The following paper explores eight published articles that address the issue of bar code scanning for medication administration and patient safety. Online research was conducted to locate and review articles which are included in review of literature, and to acquire accurate information addressing the issues discussed. The understanding of Bar Code Scanning for Medication Administration (BCMA) is a valuable tool, providing safe practice needed to reduce medication errors leading to safer patient handling. Patient safety is defined by the Institute of Medicine (IOM) as the prevention of harm caused by errors of commission and omission (Henneman, 2010, p. 8). The use of BCMA changed medication administration, documentation, and communication regarding patient care (Spetz, Burgress, & Phibbs, 2012, p. 158). Key words: bar code scanning of medications, patient safety and workarounds Issues
1. Discuss bar code scanning in medication administration (BCMA). 2. Discuss how the use of BCMA has affected patient safety. 3. Discuss the implications of workarounds in medication administration to the patient. Literature Review
Discuss How the Use of BCMA has Affected Patient Safety
The following articles were reviewed for the purpose of addressing the issue: how BCMA has affected patient safety. Patient safety has been an issue in all realms of healthcare. The use of BCMA introduced a new avenue to establish the best practice of drug administration for patient safety. “Medication Administration: The Implementation Process of Bar-Coding for Medication Administration to Enhance Medication Safety” (Foote & Coleman, 2008) discusses the issue of patient safety with the use of BCMA. According to (Foote & Coleman, 2008, p. 207) medication errors strike at the heart of being a nurse: the value of “do no harm”. The reduction of medication errors has had a direct and indirect effect on the patient and the nurse (Foote & Coleman, 2008, p. 207).
The direct effect can be a safety threat to the patient and an indirect effect can compromise the confidence of nursing practice (Foote & Coleman, 2008, p207). The use of BCMA has increased patient safety by system validation of the six rights of medication administration: right drug, right patient, right time, right route, right route, and right reason. The findings concluded patient safety has increased with the use of BCMA. Reduction of paperwork using BCMA for the nurse allows for more time with the patient reducing the risk for error.
“Impact of BCMA on Medication Errors and Patient Safety: A Summary” (Marini & Hasman, 2009) was also reviewed. The Institute of Medicine (IOM) estimates that one hospitalized patient is on average subject to one medication error per day. Medication errors that result in preventable adverse drug events may occur during any stage of the medication use process: ordering (56%) transcribing (6%) dispensing (4%) and administration (34%). The use of BCMA has addressed the issue of medication administration safety as a priority for patient safety (Marini & Hasman, 2009, p. 439). BCMA system use has decreased the errors in the administration phrase by possibly intercepting administration errors before they reach the patient (Marini & Hasman, 2009, p. 439). Enacting the BCMA technology into patient care has acted as a point of care safety system that assists in the protection from potential errors and safeguards the medication administration process where none previously existed (Marini & Hasman, 2009, p. 440).
Safeguards that have been put in place since the implication of BCMA into the healthcare field have shown from this article that safe practice has increased. The article, “Patient Misidentifications Caused by Errors in Standard Bar Code Technology (Snyder, Carter, Jenkins, & Fantz, 2010), discusses some medication errors on misreading wristband bar codes. The use of bar code scanning has decreased transcription errors in many healthcare applications including patient identification (Snyder et al., 2010, p. 1554). The study indicated misidentifications of patients could occur, contributing to unsafe patient practices. Wristbands used for identification can assist with identifying the correct patient in the six rights of medication administration. While this is not a failsafe answer it is valuable in providing a safe practice of medication administration to patients. Discuss Bar Code Scanning in Medication Administration (BCMA)
The following articles were reviewed for the purpose of addressing bar code scanning in medication administration. Nursing requires the critical skill of accurate medication administration. The use of electronic medication administration has brought about many changes in the healthcare field. The article,” What Determines Successful Implementation of Inpatient Information Technology Systems” (Spetz et al 2012), was reviewed to address the above question. Computerized patients records and bar-code medication systems continue to gain favor in healthcare. This idea spread across the nation in all VA sites (Spetz et al., 2012, p. 157), providing a safer environment for patient care. The use of bar code scanning utilizes the perfection of computers into medication-administration process. Training to use (BCMA) indicated from the article can be cumbersome and staff can be apprehensive about the change. The time needed for BCMA showed extremely high demands with the implementation of BCMA system (Spetz et al., 2012, p. 160).
The initial implementation of BCMA interrupted the flow of care for physicians and nurses (Spetz et al., 2012, p. 160) Training and time management were issues addressed including support, work flow changes, and communication allowing flexibility for changes and updates (Spetz et al., 2012, p. 161). In review of information, BCMA has assisted healthcare in providing a safer environment for patient care. The use of BCMA has increased awareness of mistakes, increased accountability to the staff by having recorded times of medication administration, and patient identifiers in patient care. The review of article “An Evaluation Process for an Electronic Bar Code Medication Administration Information System in an Acute Care Unit” (Bargen & Lu, 2009) discussed the development and use of BCMA in medication administration. An IOM report attributed 7,000 deaths annually to medication errors (Bargen & Lu, 2009, p. 356). Bar code medication administration systems were designed as a safety tool for nurses. The use of this system assists in reduction of errors at the point of medication administration (Bargen & Lu, 2009, p. 356). The reduction of medication errors was introduced by using computerized alerts and warnings.
These compelled users to stop and reconsider potentially unsafe steps in the medication administration process (Bargen & Lu, 2009, p. 356). This caused a workflow disturbance for nurses. BCMA processes were examined using direct staff observation, process mapping, and informal group discussion. The process assisted in data collection and reconfiguration of BCMA, thus reducing unnecessary alerts in the BCMA system. The conclusion drawn from review showed that a decrease in the numbers of unnecessary alerts triggered by the BCMA system can help ensure the workflow blocks nurses encounter are clinically significant and justified (Bargen & Lu, 2009, p. 357). Although the workflow blocks are there it is sometimes necessary to assist in safe patient handling. Another article reviewed was, “Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation” (Wideman, Whittler, & Anderson, 2006).
The use of bar code scanning has been used in retail for many years and was adapted for the use of medication administration originally by the Veterans Health Administration in the year 2000 and has spread across the US since that time (Wideman, Whittler, & Anderson, 2006, p. 437). The system was designed to improve accuracy in administration of medication through real time network connectivity. This allowed documentation electronically of administration of medications at the bedside (Wideman et al., 2006, p. 437). On April 04,2004 the U.S. Food and Drug Administration ruled that barcodes were mandatory on labels of thousands of human medication and biological products by the year 2006 (Wideman et al., 2006, p. 438). The VA health care system used barcode scanning already in place and included the barcode of the medications in the safety system. This provided a better opportunity for patient safety using the BCMA system.
The use of a handheld barcode scanner at the bedside registered each medication, software verified correct medication was ordered, time of administration is correct, measured in the correct dose, and in real time documents the administration of the medication (Wideman et al., 2006, p. 439). Alleviation of paper medication record for the nurse reduced the chance for medication error and harm to the patient. By the use of this system missed medications, medication actions, and medication ordering could be done as the bedside. The induction of BCMA into patient bedside medication administration also reduced phone calls to the pharmacy from nurses. This helped to increase efficiency for medication administration providing a safer environment for patient care. Discuss the Implications of Workarounds in Medication Administration to the Patient The use of BCMA for medication administration was not received with open arms.
The training, computer knowledge, workflow blocks, were some of the complaints by nurses. The following articles reviewed discussed workarounds when using BCMA. The article reviewed “Patient Safety and Technology” (Henneman, 2010) discussed safety and BCMA. The goal for BCMA systems was to prevent medication administration errors (Henneman, 2010, p. 9). Identifying and verification of the patient’s identity is critical to assure patient safety and reduction of medication errors. Work-arounds have been reported with the use of the BCMA system in place. These work arounds create a serious threat to patient safety (Henneman, 2010, p. 9). Workarounds include affixing patient identification bar codes to computer carts, clip boards and carrying several patients’ pre scanned medications on carts (Henneman, 2010, p. 10). BCMA systems have assisted in creation of some work-arounds with unreadable medication bar codes, non-bar coded medications, malfunctioning scanners at the bedside, and missing patient armbands used as a patient identifier (Henneman, 2010, p. 10).
The review indicates workarounds can be created for any situation. It is the responsibility of the nurse to ensure the correct medication is being administered to the correct patient using the six rights of medication administration. BCMA is only a tool to assist in safe patient handling. Another article reviewed, “Medication Errors Occurring with the Use of Bar-Code Administration Technology” (Pennsylvania patient safety advisory, 2008) discussed workarounds as a method of accomplishing an activity through other arrangements when not able or willing to use the correct method. A temporary solution is not the answer and, puts the patient at greater risk for medication error. Using work-arounds such as typing the patients’ social security number, indicating the medication will not scan, or affixing the wristband of patients to bedsides rather than the patient’s wrist puts the patient at risk (Pennsylvania patient safety advisory, 2008, p. 125). The summary from review indicates it is the nurse’s responsibility to ensure safe medication administration even though it is not always the fastest method.
Analysis of Findings
Patient safety, bar code scanning and work-arounds all relate safe patient handling. The review of literature indicates safety is the number one priority in healthcare. The development of BCMA was part of the process to ensure a safer procedure for medication administration. Medication errors indicated that BCMA was not always the cause of the problem. Mislabeling of medications, work-arounds, missed scanned wristbands have all contributed to errors in medication administration. Findings indicate that although BCMA is an excellent tool to assist in the six rights of medication administration to the patient. It is not an overall solution to medication errors. The responsibility is a collective effort by physicians, pharmacists, and nurses to ensure the safest practice for the patient.
Implication for Practice
BCMA is an excellent tool to assist the nurse in bedside medication administration. The inpatient environment is hectic for the nurse, having multiple patients and time limitations. Patient safety is a priority in healthcare and taking the time to ensure the correct medication is being administered to the correct patient is part of nursing practice. The use of BCMA assists this process by ensuring the medication has been correctly ordered by the physician, verified by the pharmacist, and verification of patient identifiers. The system alerts nursing when there is a question of correct dose, medication, time, route, or patient. This assists the nurse in providing a safer method of medication administration. The field of nursing requires critical thinking skills in all realms of patient care. Medication administration is only one area of nursing practice. A safer environment for the patient is part of everyday practice for the inpatient nurse.
The use of BCMA assists the nurse in providing this environment in patient care. Although work-arounds are many times easier for the nurse in time management, it is not the safest practice. Identifying and verification of the patient’s identity is critical to assure patient safety and reduction of medication errors. The understanding of Bar Code Scanning for Medication Administration (BCMA) is a valuable tool, providing safe practice needed to reduce medication errors leading to safer patient handling. Patient safety is defined by the Institute of Medicine (IOM) as the prevention of harm caused by errors of commission and omission (Henneman, 2010, p. 8). The use of BCMA changed medication administration, documentation, and communication regarding patient care (Spetz, Burgress, & Phibbs, 2012, p. 158). In the practice of nursing this all relates to everyday practice. Patient safety, avoiding the temptation of work-arounds, and using tools such as BCMA ensure that nursing is utilizing all the information to assist patients in the healing process.
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