DNP 715 Module 4 Technology Assessment Paper Example

Scan, Match, Give: Assessing Barcode Medication Administration on a Medical-Surgical Unit

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 715: Dynamics and Principles of Information in Healthcare

Instructor Name

Month Day, Year

Scan, Match, Give: Assessing Barcode Medication Administration on a Medical-Surgical Unit

The Technology and Setting

Barcode medication administration (BCMA) links the patient's wristband, the medication's barcode and the electronic medication administration record. Here, a nurse scans the wristband first and then every drug at the bedside; the system checks the five rights against the active order and either confirms or displays an alert. The administration is then documented automatically. All medications except a short list of emergency drugs must be scanned.

My floor has 30 adult medical-surgical beds inside a 400-bed community hospital in Tucson, where day shift runs about five patients per nurse. Most patients are older adults admitted from the emergency department with infections, heart failure or diabetes complications, and a typical patient receives 12 to 18 scheduled doses a day, so a nurse with five patients may complete more than 60 scans on a single shift. Each nurse carries a handheld scanner tethered to a workstation on wheels, and the wristband is printed in the emergency department at registration.

The system works in a fixed sequence. The nurse opens the patient's record, scans the wristband, then scans each package as it is removed from the drawer. If the drug, dose, route or time does not match an active order, the screen shows an alert that must be acknowledged with a reason before the dose can be charted. High-alert drugs, insulin and heparin among them, need a second nurse's sign-in. When a scan fails, the nurse can type the medication manually, which is also recorded as an override.

Effectiveness: The Evidence

The best evidence is a study at one academic medical center that watched more than 14,000 administrations before and after the change. On units that adopted barcode technology with an electronic administration record, the rate of administration errors other than timing errors fell by 41.4%, and the harm those errors could have caused was cut roughly in half; timing errors also decreased (Poon et al., 2010). The technology works when used as designed.

Other evidence is less direct. Much of the published support comes from one hospital at a time and from comparisons of a period before with a period after, so changes in staffing or culture during the same months could explain part of the gain, and the benefit reported depends on the system being paired with an electronic administration record. Effectiveness therefore has two parts: whether the design prevents errors when followed, and whether the unit follows it.

Effectiveness: Our Unit

Our hospital's BCMA dashboard shows that patient wristband scanning compliance on my unit averaged 92% and medication scanning 95% over the last quarter, slightly below the hospital's 95% and 97% goals. Overrides, administrations given despite an alert, were documented on 3% of doses. The numbers suggest the system is mostly used, but 5% to 8% of scans are missing, and the dashboard cannot show whether completed scans happened at the bedside.

To test what the dashboard cannot show, I observed 20 medication passes on two day shifts with the manager's permission, recording where each scan happened. In 17 of the 20 passes, the wristband and every medication were scanned at the bedside. In three, the nurse scanned a printed label at the workstation and then carried the medications into the room. Twenty passes is a small convenience sample, so the 15% figure is an estimate to be checked, not a rate.

Area Needing Improvement: Workarounds

Override alerts that fire too often carry the same risk as noisy monitors, since clinicians learn to stop attending to them (Sendelbach & Funk, 2013). Nurses on my unit also describe ways around the system: scanning a spare patient label kept at the workstation instead of the wristband, scanning several medications before reaching the room, and overriding alerts they believe are false. A study of BCMA workarounds identified 15 types and 31 causes, including unreadable or missing wristbands, poor wireless coverage, interruptions and alerts that clinicians judged unhelpful, and showed that workarounds can reintroduce the errors BCMA is meant to prevent (Koppel et al., 2008). Our unit matches several of these causes: wristbands smudge after bathing, two rooms have weak wireless signals, and scanners are shared.

A sociotechnical view explains why these causes cluster. Safety depends not only on the software but on hardware, workflow, people, organizational policy and the way all of them interact, and a change in one part can undo the benefit of another (Sittig & Singh, 2010). On this unit, the software performs as designed; the failures come from the wristband stock, the wireless network, the number of scanners and the alert settings.

Why It Matters

A scan of a label at the workstation produces a compliant record but none of the safety. The gap between documented compliance and actual practice is the improvement target.

Patients carry the risk. Older adults with many scheduled doses and changing orders are the group most exposed to a wrong-patient or wrong-dose error, and they are the patients this unit serves. Leaders also lose information: as long as the dashboard reports 92% to 95% compliance, the workarounds stay invisible, and resources go elsewhere. Naming the gap is the first step toward a fix that nurses will accept, because it locates the problem in equipment and workflow rather than in individual nurses.

Conclusion

BCMA is effective when used at the bedside and as designed. On my unit, workarounds driven by equipment and workflow problems weaken it. My second assignment will recommend evidence-based fixes in SBAR format.

References

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616

Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, J. M., Kachalia, A. B., Hayes, J., Churchill, W. W., Lipsitz, S., Whittemore, A. D., Bates, D. W., & Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698-1707. https://doi.org/10.1056/NEJMsa0907115

Sendelbach, S., & Funk, M. (2013). Alarm fatigue: A patient safety concern. AACN Advanced Critical Care, 24(4), 378-386. https://doi.org/10.1097/NCI.0b013e3182a903f9

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085