Barcode Medication Administration

Barcode Medication Administration: Promising Technology in Preventing Medication Errors?
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Barcode Medication Administration: Promising Technology in Preventing Medication Errors?
Medication errors are quite common across different healthcare settings. Medication errors lead to negative health outcome in patients. Hence, nursing professionals and allied healthcare professionals should be cautious in preventing medication errors in their clinical settings. Medication administration is a routine and common phenomenon in clinical practice. However, preoccupation and inability to recognize the prescribed medications and their respective dosing schedules are the major causes of medication errors. Different initiatives are implemented across clinical settings for preventing medication errors (Novak, 2012).
Barcode medication administration is one such initiative that is implemented across different clinical settings for preventing medication errors. Almost 65.5% of U.S. hospitals have adopted the BCMA system. In the traditional paper-based prescription process of administering medications, nursing professionals manually verify the medication and the patient before they are administered. However, manual administration is subjected to different subjective errors. Bar code medication administration systems ensure an additional safety layer before medications are dispensed to patients (Novak, 2012).
However, different studies have raised questions regarding the viability of barcode medication administration.

The present article would help to compare between conventional and evidence-based techniques for improving medication administration and reduction of medication errors across clinical settings. The article would appraise the viability and utility of barcode medication administration across different clinical settings. The article would help to elucidate whether barcode medication administration is an effective strategy in preventing the prevalence of medication errors.
History of Nursing Practice
Nursing is a challenging profession as nurses have to ensure safe and quality healthcare across a diverse range of patients. Each and every patient is different and has unique therapeutic or personal needs. Such diversification and different therapeutic needs impose clinical challenges in nurses. Nurses have to administer different pharmacological and non-pharmacological interventions for ensuring positive health outcomes for patients. However, extending healthcare to a diverse range of patients with different clinical needs is quite challenging. The major challenges include appropriate and timely administration of medications as recommended by consulting physicians. Medication errors are quite common in clinical settings. Such errors are attributed to personal and technical factors (Novak, 2012).
Personal factors include the lack of awareness on the dose and indications for various medications, the lack of awareness on the toleration profile and side effects of different medications, the lack of awareness and skills in ensuring appropriate dosage titrations and presence of stress. Technical factors include improper storage conditions, the inability of pharmacists in identifying the medication and the dosage guidelines as prescribed by the consulting physicians and lack of awareness on the expiry date of medicines. Moreover, non-compliance with Electronic Health records and inability to use Health information technology systems are some of the technical reasons that lead to medication errors. Medication errors must be prevented by ensuring safe and quality healthcare in patients. Prevention of medication errors is strongly associated with positive health outcomes and improved prognosis of patients. However, therapeutic interventions are often challenging, and ineffective administration of such interventions may lead to negative health outcomes in patients (Novak, 2012).
Nurses are an integral part of the healthcare system, and the efficacy and quality of nursing care strongly influences health outcomes in patients. Hence, nurses should be skilled and acquire appropriate evidence-based knowledge for improving health outcomes in their patients. The present article appraised the different evidence-based approaches for preventing medication errors. Different initiatives are undertaken for preventing medication errors across clinical settings. Such initiatives are mainly technical, technological and administrative. Bar medication administration is a technology driven technique for administering appropriate and timely medications to patients. Hence, barcode medication administration promises a reduction in the prevalence of medication errors in healthcare settings.
Review of Literature Examining the Intervention
Bar code enabled point of care (BPOC) or Bar code medication administration (BCMA) technology systems are increasingly adopted across different healthcare settings all over the world. BCMA or BPOC are an integral part of the Electronic Health Record systems. With the increased adoption of health information technology across different healthcare set-ups; bar code medication administration is becoming a rule rather than an exception. Almost 65.5% of U.S. hospitals have adopted the BCMA system. BCMA helps to identify and verify the therapeutic needs of patients as per their Electronic health records. Such verification helps to administer correct medications in appropriate doses. Hence, BCMA or BPOC aims to reduce the prevalence of medication errors in healthcare settings (Wulff , Cummings & Marck, 2011).
Nursing professionals are required to scan the bar code on patient’s identification tag and the barcode on medications which are intended for that specific patient. Nurses compare such details in patient’s electronic medication administration records (EMARs) before administering such medications to the patient. However, if a mismatch is detected, an auditory warning signal is conveyed from the EMAR system and the respective nurse is alerted. Such warning is essential for preventing medication errors and for ensuring quality healthcare in concerned individuals. The theoretical framework of BCMA is guided by the five principles of “Effective medication management.” These principles include prevent medications to wrong-patients, prevent wrong medication doses, prevent medication administration at wrong-time, preventing administration of wrong-drug and preventing wrong-route of administration. These guiding principles are mandatory for preventing medication errors. The system also assures accurate and appropriate documentation of medication administration schedules and processes (Huang & Lee, 2011).
Different experimental studies have evaluated the effectiveness of BCMA systems in reducing the prevalence of medication errors. Quasi-experimental studies have indicated that the prevalence of medication error with BCMA systems is significantly lesser than the traditional system of medication administration (6.8% versus 11.9%, p <0.001). Therefore, BCMA systems could reduce the prevalence of medication errors by 41.4%. Such reductions are statistically significant (p <0.001). Moreover, the rate of drug-related adverse reactions was also significantly lower with BCMA systems compare to conventional systems (1.6% versus 3.1%, p < 0.002). The reduction in timing errors with BCMA systems was also considered statistically significant (27.3%, p <0.001). Such results are encouraging because studies have indicated that there has been 117% increase in timing errors in neonatal ICU units (Novak, Anders & Gadd, 2012).
Henneman et al. (2012) reported that fewer nurses administered medications to incorrect patients while using BCMA systems compared to those nurses who used a manual system of medication administration (8% versus 39%, p <0.05). However, implementation and appraisal of BCMA systems remain a concern across different healthcare set-ups. Data collected from six hospitals indicated that although 42% of medication administrations received warning alert, 78% of such signals were ignored by nursing/allied healthcare professionals.
Barriers Limiting Implementation of BCMA
For effective compliance with BCMA systems, all medications should be tagged with appropriate bar codes. Such tagging should be matched to the electronic health records of the patients. Therefore, pharmacists need to affix relevant bar codes to different medications manually. Such manual tasks may impose significant challenges on pharmacists. Moreover, different disadvantages of BCMA systems are recognized through various studies. BCMA systems reduce the flexibility of deviating from routine sequences and schedules. Such flexibility is essential for nursing or allied healthcare professionals in prioritizing healthcare needs across diverse patients. BCMA systems often generate false and inappropriate warning signals for minor medication errors (Hassink , Essenberg, & Roukema, 2013).
Such alerts impose time challenges in a nursing professional. This is because the nursing professionals become preoccupied in analyzing the warning signals. Such situations may lead to time constraints in nursing professionals. Such time constraints may impose negative health outcomes on other patients. Studies have indicated that implementation of BCMA increases the time spent in direct patient care compared to manual/traditional approaches (182.3 seconds versus 47.4 seconds, p < 0.001). Moreover, the bar codes are often faulty, and scanning system may generate an error. Such issues reduce the safety and quality healthcare in concerned individuals (Dwibedi, Sansgiry, & Frost, 2012).
Conclusion
Medication errors are undoubtedly an area of concern across different healthcare settings. Hence, each and every measure should be implemented for preventing medication errors in clinical settings. Prevention of medication errors is extremely essential for ensuring safe and quality healthcare. BCMA systems are effective in reducing medication errors. However, such systems are often constrained by technological limitations and poor design. Moreover, BCMA systems are associated with increased time of care. Such time constraints may impose additional challenges in nursing professionals and may reduce their productivity in their clinical settings. Hence, appropriate and effective BCMA systems should be designed in the near future for addressing such challenges. However, BCMA systems should be coupled with manual approaches for administering medications to patients.
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