Barcode medication administration
Barcode Medication Administration Systems and Adverse Drug Events Medication administration errors have the potential to induce Adverse Drug Events (ADE) that can potentially cause serious harm to patients. Barcode Medication Administration (BCMA) systems are designed to reduce the potential for ADEs by reducing the cognitive load placed on nursing staff during the medication administration process. BCMA systems maximize the cognitive load in the medication administration process by electronically verifying the accuracy of the “5 rights” of right patient, drug, dose, time and pathway. To achieve this level of functionality BCMA systems as highly dependent on a user interface culture where safe-use protocols are consistently adhered too. In such cases the benefits are real. In a 2010 quasi-experimental study Poon, et al., report that barcode medication administration systems have been associated with a 41% reduction in non-timing administration errors and a 51% reduction in potential adverse drug events from these errors, carrying the potential to prevent 95,000 possible ADEs (2010).
Workarounds: Workarounds consist of processes that allow for the task to be complete but do not necessarily follow the desired workflow, designed to achieve specific quality and safety outcomes. In developing workarounds, providers deviate from required safe-use protocols, thereby limiting BCMA benefits, effectively creating new pathways to adverse drug events at the time of medication administration (Koppel, et al., 2008).
Why Workarounds: BCMA systems are complex and involve the efforts of multiple systems to coordinate the work of providers over time and space. Implementation of BCMA systems is often disruptive. Accordingly, the majority of workarounds are developed to cope with the disruptions that occur to workflows that had previously coordinated medication administration tasks across shifts and between departments and units (Novak & Lorenzi, 2008).
Categories of BCMA Workarounds A typology of workarounds has been posited by Koppel, et al., in a 2008 article titled Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety. The authors conducted a mixed-method study of BCMA use over a three-year period between 2003 and 2006 at a 470 bed Midwestern hospital and a 929 bed East Coast health system. Results of the study identified omitted steps (i.e. failure to scan wristband), incorrect sequence (i.e. prospective medication documentation) and unauthorized steps (i.e. disabling device alert safety features) as the most commonly observed workarounds. The study concluded that workarounds could be associated with technology, task, organization, patient and environmental causes. Workaround triggers range from software or hardware failure to the need to save time to patient circumstances (i.e. sleeping or vomiting).
References Koppel, R. P., Wetterneck, T. M., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to Barcode Medication Administration Systems: Their Occurances, Causes, and Threats to Patient Safety. Journal of the America Medical Informatics Association , 408-421. Novak, L. L., & Lorenzi, N. M. (2008). Barcode Medication Administration Administration: Supporting Transitions in Articulation Work. AMIA 2008 Symposium Proceedings, (p. 515). Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M. B., Bane, A. R., Levtzion-Korach, O. M., et al. (2010). Effect of Bar-Code Technology on the Safety of Medication Administration. New England Journal of Medicine , 362 (18), 1698-1707.
