subgroup reviewed access to this form. The team determined nursing units could utilize this report when needed in the format of each nurse selecting their patients and the current active medications. Nurse managers were concerned this report could be utilized instead of accessing the VDL. Nurse managers felt this could be useful for the off tours and for the unit managers. Nursing staff decided to utilize this in addition to the Med Log Report and found it more user friendly.The subgroup reviewed access to this form. The team determined nursing units could utilize this report when needed in the format of each nurse selecting their patients and the current active medications. Nurse managers were concerned this report could be utilized instead of accessing the VDL. Nurse managers felt this could be useful for the off tours and for the unit managers. Nursing staff decided to utilize this in addition to the Med Log Report and found it more user friendly.

15. 15 PRN Overview Report Usage nursing Usage managers Usage medication safety team Performance improvement The subgroup reviewed the report relative to nursing unit applicability, applicability to nurse managers, medication safety team usage and development of performance improvement criteria.The subgroup reviewed the report relative to nursing unit applicability, applicability to nurse managers, medication safety team usage and development of performance improvement criteria.

16. 16 PRN Overview Report The subgroup determined this report would be utilized every shift by nursing staff to review the active PRN medications. Nurse managers will print the report weekly tabulate documentation of PRN effectiveness and report this information to the medication safety team and performance improvement. The goal is to have 100% documentation of PRN effectiveness.The subgroup determined this report would be utilized every shift by nursing staff to review the active PRN medications. Nurse managers will print the report weekly tabulate documentation of PRN effectiveness and report this information to the medication safety team and performance improvement. The goal is to have 100% documentation of PRN effectiveness.

17. 17 IV Overview Report Tailor usage to each nursing unit Infusing bag report Expired bag report Medication safety team usage Performance Improvement The subgroup determined this report to be the most applicable to the nursing units. The group focused on the infusing bag report and the expired bag report. The group developed criteria for reporting to medication safety and performance improvement.The subgroup determined this report to be the most applicable to the nursing units. The group focused on the infusing bag report and the expired bag report. The group developed criteria for reporting to medication safety and performance improvement.

18. 18 IV Overview The subgroup determined the infusing bags report with actions and comments should be printed prior to the end of each shift. Nursing staff will print the report for their patients and insure all infusing bags have been completed. A form was developed for nursing to document infusing bags which should have been completed and this information is to be sent to the unit managers daily for tabulation and reporting to medication safety team and performance improvement.The subgroup determined the infusing bags report with actions and comments should be printed prior to the end of each shift. Nursing staff will print the report for their patients and insure all infusing bags have been completed. A form was developed for nursing to document infusing bags which should have been completed and this information is to be sent to the unit managers daily for tabulation and reporting to medication safety team and performance improvement.

19. 19 Expired/Expiring Orders Report When to print report Provider input and usage Is this a performance improvement issue? The subgroup reviewed the specifics inclusive of the expired and discontinued orders, as well as orders expiring within 24 hours. The group decided this report would be utilized by the night shift to assist providers. The group determined this information would not be valuable to performance improvement.The subgroup reviewed the specifics inclusive of the expired and discontinued orders, as well as orders expiring within 24 hours. The group decided this report would be utilized by the night shift to assist providers. The group determined this information would not be valuable to performance improvement.

20. 20 Expired/DC�d/Expiring Orders The subgroup determined the most applicable usage for the nursing units was to print the Expiring Today and Expiring Tomorrow report for the patients on each nursing unit. The nurse will review the report and inform the providers so the providers may determine whether to renew or discontinue the medication.The subgroup determined the most applicable usage for the nursing units was to print the Expiring Today and Expiring Tomorrow report for the patients on each nursing unit. The nurse will review the report and inform the providers so the providers may determine whether to renew or discontinue the medication.

21. 21 Medication Therapy Report History of this report � origination Nursing unit usage Nurse manager usage Incident reporting usage Performance Improvement The medication therapy report evolved from a VistA based pharmacy report titled Patients on Specific Drugs Report and is similar to the current Medication History Report, however it includes additional information. This report does not require a patient record to be open in order to query this report. The report encompasses numerous features and may be queried by date range, schedule type and by selected drug(s). This report will search through all of a currently admitted patient�s previous administrations that fall within the specified date range and match the criteria specified at run time. The subgroup determined the usage would be applicable to nurse managers, BCMA Coordinator, patient safety coordinator and incident reporting.The medication therapy report evolved from a VistA based pharmacy report titled Patients on Specific Drugs Report and is similar to the current Medication History Report, however it includes additional information. This report does not require a patient record to be open in order to query this report. The report encompasses numerous features and may be queried by date range, schedule type and by selected drug(s). This report will search through all of a currently admitted patient�s previous administrations that fall within the specified date range and match the criteria specified at run time. The subgroup determined the usage would be applicable to nurse managers, BCMA Coordinator, patient safety coordinator and incident reporting.

22. 22 Search by VA Drug Class, Orderable Item or Dispense Drug If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified Multiple search entries are allowed. This report allows multiple search entries such as: If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified. If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified. If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified. This report allows multiple search entries such as: If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified. If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified. If searching by VA Drug Class, report displays all administrations whose dispense drug matches the VA drug classes specified If searching by Orderable Item, report displays all administrations whose dispense drug matches the Orderable items specified If searching by Dispense Drug, report displays all administrations whose dispense drug matches the Dispense Drug Specified.

23. 23 This example illustrates a search by orderable item.

24. 24 Once the orderable items are selected, the user clicks OK.Once the orderable items are selected, the user clicks OK.

25. 25 IV Bag Status Report IV Bag Status versus IV Overview Report Applicability Usage The subgroup compared the IV Bag Status Report and the IV Overview report. The group determined the reports were similar and nursing unit staff could utilize them interchangeably.The subgroup compared the IV Bag Status Report and the IV Overview report. The group determined the reports were similar and nursing unit staff could utilize them interchangeably.

26. 26 This report allows a user to: Run a list of bags in a particular state for a particular order status Run a report for bags on expired or discontinued orders that are still marked as infusing Run a report for IV orders for which no action has been taken

27. 27 Advantages to the IV Bag Status report is nursing could select DC�d and Expired as well as the status Infusing, Held, Stopped, Refused. This report drills down explicitly which is an excellent feature.Advantages to the IV Bag Status report is nursing could select DC�d and Expired as well as the status Infusing, Held, Stopped, Refused. This report drills down explicitly which is an excellent feature.

28. 28 BCMA Toolbar Team will determine segments to be placed here Links to drug and disease references Patient incident reporting form BCMA training materials Medication Management Policy Nursing procedures The subgroup requested the addition of station abbreviations, nursing procedures, links to drug and disease references, links to the patient incident reporting form, BCMA training materials and the medication management policy.The subgroup requested the addition of station abbreviations, nursing procedures, links to drug and disease references, links to the patient incident reporting form, BCMA training materials and the medication management policy.

29. 29 Managing Scanning Failures Purpose of project Timeline of project Reports Response time MSF stands for Managing Scanning Failures. This software enhancement to BCMA will allow the nurse to electronically send a message to the BCMA C, IRM, inpatient supervisor or anyone that the site delegates that any product did not scan in BCMA. This can be a medication or a wristband. I will explain the purpose of the project, its timeline and why it has taken so long to get to the field, the reports that will be generated by the upgrade and the resulting impact on response time to correct problems that are uncovered by the system. This is not intended to be a MSF training session that will come later through national presentations.MSF stands for Managing Scanning Failures. This software enhancement to BCMA will allow the nurse to electronically send a message to the BCMA C, IRM, inpatient supervisor or anyone that the site delegates that any product did not scan in BCMA. This can be a medication or a wristband. I will explain the purpose of the project, its timeline and why it has taken so long to get to the field, the reports that will be generated by the upgrade and the resulting impact on response time to correct problems that are uncovered by the system. This is not intended to be a MSF training session that will come later through national presentations.

30. 30 MSF Purpose Software enhancement that provides users with an automated reporting process for scanning failures during the medication administration process Wristbands Medications Captures information on why manual medication was used and a reason that scanning was by passed Information not tied to an individual MSF will automate the process of reporting products that fail to scan during the administration process in BCMA. It can be a wristband, a medication or an IV that fails to scan at the point of care. The multi-disciplinary approach to getting this information is extremely important. Pharmacy can react to a medication not scanning but cannot repond to a writsband failure. This enhancement captures only the fact that something failed to scan and a reason noted if known. It does not identify any individual that sent the report. The nurses name is always confidential.MSF will automate the process of reporting products that fail to scan during the administration process in BCMA. It can be a wristband, a medication or an IV that fails to scan at the point of care. The multi-disciplinary approach to getting this information is extremely important. Pharmacy can react to a medication not scanning but cannot repond to a writsband failure. This enhancement captures only the fact that something failed to scan and a reason noted if known. It does not identify any individual that sent the report. The nurses name is always confidential.

31. 31 MSF Purpose Create reports that notify pharmacy, nursing, quality management, IRM or bio-medical of system issues that caused a scanning failure Not relying on nurse to remember a problem Identifies medication-not lot number or repacking number A mail man message will be sent to members designated to receive that information. You need to think very carefully about who gets this message and will they be able to respond in a timely manner. In the past , BCMA has relied upon the nurse to remember a particular medication or wristband malfunction. Many times this was done after the medication pass and the nurse could not remember the products that did not scan. It was not fair to expect the nurse to remember these things. Nurses have enough to do! Pharmacy needs to remember that the medication will be identified but not the particular lot number or packing number. If there is more than one supplier of an item on the shelf they must all be reviewed to make sure they scan. If all the wristbands on a particular unit fail to scan, that is not a nursing issue but the printer needs to be repaired quickly. Through MSF these issues will be identified easily and corrective actions taken.A mail man message will be sent to members designated to receive that information. You need to think very carefully about who gets this message and will they be able to respond in a timely manner. In the past , BCMA has relied upon the nurse to remember a particular medication or wristband malfunction. Many times this was done after the medication pass and the nurse could not remember the products that did not scan. It was not fair to expect the nurse to remember these things. Nurses have enough to do! Pharmacy needs to remember that the medication will be identified but not the particular lot number or packing number. If there is more than one supplier of an item on the shelf they must all be reviewed to make sure they scan. If all the wristbands on a particular unit fail to scan, that is not a nursing issue but the printer needs to be repaired quickly. Through MSF these issues will be identified easily and corrective actions taken.

32. 32 Project Timeline Original agreement with unions signed 11/2005 Prototype shown to BCMA C in June 2006 Feedback showed some design flaws Based on user input, re-design undertaken New service requests added to SRS New agreement with unions in 11/2007 Installed in test sites in June 2008 National release-October 2008 Why has this project taken so long to get released. Originally the national unions agreed with this project in late 2005. As with all our BCMA enhancements, we allow for user input to guide us in modifying our software. When the protoype was showed to the BCMA C at our annuual conference in June 2006 some design flaws were noticed by some observers. The development team took these requests and reworked the Specifications Requirements documents and redesigned the software. Once all that was approved it needed to regain the approval of the national unions. The approval was received in late 2007 and the test version will be in test accounts by June 1 and planned national release by October 2008.Why has this project taken so long to get released. Originally the national unions agreed with this project in late 2005. As with all our BCMA enhancements, we allow for user input to guide us in modifying our software. When the protoype was showed to the BCMA C at our annuual conference in June 2006 some design flaws were noticed by some observers. The development team took these requests and reworked the Specifications Requirements documents and redesigned the software. Once all that was approved it needed to regain the approval of the national unions. The approval was received in late 2007 and the test version will be in test accounts by June 1 and planned national release by October 2008.

33. 33 Wristband unable to scan I want to begin my section on the screen captures by stating this is what I had available at the time this presentation was due. There will be formal training presentations presented before the final release of the enhancement I will be brief in my presentation since it is not designed as a training session. There may be some tweaking of the screen captures as more test sites give feedback during the beta testing. What will happen if a wristband cannot be scanned? Try to scan the wristband the normal way, if it does not scan notice the new unable to scan button. Click on that buttonI want to begin my section on the screen captures by stating this is what I had available at the time this presentation was due. There will be formal training presentations presented before the final release of the enhancement I will be brief in my presentation since it is not designed as a training session. There may be some tweaking of the screen captures as more test sites give feedback during the beta testing. What will happen if a wristband cannot be scanned? Try to scan the wristband the normal way, if it does not scan notice the new unable to scan button. Click on that button

34. 34 Wristband confirmation box Now you will be presented with the BCMA unable to scan wristband dialogue box. The nurse will be able to supply a reason the wristband di not scan if it is known. If not select unable to determine and let IRM or bio-med fix the problem. The nurse will confirm that they have used 2 measn to verify the patients identify. But how can they due this is the wristband did not scan?Now you will be presented with the BCMA unable to scan wristband dialogue box. The nurse will be able to supply a reason the wristband di not scan if it is known. If not select unable to determine and let IRM or bio-med fix the problem. The nurse will confirm that they have used 2 measn to verify the patients identify. But how can they due this is the wristband did not scan?

35. 35 Ward selection box The nurse will be taken to a ward list selection box. The ward can be entered, or the usual initial and last 4 and the normal VDL will be seen.The nurse will be taken to a ward list selection box. The ward can be entered, or the usual initial and last 4 and the normal VDL will be seen.

36. 36 Unit dose, IVP, IVPB, IV unable to scan 2 methods-select from due list or right click To make selecting a unable to scan medication, IVP or IVPB or IV, 2 methods were selected to be able to mark a medication unable to scan. The nurse can use the due list or right click on the order and the unable to scan dialogue box will open.To make selecting a unable to scan medication, IVP or IVPB or IV, 2 methods were selected to be able to mark a medication unable to scan. The nurse can use the due list or right click on the order and the unable to scan dialogue box will open.

37. 37 Confirmation screen Here is what a medication confirmation screen will look like. The screen will be similar for IVP, IVP and IV. If the item is an IV and prepared by pharmacy the bag number will be listed. The medication and dosage will be shown. The reasons were previously listed. You can enter a comment if needed. This is really a brief overview. Again there will be more extensive training as the enhancement gets closer to national release.Here is what a medication confirmation screen will look like. The screen will be similar for IVP, IVP and IV. If the item is an IV and prepared by pharmacy the bag number will be listed. The medication and dosage will be shown. The reasons were previously listed. You can enter a comment if needed. This is really a brief overview. Again there will be more extensive training as the enhancement gets closer to national release.

38. 38 Validation screen This is a new screen that will appear. You can type in the human readable IEN number on the package and give the medication. If you use this method a new site parameter will allow sites to have the nurse verify that they verified the five rights of medication administration before giving the medication.This is a new screen that will appear. You can type in the human readable IEN number on the package and give the medication. If you use this method a new site parameter will allow sites to have the nurse verify that they verified the five rights of medication administration before giving the medication.

39. 39 BCMA Parameters This is the new BCMA parameters box that will allow the set up of the mail group and the 5 rights over ride. Once the mail group is entered in the VistA system e-mails will be generated. Think carefully about who gets this e-mail. Do you want the regular staff or part time pharmacist to get all those e-mails?This is the new BCMA parameters box that will allow the set up of the mail group and the 5 rights over ride. Once the mail group is entered in the VistA system e-mails will be generated. Think carefully about who gets this e-mail. Do you want the regular staff or part time pharmacist to get all those e-mails?

40. 40 Reports Wristband report Successful scans Unsuccessful scans Typed into BCMA Medication report Successful scans Unsuccessful scans Typed into BCMA Detail report Specific date range Totals and percentages for each value The reports that can be generated through MSF are the wristband report, the medication report and a detailed summary report. Each report will show you the number of successful scans, the number of unsucessful scans and the number of products typed into BCMA rather than being scanned. This is the type of information that the BCRO will expect you to report on a national level. The exact details of the exact procedure will come later.The reports that can be generated through MSF are the wristband report, the medication report and a detailed summary report. Each report will show you the number of successful scans, the number of unsucessful scans and the number of products typed into BCMA rather than being scanned. This is the type of information that the BCRO will expect you to report on a national level. The exact details of the exact procedure will come later.

41. 41 Wristband unable to scan notice This is a reprint of the wristband unable to scan notice. It works exactly like the current missing dose notification. Yes it will print in pharmacy also but if the BCMA C is a pharmacist, they may be the poc for getting the problem fixed.This is a reprint of the wristband unable to scan notice. It works exactly like the current missing dose notification. Yes it will print in pharmacy also but if the BCMA C is a pharmacist, they may be the poc for getting the problem fixed.

42. 42 Medication unable to scan notice This is the same as the current missing dose report. There is one report of a missing dose and another notice for medications that will not scan. They are 2 different things and should be treated as such.This is the same as the current missing dose report. There is one report of a missing dose and another notice for medications that will not scan. They are 2 different things and should be treated as such.

43. 43 Summary report typed vs scanned This is the summary of the typed versus scanned report. Everyone has asked to find out how many products where actually scanned or typed into BCMA. Scanner bypass may be due to unable to scan items so this is a good report to base your improvement on. It should not be the only report you use. The BCRO will be asking for data form the sites concerning MSF improvements. The final report has not been determined but I would keep this report weekly or monthly in the beginning. As less of the unable to scan items occur, scanning items should increase.This is the summary of the typed versus scanned report. Everyone has asked to find out how many products where actually scanned or typed into BCMA. Scanner bypass may be due to unable to scan items so this is a good report to base your improvement on. It should not be the only report you use. The BCRO will be asking for data form the sites concerning MSF improvements. The final report has not been determined but I would keep this report weekly or monthly in the beginning. As less of the unable to scan items occur, scanning items should increase.

44. 44 MSF-Things to think about Define a scanning failure at your site Who gets reports? How often are reports run? How will they be responded to? Keep records of your progress Optional 5 rights verification As with any new software release there are many things to think about. Have you defined what a scanning failure really is? Is it one scan, 2 scans? Remember the reports need to be seen by more than just pharmacy-IRM, bio med, nursing managers, quality management way all want to see reports. When are you going to run the reports-daily, after each med pass, what happens on the weekends and evenings? Keep records! Use the first months reporting period as a baseline and hopefully the number of reported items will decrease each month thereafter. Nationally we are required to show the unions that this software enhancement has made a positive impact on patient care. The BCRO will be asking for your monthly data soon after national release.As with any new software release there are many things to think about. Have you defined what a scanning failure really is? Is it one scan, 2 scans? Remember the reports need to be seen by more than just pharmacy-IRM, bio med, nursing managers, quality management way all want to see reports. When are you going to run the reports-daily, after each med pass, what happens on the weekends and evenings? Keep records! Use the first months reporting period as a baseline and hopefully the number of reported items will decrease each month thereafter. Nationally we are required to show the unions that this software enhancement has made a positive impact on patient care. The BCRO will be asking for your monthly data soon after national release.

45. 45 Durham�s lessons learned Volume of reports When to run? Replacement of equipment Pharmacy processes Replacement of medications Drug synonym matches End user observations to find issues IV large volume ward stock At first you will probably receive a large volume of unable to scan reports. Previously I mentioned that the staff receiving these reports will need the time to review them. You need as a group when to run these reports-after each major med pass, daily, weekly? Remember the entire purpose of the nurse notifying you of a non scan issue is so that it can be corrected. They will lose confidence in the system if their non scan issues are not acted on in a timely manner. Who is going to replace a bad printer or scanner? Do you have replacement equipment available to swap out? What work flow issues will pharmacy need to change to review and replace medications that are not scanning. The item may have a valid bar code but may not be in the drug synonym file. Will the ADPAC be available to find this out in a timely manner? End user observations will be critical during implementation. This can serve as another chance to collect data for the Bar Code Quaility Directive. Observation show a proactive approach to solving problems rather then waiting for the report to print out. If the staff nurse sees someone is trying to help them they will react more positive to the software enhancement. Expect a lot of problems with the large volume IVs being reported. We all know the problems, the white bar code place at the top of the IV bag. The manufacturer�s are working on solutions to your complaints.At first you will probably receive a large volume of unable to scan reports. Previously I mentioned that the staff receiving these reports will need the time to review them. You need as a group when to run these reports-after each major med pass, daily, weekly? Remember the entire purpose of the nurse notifying you of a non scan issue is so that it can be corrected. They will lose confidence in the system if their non scan issues are not acted on in a timely manner. Who is going to replace a bad printer or scanner? Do you have replacement equipment available to swap out? What work flow issues will pharmacy need to change to review and replace medications that are not scanning. The item may have a valid bar code but may not be in the drug synonym file. Will the ADPAC be available to find this out in a timely manner? End user observations will be critical during implementation. This can serve as another chance to collect data for the Bar Code Quaility Directive. Observation show a proactive approach to solving problems rather then waiting for the report to print out. If the staff nurse sees someone is trying to help them they will react more positive to the software enhancement. Expect a lot of problems with the large volume IVs being reported. We all know the problems, the white bar code place at the top of the IV bag. The manufacturer�s are working on solutions to your complaints.

46. 46 Durham�s Experience Tested MSF 9/1/06-9/30/07 MSF implementation process Multi-disciplinary team Education Implementation support Data collection Evaluation of data Determine baseline data collection period The Durham VA was allowed to put MSF into production before the new version was redesigned. They had over a years experience using the software. These are some of the words of wisdom they have expressed to us. Involve your multi-disciplinary committee early in the process. Wristband failures are now part of the equation so you must include whomever takes care of them at your site. All staff must be educated-think outside the box. Obviously nursing is high on the list but do not forget pharmacy, quality management or others that may request the reports generated by the software. You will need a lot of support when you go live not only because things are new but the volume of reports may be overwhelming to response to. Who is going to get the data collected and who is going to do the trend analyze. May sure that the staff doing the evalutation of the data have adequate time allotted for this. The BCRO will be asking for some of the data to be reported. We have to show, after 9 months, that this software enhancement had a positive result in reducing scanning circumvention. Determine your baseline data collection period early. You may want to use monthly reports to track and trend data but you must make sure that the months are compararable. If you start on the 15th of a month then your collection period would be through the 14th of the next month.The Durham VA was allowed to put MSF into production before the new version was redesigned. They had over a years experience using the software. These are some of the words of wisdom they have expressed to us. Involve your multi-disciplinary committee early in the process. Wristband failures are now part of the equation so you must include whomever takes care of them at your site. All staff must be educated-think outside the box. Obviously nursing is high on the list but do not forget pharmacy, quality management or others that may request the reports generated by the software. You will need a lot of support when you go live not only because things are new but the volume of reports may be overwhelming to response to. Who is going to get the data collected and who is going to do the trend analyze. May sure that the staff doing the evalutation of the data have adequate time allotted for this. The BCRO will be asking for some of the data to be reported. We have to show, after 9 months, that this software enhancement had a positive result in reducing scanning circumvention. Determine your baseline data collection period early. You may want to use monthly reports to track and trend data but you must make sure that the months are compararable. If you start on the 15th of a month then your collection period would be through the 14th of the next month.

47. 47 Closed Loop Verification Program Objectives Rational for program Understanding verification Items tracked Reports to sites Reports to manufacturers Positive results The last topic of our presentation is the VA Closed Loop Verification program. I will explain why the BCRO decided to do this program, a quick overview of verification, what items we track, how the BCRO tries to help sites, our reporting system about problematic bar codes to manufacturers and some of the positive results we have achieved because of your complaints.The last topic of our presentation is the VA Closed Loop Verification program. I will explain why the BCRO decided to do this program, a quick overview of verification, what items we track, how the BCRO tries to help sites, our reporting system about problematic bar codes to manufacturers and some of the positive results we have achieved because of your complaints.

48. 48 Closed Loop Verification Program Direct result of complaints about products not scanning from VA sites Products also identified through Bar Code Quality Directive or MSF BCRO does the investigation and contacts the supplier Speak as one voice for the entire VA BCRO contacts Contracting and the FDA This program is a direct result of your complaints about bar code quality and what could the VA do about it as an organization. I want your complaints about products whether it is a result of direct observation, testing during the Bar Quality Directive or MSF. We do not want the sites to spend the time trying to investigate a problem on their own. I can speak as one voice for the organization and usually get more impact that way. We have the contact information in contracting to notify them of persistent problems and we have a contact in the FDA Office of Compliance who is helping us resolve issues. This program is a direct result of your complaints about bar code quality and what could the VA do about it as an organization. I want your complaints about products whether it is a result of direct observation, testing during the Bar Quality Directive or MSF. We do not want the sites to spend the time trying to investigate a problem on their own. I can speak as one voice for the organization and usually get more impact that way. We have the contact information in contracting to notify them of persistent problems and we have a contact in the FDA Office of Compliance who is helping us resolve issues.

49. 49 Closed Loop Verification Program Mechanism to track problems in VA system Not limited to manufacturer products Central depository of information One voice speaking to suppliers 2 verification labs Give products to BCMA Coordinator The program is designed to track problems within VA. If we do not know what the problems are how can we solve them? This is how we discovered that the original scanners we purchased for BCMA would not read stacked bar codes. We try to assess problems that occur in VA sites as well as manufacturers products. This program allows the VA to have one central depository of information rather than 172 databases. When I call a supplier about a problematic bar code I tell them I represent the entire VA. Anytime you have a problematic bar code at your site give it to the BCMA Coordinator. They will forward the item to me and hopefully we can solve the problem.The program is designed to track problems within VA. If we do not know what the problems are how can we solve them? This is how we discovered that the original scanners we purchased for BCMA would not read stacked bar codes. We try to assess problems that occur in VA sites as well as manufacturers products. This program allows the VA to have one central depository of information rather than 172 databases. When I call a supplier about a problematic bar code I tell them I represent the entire VA. Anytime you have a problematic bar code at your site give it to the BCMA Coordinator. They will forward the item to me and hopefully we can solve the problem.

50. 50 Closed Loop Verification Program VA product Give recommendations to resolve issue IV labels, drug labels, wristbands, ATC Supplier product grade D or F Send letter to supplier Send letter to GS1, NAC, PBM and FDA If I receive a VA product, such as a wristband, IV label or Zebra label, I will try to identify the problem and give the site recommendations on how to solve the problem. If we receive a problematic bar code from a supplier and it verifies grade D or F we send a form letter to the supplier, and notify Global Standards1, which is an international bar code standards organization, we notify contracting, pharmacy benefits management and the FDA if needed thru their MedWatch program. GS1 has stated that the VA has the best reporting system in the world!If I receive a VA product, such as a wristband, IV label or Zebra label, I will try to identify the problem and give the site recommendations on how to solve the problem. If we receive a problematic bar code from a supplier and it verifies grade D or F we send a form letter to the supplier, and notify Global Standards1, which is an international bar code standards organization, we notify contracting, pharmacy benefits management and the FDA if needed thru their MedWatch program. GS1 has stated that the VA has the best reporting system in the world!

51. 51 What is verification? Verification is a quality control term Involves testing of a bar codes print quality Verification applies a pro-active approach 9 internationally accepted parameters make up a bar code Lowest grade on all parameters is the grade for the bar code DO NOT EXPECT VA SITES TO DO THIS So what in the world is verification? It is a quality control term that involves testing of the print quality. Suppliers are supposed to be doing this but we have seen many times they do not always do this. Verification is trying to be proactive rather than finding a problem later. There are 9 internationally accepted parameters for a bar code. The lowest grade on any parameter is the grade that bar code gets. It could have 8 As and 1 F, then the grade is F. The BCRO does not expect the sites to do this. We will handle the verification scoring.So what in the world is verification? It is a quality control term that involves testing of the print quality. Suppliers are supposed to be doing this but we have seen many times they do not always do this. Verification is trying to be proactive rather than finding a problem later. There are 9 internationally accepted parameters for a bar code. The lowest grade on any parameter is the grade that bar code gets. It could have 8 As and 1 F, then the grade is F. The BCRO does not expect the sites to do this. We will handle the verification scoring.

52. 52 ANSI/ISO Verification Parameters These are the 9 ISO/ANSI parameters measured by verifiers. ISO stands for International Standards Organization. ANSI stands for American National Standard Institute. Some verifiers do more- and that would be a feature or attribute of that verifier. Here�s a short summary of what they mean: 1-Edge Determination is a calculation and comparison that is made to determine if there are the proper number of bars and spaces in the symbol. This is not a graded item, it is pass/fail. 2-Reflectance minimum/Reflectance maximum is a determination of the �darkness� of the bars. 3-Minimum Edge Contrast is a determination of contrast of the edge of the bars to the adjacent spaces. 4-Symbol Contrast measures the contrast between the darkest bar and the brightest space 5-Modulation is a measurement of how a scanner sees the wide bars and spaces relative to the narrow bars and spaces (the way a scanner sees adjacent bars and spaces is different than the human eye) 6-Defects- these are �holes� in the bars or �splotches� in the spaces 7-Decodabilty- says that you can convert the bars and spaces to data the way a symbol specification says you�re supposed to be able to (usually has to do with the bars and spaces being the proper widths). 8-Decode- a symbol passes (or fails) when it successfully converts the bars and spaces into data. 9- Quiet Zone- All symbols (except for RSS) require a quiet zone- this measures if an appropriate quiet zone exists. The quiet zone is the �empty� space on the left and the right of the barcode.These are the 9 ISO/ANSI parameters measured by verifiers. ISO stands for International Standards Organization. ANSI stands for American National Standard Institute. Some verifiers do more- and that would be a feature or attribute of that verifier. Here�s a short summary of what they mean: 1-Edge Determination is a calculation and comparison that is made to determine if there are the proper number of bars and spaces in the symbol. This is not a graded item, it is pass/fail. 2-Reflectance minimum/Reflectance maximum is a determination of the �darkness� of the bars. 3-Minimum Edge Contrast is a determination of contrast of the edge of the bars to the adjacent spaces. 4-Symbol Contrast measures the contrast between the darkest bar and the brightest space 5-Modulation is a measurement of how a scanner sees the wide bars and spaces relative to the narrow bars and spaces (the way a scanner sees adjacent bars and spaces is different than the human eye) 6-Defects- these are �holes� in the bars or �splotches� in the spaces 7-Decodabilty- says that you can convert the bars and spaces to data the way a symbol specification says you�re supposed to be able to (usually has to do with the bars and spaces being the proper widths). 8-Decode- a symbol passes (or fails) when it successfully converts the bars and spaces into data. 9- Quiet Zone- All symbols (except for RSS) require a quiet zone- this measures if an appropriate quiet zone exists. The quiet zone is the �empty� space on the left and the right of the barcode.

53. 53 Verification Grading There is an international specification that governs the method of verification, it is called ISO 15416. According to this specification there is a distinction to be made between an over-all Symbol grade and a grade for a single scan path. A single scan path grade entails passing the measuring verifier�s laser through the symbol once and then the verifier delivers a grade for that single scan path. That is measuring only a small portion of the bar code, therefore ISO 15416 specifies an average of 10 equally spaced scan path grades to come up with an overall symbol grade.There is an international specification that governs the method of verification, it is called ISO 15416. According to this specification there is a distinction to be made between an over-all Symbol grade and a grade for a single scan path. A single scan path grade entails passing the measuring verifier�s laser through the symbol once and then the verifier delivers a grade for that single scan path. That is measuring only a small portion of the bar code, therefore ISO 15416 specifies an average of 10 equally spaced scan path grades to come up with an overall symbol grade.

54. 54 What Does VA Track? Drug, strength, dosage form, symbology Manufacturer, lot number, expiration date Reporting site Verification parameter grades Manufacturer point of contact Date letter sent, response received Corrective actions What do we track for all products sent to us. We record the drug, strength, dosage form and bar code symbology. If it is a manufacturer's product we record the lot number and expiration date. We record the reporting site. So far over � of the VA sites have reported at least one problem. We record all the verification parameter grades. Over the years the BCRO has found contact information for many suppliers. These quaility control experts want to be notified directly of any problems that occur. Of course we record when a letter was sent and if a response was received. We do not require suppliers to reply to us but most of them do. We keep track of all the corrective actions that have occurred because of our interventions.What do we track for all products sent to us. We record the drug, strength, dosage form and bar code symbology. If it is a manufacturer's product we record the lot number and expiration date. We record the reporting site. So far over � of the VA sites have reported at least one problem. We record all the verification parameter grades. Over the years the BCRO has found contact information for many suppliers. These quaility control experts want to be notified directly of any problems that occur. Of course we record when a letter was sent and if a response was received. We do not require suppliers to reply to us but most of them do. We keep track of all the corrective actions that have occurred because of our interventions.

55. 55 Closed Loop Verification Program 2004 -Started to collect data 2005 Formalized letter to supplier Contact sites with suggestions for improvement Contracting clause for bar code quality FY 2006 64 facilities submitting bar code products 356 bar code products submitted for verification analysis 57 letters sent to suppliers 20 responses received

56. 56 Results from FY 2006 This is pie chart of what occurred in FY 2006. This is pie chart of what occurred in FY 2006.

57. 57 Problems Did not anticipate wristband problems Needed to act immediately to rectify problem Annual wristband printer and media survey Standardized process to contact suppliers Standardized letter to suppliers Sent sample of product to suppliers When these results started to come in, the BCRO was stunned by the results. We saw that wristbands where just as big a problem as manufacturers products. We knew we had to do something, so we started our annual wristband survey to see what the problems where. This information became the basis for VHA Directive 2006-069 Purchasing of wristband scanners, wristband printers and wristband media. Only approved BCRO approved products can be purchased for use in BCMA. We test products and compare their results equally so that �best in breed� options are available. We changed the format of our letters to suppliers to include the actual sample of the product sent to our office. We added contracting and the FDA to our mailing list. When these results started to come in, the BCRO was stunned by the results. We saw that wristbands where just as big a problem as manufacturers products. We knew we had to do something, so we started our annual wristband survey to see what the problems where. This information became the basis for VHA Directive 2006-069 Purchasing of wristband scanners, wristband printers and wristband media. Only approved BCRO approved products can be purchased for use in BCMA. We test products and compare their results equally so that �best in breed� options are available. We changed the format of our letters to suppliers to include the actual sample of the product sent to our office. We added contracting and the FDA to our mailing list.

58. 58 Closed Loop Verification Program FY 2007 10 additional facilities submitted bar codes 96 bar code products submitted for verification analysis 24 letters sent to suppliers 12 responses received

59. 59 Results from FY 2007

60. 60 Results for FY 2008 October through April 2008 3 additional facilities submitted bar codes Over 50% of facilities have sent samples 52 bar code products submitted fore verification analysis 14 letters to manufacturers 7 responses received

61. 61 Results for FY 2008

62. 62 Positive Results Contracts C target A written into new contracts IV solutions BCRO staff added to GS1 HUG international standards workgroup FDA involvement Direct meetings MedWatch Global Standards1support Dimpled Foil Backgrounds Small vials Now less talk about some of the positive results from this program. We are probably the only health care organization that has a bar code quality clause written into all VA national purchases. I was added to the GS1 Health Users Group pharmaceutical standards group specifically looking at IV products. Chris Tucker is co-chair of another committee looking at bar code standards. Through our intervention we have the FDA engaged in monitoring that bar code products comply with labeling regulations. They were not engaged until Russ Carlson and myself met with them. They also asked that we submit any problem to them through their product complaint reporting system MedWatch. Global Standards has been calling suppliers on our behalf when they receive one of our complaints. This puts a little fire under the supplier to do better. Many of you remember the dimpled foil unit dose liquids, they have been removed from the market thanks to your complaints. We all remember the small vials that had bar codes printed on them that wrapped around the vial and could not be scanned. Most of them have been removed from the market also.Now less talk about some of the positive results from this program. We are probably the only health care organization that has a bar code quality clause written into all VA national purchases. I was added to the GS1 Health Users Group pharmaceutical standards group specifically looking at IV products. Chris Tucker is co-chair of another committee looking at bar code standards. Through our intervention we have the FDA engaged in monitoring that bar code products comply with labeling regulations. They were not engaged until Russ Carlson and myself met with them. They also asked that we submit any problem to them through their product complaint reporting system MedWatch. Global Standards has been calling suppliers on our behalf when they receive one of our complaints. This puts a little fire under the supplier to do better. Many of you remember the dimpled foil unit dose liquids, they have been removed from the market thanks to your complaints. We all remember the small vials that had bar codes printed on them that wrapped around the vial and could not be scanned. Most of them have been removed from the market also.

63. 63 Closed Loop Verification Program Send any problematic bar code Ron Schneider Pharmacy Service (119) 7525 Greenway Center Drive Suite T4 Greenbelt, Maryland 20770 Send any bar codes that you cannot scan to me. Send me prescription products that do not have a bar code. I will contact the supplier to get the process started to get things changed. OTC products represent more of a challenge since the suppliers fall back on the OTC exemption in the bar code regulation. I have 2 addresses listed to send me products. Regular mail send to the DC VA is still checked for antrax and that can destry wristbands and some backings on the bar code. The regular mail will get to me but just take a couple of days longerSend any bar codes that you cannot scan to me. Send me prescription products that do not have a bar code. I will contact the supplier to get the process started to get things changed. OTC products represent more of a challenge since the suppliers fall back on the OTC exemption in the bar code regulation. I have 2 addresses listed to send me products. Regular mail send to the DC VA is still checked for antrax and that can destry wristbands and some backings on the bar code. The regular mail will get to me but just take a couple of days longer

64. 64 Contracting involvement Attached is a letter dated April 28, 2008 from the Veteran Health Administration�s Bar Code Resource Office. In order to maintain the integrity of VA�s patient safety systems, vendors are requested to conform to bar code quality printing guidelines by provide products that meet ANSI / ISO verification grade minimum C target A. In the letter, the Bar Code Resource Office notes that Sandoz�s Haloperidol 5 mg tablet, NDC# 00781-1396-13, Lot # 163084, expiration date 9/2008, has an Overall ANSI Grade of F. Please follow up with us to (1) explain why the product from the lot number noted above did not meet the bar coding requirements; and (2) how Sandoz intends to correct any deficiencies in your bar coding processes in order to ensure Sandoz�s future compliance with the bar coding requirements.

65. 65 Summary Report any problematic bar code identified by Directive process or MSF GS1 �VA has the best reporting system in the world� BCRO on GS1 Standards Group for Pharmaceuticals FDA is working with us to get things changed Manufacturers are working with us to get things changed The Directive leads me into another topic that I will just talk about briefly. What do we do if you find a problematic bar code? If you cannot get it to scan send it to me, so we can determine (if possible) what the issue is. Global Standards 1, an international bar code specifications group, states that we have the best reporting system in the world. I have been added to their Health User Group Standards for Pharmaceuticals. The end user has never been considered in the evaluated on bar coded products. We are now. The FDA is now assisting in our reporting of problematic bar codes. They have asked to be added to our notification list. I am receiving calls now from manufacturers stating that the FDA has contacted them about one of our issues. The manufacturers are now listening to our complaints also. We are in constant communication with them about issues with bar codes. An example is the new unit dose ointment packets that are on VA contract. They did not have a bar code on the packette. We are making progress but it is slow.The Directive leads me into another topic that I will just talk about briefly. What do we do if you find a problematic bar code? If you cannot get it to scan send it to me, so we can determine (if possible) what the issue is. Global Standards 1, an international bar code specifications group, states that we have the best reporting system in the world. I have been added to their Health User Group Standards for Pharmaceuticals. The end user has never been considered in the evaluated on bar coded products. We are now. The FDA is now assisting in our reporting of problematic bar codes. They have asked to be added to our notification list. I am receiving calls now from manufacturers stating that the FDA has contacted them about one of our issues. The manufacturers are now listening to our complaints also. We are in constant communication with them about issues with bar codes. An example is the new unit dose ointment packets that are on VA contract. They did not have a bar code on the packette. We are making progress but it is slow.

66. 66