Think Bar-Code Medication Administration Eliminates Adverse Drug Events? Think Again!

Abstract

I am a clinical nurse specialist (CNS) in an academic medical center that is implementing Bar-Code Medication Administration (BCMA). Does BCMA eliminate errors? How strong is the evidence supporting this expensive technology? What is the impact of BCMA on nursing workflow? B ar-code medication administration is the application of a widely used and reliable commercial technology to prevent medication errors. 1 A unique identifier or bar code placed on each medication is read by an optical scanner. Bar-code medication administration uses the National Drug Code, which describes the drug name, dose, drug company, and type of packaging. 2 In addition, the patient is provided a bar-code identifier attached to the wristband to ensure correct patient identification. 3 Bar-code medication administration is endorsed as a patient safety intervention by the Agency for Healthcare Research and Quality and the Institute of Medicine. 4,5 Whereas computerized physician order entry reduces prescribing and transcribing errors, BCMA targets errors associated with dispensing and administration of medications. 3 Emerging evidence suggests that nurses are satisfied overall with the BCMA technology. In a survey of 1,087 nurses and 28 interviews, satisfaction with the conversion to BCMA was assessed. Although medication administration was perceived as more time-consuming, nurses were satisfied with the efficacy and safety provided by BCMA. 6 However, nurses have also identified problems associated with BCMA. Lack of technology flexibility often results in conflicts when reconciling the ever-changing priorities in clinical care, provision of nonroutine medications, and administration of scheduled doses. Furthermore, difficulties in care coordination and nurse-physician communication may be enhanced by BCMA. 6,7 Early evidence suggests that BCMA exerts a significant burden on workload, which is supported by nurses' perceptions that BCMA is a time-consuming process. In a time study of 108 nurses in a 735-bed medical center, one hundred sixteen 2-hour periods of practice were observed to evaluate the impact of BCMA. Result demonstrated that 26.9% of the nurse's time was spent on medication-related activities, which included information retrieval, management of physician orders, waiting, obtaining and verifying medications, medication administration, and documentation. 8 BCMA ErrorsBar-code medication administration errors can occur in the dispensing or administration phases. In a recent report, 515 reports were evaluated from MEDMARX, a national database of voluntarily reported medication errors. 3 In 70 reports, BCMA prevented an error from reaching a patient; 51 of the errors began in the dispensing phase, 14 errors were about wrong doses, and 11 were stocking errors. Nurses intercepted 27% (19) of the 70 errors during medication administration. However, in 445 reports, medication errors were a consequence of BCMA. Two hundred and eighty-four errors were reported as near misses, 160 were nonharmful, and 1 of the 445 errors was deemed harmf...

Is a bar code medication system right for your ICU?

“…34 Also, communication between caregivers, caregiver education, best practice reinforcement, and error reporting policies can help fill in the safety gaps when using the BCMA system. 40 ❖ 39 Ultimately, further patient-safety research is needed to help pinpoint and address errors caused by the BCMA as well as proving the efficiency of the BCMA system in ICU settings.…”

A Pilot Study of Bar Codes in a Canadian Hospital

“…[10][11][12] As a result, many health care professionals think that using bar codes can help to reduce, though not eliminate, medication errors. 13,14 Notably, emergence of the concept of human factors engineering may contribute to more effective management of the introduction and optimal use of bar codes in the medication-use system. 15 The 2009-2010 survey of hospital pharmacy in Canada found that 49% of health care institutions used bar codes (72% of university hospitals and 40% of nonuniversity hospitals).…”

Is technology the best medicine? Three practice theoretical perspectives on medication administration technologies in nursing

“…According to O'Malley ‘bar code medication administration is …[a] unique identifier or bar code placed on each medication which is read by an optical scanner… In addition, the patient is provided a bar code identifier attached to the wristband to ensure correct patient identification' (O'Malley , 269). In the extant empirical literature on bar code medication administration (BCMA), the focus tends to be primarily on safety and/or on how use of these technologies by nurses might affect safety.…”