This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
The technology
Barcode medication administration (BCMA) links a handheld scanner to the electronic medication administration record (eMAR). The nurse scans the patient's wristband and each medication, and the system checks them against the active orders before the dose is given. It is designed to support the "rights" of medication administration at the bedside, the last point at which an error can be caught.
Evidence that it works
In a before-and-after study at an academic medical center, researchers observed 14,041 medication administrations and reviewed 3,082 order transcriptions. On units using bar-code eMAR, nontiming administration errors fell from 11.5% to 6.8%, a 41.4% relative reduction. Potential adverse drug events from those errors fell by 50.8%, timing errors fell by 27.3%, and transcription errors, which occurred at a rate of 6.1% without the system, were eliminated (Poon et al., 2010). The system reduced errors but did not remove them.
Why the safety features get bypassed
Koppel et al. (2008) studied BCMA use at five hospitals through observation, interviews and override logs. They identified 15 types of workarounds and 31 types of causes. Examples included:
| Workaround | Typical cause |
|---|---|
| Patient ID barcodes taped to carts, doorjambs or a nurse's belt | Wristbands unreadable, missing or hard to reach on a sleeping patient |
| Scanning several patients' medications in advance and carrying them together | Time pressure and long medication passes |
| Overriding alerts without reading them | Frequent alerts the nurse sees as irrelevant |
| Giving unscanned medications | Missing or crinkled barcodes, failing batteries, poor wireless connection |
Nurses overrode alerts for 4.2% of patients charted and 10.3% of medications charted. Each workaround removes the check the system was bought to provide, and the authors traced most of them to problems with design, implementation and workflow rather than careless staff.
Recommendations for a unit
- Track workarounds as system signals. Review scanning compliance and override reports monthly, and ask nurses what caused them.
- Fix the causes. Replace damaged wristbands at every assessment, keep spare scanner batteries charged, and have pharmacy relabel products with unreadable barcodes.
- Reduce unhelpful alerts. Work with pharmacy and informatics to remove alerts that rarely change practice, so the important ones are read.
- Involve frontline nurses in testing any change to the scanning workflow before it goes live.
The BSN nurse's role
The BSN nurse uses BCMA every shift and is often the first to see when it doesn't fit real work. Reporting barriers, joining unit informatics or practice councils, and modeling scanning at every dose help the technology deliver the safety gains shown in research.
References
Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408–423. https://doi.org/10.1197/jamia.M2616
Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, J. M., Kachalia, A. B., Hayes, J., Churchill, W. W., Lipsitz, S., Whittemore, A. D., Bates, D. W., & Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698–1707. https://doi.org/10.1056/NEJMsa0907115
