Workarounds to Barcode Medication Administration Systems
This is a fabulous pre-print paper from JAMIA (PDF) that sums up the issues perfectly. Bar code medication administration (BCMA) does help with patient safety, more so than computerised physician order entry (CPOE) does, and at a fraction of the price and headaches. But it is still costly and it causes headaches for the nurses.
The headaches appear as workarounds: things nurses do to avoid the pain of BCMA.
Hospital CIOs have to pay attention to workarounds to improve patient safety – by maintaining the workflow of BCMA – but also to help the nurses – they are too busy to complain when the system is not working.
Table 1 in the paper is well worth reading as it summarizes the workarounds:
Omission of process steps
- User scans medication from patient drawer without visual check of medication list, medication name and dose.
- Physicians do not review electronic medication administration record to verify current medications.
- User administers medication without reviewing parameters for medication administration.
- Users bypass policy for “medication double check” by second provider, or second nurse confirms without reviewing medications.
- User does not check / verify patient’s new medication orders before administering medication.
- User administers medication without scanning patient ID to confirm correct patient.
- User administers medication without scanning barcode to confirm it is correct medication, time, dose.
- User documents medication administration before medication is administered and / or observed ingested by patient
- Patient barcode placed on another object (not patient) and user scans it.
- User prepares, scans and transports medications for > 1 patient at a time when administering medications.
- User scans barcode after barcode label has been removed from the medication itself.
- User has multiple medication packages for full dose and scans the same medication package multiple times.
- User takes the scanner separate from the cart into the room where the cart alarm cannot be seen.
- User gives partial dose but electronically documents full dose.
- User disables audio alarms on device.