Dear all:

I would like to take your opinion in the following:
In our hospital we use Insulin pen in the inpatient setting as a patient specific medication devices, when dispensing the medication to the patient we label it with a patient specific dose including patient identification, dose, route frequency and a barcode. and when there is any change in the dose and/or frequency the pharmacy is expected to re-dispense a new pen to the patient labelled with a correct information that is reflected on the medication barcode.

Last year we noticed that we have a huge amount of return and waste of Insulin pen, related mainly to possible dose or frequency change of Insulin, and the pharmacy every time dispensing a new Insulin pen with each change.

Based on this we initiated a performance improvement project, were the pharmacy will dispense the pen to the admitted patient once prescribed, then in case of any dose/ frequency change, the pharmacy will review and verify the orders then subsequently the change will be reflected on the eMAR but the pharmacist will not dispense a new pen and the nurse would be expected to follow the dose form eMAR not from the label.

When we started to implement the BCMA (bed side medication barcode scanning) we faced a challenge that when the nurse would scan the barcode it would populate the dose included in the barcode (the initial starting dose) not the most recent patient dose, and there would be discrepancy during medication charting between the barcode dose and the eMAR dose.
I would like to learn from your experience on how you are managing Insulin pen dispensing and utilization in the in-hospital setting incase of dose change.
and if you have BCMA how are you managing the discrepancy challenge during barcode scanning and medication administration charting

I wish I was able to describe the issue and would highly appreciate your opinion in this if any