Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds

Abstract

Spanish

French

BACKGROUND:

Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors.

OBJECTIVE:

To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR).

METHODS:

Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted.

RESULTS:

Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time.

CONCLUSIONS:

BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology.

Keywords

bar code medication administration medication errors medication safety

Get full access to this article

View all access options for this article.

References

Pedersen

C A

Schneider

P J

Scheckelhoff

D J

. ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education—2009. Am J Health Syst Pharm 2010; 67: 542–58.

Pedersen

C A

Schneider

P J

Scheckelhoff

D J

. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2005. Am J Health Syst Pharm 2006; 63: 327–45.

Pederson

C A

Schneider

P J

Scheckelhoff

D J

. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2002. Am J Health Syst Pharm 2003; 60: 52–68.

Sakowski

Newman

J M

Dozier

Severity of medication administration errors detected by a bar-code medication administration system. Am J Health Syst Pharm 2008; 65: 1661–6.

Poon

E G

Koehane

C A

Yoon

C S

. Effect of bar-code technology on safety of medication administration. N Engl J Med 2010; 362: 1698–707.

Johnson

C L

Carlson

R A

Tucker

C L

. Using BCMA software to improve patient safety in Veterans Administration medical centers. J Healthcare Inform Mgmt 2002; 16: 46–51.

Kelly

Medication administration error reduction at six acute care hospitals using barcode point of care technology. http://www.bridgemedical.com/pdf/whitepaper_6hospitals.pdf (accessed 2008 Oct 20).

Paoletti

R D

Suess

T M

Lesko

M G

. Using bar-code technology and medication observation methodology for safer medication administration. Am J Health Syst Pharm 2007; 64: 536–43.

Larrabee

Brown

Recognizing the institutional benefits of bar-code point-of-care technology. Joint Comm J Qual Saf 2003; 29: 345–53.

10.

Koppel

Wetterneck

Telles

J L

. Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008; 15: 408–23.

11.

Patterson

E S

Cook

R I

Render

M L

. Improving patient safety by identifying side effects from introducing bar coding in medication administration. J Am Med Inform Assoc 2002; 9: 540–53.