Barcode Medication Administration Work-Arounds

Voshall, Barbara; Piscotty, Ronald J.; Lawrence, Jeanette A.; Targosz, Mary

doi:10.1097/nna.0b013e3182a3e8ad

Cited by 36 publications

(13 citation statements)

References 19 publications

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“…Studies estimate the rate of adverse drug events (ADEs) to be between 6.5 and 15 ADEs per 100 hospital admissions with 28% to 75% of ADEs being preventable [5,6]. Of all hospital ADEs, 34% take place during medication administration, and less than 2% are caught before administration is complete [7,8]. …”

Section: Introductionmentioning

confidence: 99%

Efficiency and Usability of a Near Field Communication-Enabled Tablet for Medication Administration

Landman¹,

Neri²,

Robertson³

et al. 2014

JMIR mHealth uHealth

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BackgroundBarcode-based technology coupled with the electronic medication administration record (e-MAR) reduces medication errors and potential adverse drug events (ADEs). However, many current barcode-enabled medication administration (BCMA) systems are difficult to maneuver and often require multiple barcode scans. We developed a prototype, next generation near field communication-enabled medication administration (NFCMA) system using a tablet.ObjectiveWe compared the efficiency and usability of the prototype NFCMA system with the traditional BCMA system.MethodsWe used a mixed-methods design using a randomized observational cross-over study, a survey, and one-on-one interviews to compare the prototype NFCMA system with a traditional BCMA system. The study took place at an academic medical simulation center. Twenty nurses with BCMA experience participated in two simulated patient medication administration scenarios: one using the BCMA system, and the other using the prototype NFCMA system. We collected overall scenario completion time and number of medication scanning attempts per scenario, and compared those using paired t tests. We also collected participant feedback on the prototype NFCMA system using the modified International Business Machines (IBM) Post-Study System Usability Questionnaire (PSSUQ) and a semistructured interview. We performed descriptive statistics on participant characteristics and responses to the IBM PSSUQ. Interview data was analyzed using content analysis with a qualitative description approach to review and categorize feedback from participants.ResultsMean total time to complete the scenarios using the NFCMA and the BCMA systems was 202 seconds and 182 seconds, respectively (P=.09). Mean scan attempts with the NFCMA was 7.6 attempts compared with 6.5 attempts with the BCMA system (P=.12). In the usability survey, 95% (19/20) of participants agreed that the prototype NFCMA system was easy to use and easy to learn, with a pleasant interface. Participants expressed interest in using the NFCMA tablet in the hospital; suggestions focused on implementation issues, such as storage of the mobile devices and infection control methods.ConclusionsThe NFCMA system had similar efficiency to the BCMA system in a simulated scenario. The prototype NFCMA system was well received by nurses and offers promise to improve nurse medication administration efficiency.

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Section: Introductionmentioning

confidence: 99%

Efficiency and Usability of a Near Field Communication-Enabled Tablet for Medication Administration

Landman¹,

Neri²,

Robertson³

et al. 2014

JMIR mHealth uHealth

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“…35 36 Others explored the connection between workarounds and safety, concluding Open access that BCMA has the capacity to reduce medication errors if used correctly. 14 37 Voshall et al 35 advocated improved compliance to realise the safety benefits of BCMA, while Hassink et al 36 highlighted how system design, workflow mismatch and implementation strategies influence the safety of BCMA but noted that the studies reviewed often did not elaborate on how BCMA was implemented or how the workflow mismatch was addressed. Debono et al's review 14 focuses on workarounds and why nurses use them to achieve their goals; they consider the wider context of healthcare delivery and conclude that the nurses' perspective must be understood to reduce workarounds and improve bedside care.…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology?

et al. 2021

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BackgroundIn order to reduce safety risks associated with medication administrations, technologies such as barcode medication administration (BCMA) are increasingly used. Examining how human factors influence adoption and usability of this technology can potentially highlight areas for improvement in design and implementation.ObjectiveTo describe how human factors related determinants for BCMA have been researched and reported by healthcare and human–computer interaction disciplines.Data sourcesThe Cumulative Index of Nursing, and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar.Study eligibility criteriaPrimary research published from April 2000 to April 2020, search terms developed to identity different disciplinary research perspectives that examined BCMA use, used a human factors lens and were published in English.Synthesis methodsComputerised systematic searches were conducted in four databases. Eligible papers were systematically analysed for themes. Themes were discussed with a second reviewer and supervisors to ensure they were representative of content.ResultsOf 3707 papers screened, 11 were included. Studies did not fit neatly into a clinical or human-computer interaction perspective but instead uncovered a range of overlapping narratives, demonstrating consensus on the key themes despite differing research approaches. Prevalent themes were misaligned design and workflow, adaptation and workarounds, mediating factors, safety, users’ perceptions and design and usability. Inadequate design frequently led to workarounds, which jeopardised safety. Reported mediating factors included clarity of user needs, pre/post implementation evaluations, analysis of existing workarounds and appropriate technology, infrastructure and staffing.LimitationsMost studies were relatively small and qualitative, making it difficult to generalise findings.ConclusionEvaluating interdisciplinary perspectives including human factors approaches identified similar and complementary enablers and barriers to successful technology use. Often, mediating factors were developed to compensate for unsuitable design; a collaborative approach between system designer and end users is necessary for BCMA to achieve its true safety potential.

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“…‘If the user makes an error, it’s usually the result of a design flaw’ (Eggertson, 2014: 25). We connect what nurses’ know about the circumstantial features of their work, its moment-to-moment pace and its risks, with the knowledge they rely on to invent the workarounds that seem an intractable feature of nurses’ work with digitalized systems of medication administration (Voshall et al,2013).…”

Section: The Studymentioning

confidence: 99%

Nurses’ knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses’ agency inside ruling

Boonen

Rankin

Vosman³

et al. 2018

Health (London)

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This article shows how Barcoded Medication Administration technology institutionally organizes and rules the daily actions of nurses. Although it is widely assumed that Barcoded Medication Administration technology improves quality and safety by reducing the risk of human error, little research has been done on how this technology alters the work of nurses. Drawing on empirical and conceptual strategies of analysis, this qualitative study used certain tools of institutional ethnography to provide a view of how nurses negotiate Barcoded Medication Administration technology. The approach also uses elements from practice theory in order to discern how technology operates as a player on the field instead of being viewed as a 'mere' tool. A literature review preceded participant observation, whereby 17 nurses were followed and data on an orthopaedic ward were collected over a period of 9 months in 2011 and 2012. Barcoded Medication Administration technology relies on nurses' knowledge to mediate between the embedded logics of its design and the unpredictable needs of patients. Nurses negotiate their own professional logic of care in the form of moment-to-moment deliberations which subvert the ruling frame of the barcoded system and its objectified model of patient safety. The logic of Barcoded Medication Administration technology differs from the logic of nursing care, as this technology presumes medication distribution to be linear, even though nurses follow another line of actor-bound safety practices that we characterize as 'deliberations'.

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Barcode Medication Administration Work-Arounds

Cited by 36 publications

References 19 publications

Efficiency and Usability of a Near Field Communication-Enabled Tablet for Medication Administration

Efficiency and Usability of a Near Field Communication-Enabled Tablet for Medication Administration

Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology?

Nurses’ knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses’ agency inside ruling

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