Bar Code Medication Administration



Bar Code Medication Administration

Sarah DeLaat

Ferris State University

Abstract

This paper will discuss barcode medication administration and how it is utilized in the emergency department. Barcode medication administration (BCMA) devices are seen as an advanced safety mechanism in giving medications. However, with the newness of this technology, there are still issues that need to be addressed and resolved. Variations in the way these scanners can be used and the multiple people involved in this process account for some of these issues. Patient safety and efforts to promote safe care are the primary concern of healthcare professionals.

Bar Code Medication Administration

This paper will discuss how barcode BCMA works, who is involved in the process, and its advantages and disadvantages. We will then review the issues related to this new technology and address them.

BCMA’s are the newest trend in providing increased safety in medicating patients. Hurley (2007) wrote that:

Nurses are recognized as the last line of defense in preventing medication errors made by physicians and pharmacists. Point of care technology that integrates nurse scanning of bar-coded medications with the patient’s electronic medication administration record provides nurses with a safety check during medication administration.

BCMA is a new technology that was put in place as another check system while giving medications to patients in an effort to decrease the number of medication errors. In the emergency department, the process begins as soon as the patient is registered into the system. The computer generates a wristband for the patient with a barcode attached that is specific to the patient. In addition, each medication that comes to the hospital has a barcode attached either by the manufacturer or by the pharmacy staff. Pharmacy then double checks all of the medications making sure the bar codes correlate with the medications when scanned into the computer.

The preferred method for entering medication orders in the emergency department is computerized physician order entry (CPOE). This method of ordering greatly decreases translation errors one may encounter when trying to interpret written orders. The barcode system works by scanning the barcode on the patient’s wristband, matching it to the medications ordered in the electronic medication record, and then scanning the barcode on the ordered medication. This verifies the correct medication, and correct dose. In order for the system to work properly it is critical that the patient have the correct wristband as well as the correct order placed by the physician in the electronic medical record.

Another critical component of the BCMA’s effectiveness is making sure the medications have the correct barcode labeled, which is done by pharmacy. If the dosage ordered and the dose on the medication doesn’t correlate, the nurse is alerted by a queue and is given the option to correct it and electronically chart the correct dose. For example, an order for 0.5 milligrams of dilaudid could be ordered. When the vial of dilaudid is scanned, the nurse will get a queue showing there is one milligram of dilaudid total. Giving that the order is written for 0.5 milligrams, the nurse can then double check the dosage before giving that medication, and change the dosage in the barcode device to match the order.

In the Hurley (2007) survey some participants believed that using the bar code device was more time consuming. However, almost all surveyed nurses acknowledged that the extra time was wisely spent to ensure patient safety in reducing medication errors. All participants voiced that not having to decipher hand written orders saved both time and errors.

Advantages

“The use of barcode technology at the patient’s bedside has shown impressive gains in reducing medication administration errors, which may account for as many as 7,000 deaths per year in the U.S.” (Work 2005)

The main advantages of the BCMA use are patient safety and nursing documentation. By enlisting the use of the barcode device, nurses have an automatic double check when administering medications. It focuses on the five rights: the right patient, right drug, right dose, right route, and right time. If there is any discrepancy noted in any of the above mentioned, the nurse is alerted by a queue in the system. This enables the nurse to further investigate the orders before administering the medication, thus avoiding potential mistakes before they are made. According to Hurley (2007) nurses felt an increased sense of safety when using these devices.

The ability to document in “real time” is also another advantage of these devices. It gives a more accurate account of the patient’s medical record. In a chaotic emergency department, back charting medications on a patient can lead to inaccurate times documented. This is also important when trying to capture revenue for intravenous fluids or medications. Since the barcode device timestamps the medication at the time of administration, there are no discrepancies when charging for the revenue.

Disadvantages

Koppel (2008) discovered many potential errors if the technology is used incorrectly. Among these are nurses using “workarounds” with the system. If the nurse does not scan the patient’s barcode and medication each time a new medication is ordered, the potential for mistakes is greatly increased. In theory every time the nurse leaves the patient’s room, the nurse should be re-scanning the patient’s wristband upon re-entering when medicating the patient. One of the “workarounds” nurses have used is to leave the room for a minute while still having the patient loaded into the BCMA, then re-entering the patient room with the medication in hand, scanning the medication and administering it to the patient. This is dangerous because the patient should technically be re-scanned before receiving the medication and can lead to an error. It would also be very easy for a nurse to give a partial dose of medication, as mentioned before with dilaudid, but forget to chart it as a partial dose. This could lead to under or overdosing the patient, as the electronic medication administration record would be inaccurate.

Physicians are also among those related to mistakes regarding BCMA accuracy. According to Koppel (2008) physicians are less likely to review electronic records as often as they would paper records. The potential for order entry error could significantly increase without review.

Incorrect barcodes placed on patients, mislabeled medications, disabled queue on the devices, and blatantly administering medications without using the device all leave room for error as well.

Review

Most of the potential mistakes can be attributed to human error. Nurses must be educated on using the barcode devices properly, and avoid using “workarounds” to get through the system. Physicians must review the electronic medication administration record in order to ensure correct orders are being placed. If the orders are incorrect to begin with, the chance to err increases significantly.

While using BCMA technology is the preferred method for safely administering medications, it should be mentioned that it is not always possible in the emergency department. If a patient comes in unidentified in a code or trauma situation, it is necessary to revert back to a written code record. This happens because life saving medications may be given before the patient is even registered into the system. The paper record is then scanned into the computer system at a later time where it can be viewed in the electronic record in the future.

Research suggests the use of BCMA technology is the safest to date for medicating patients. There are many advantages as well as disadvantages to the system. Using a multidisciplinary approach to the implementation of the BCMA system is extremely important in its success with the goal of improving patient safety and reducing medication errors.

References

Hurley, A. C., Bane, A., Fotakis, S., Duffy, M. E., Sevigny, A., & Poon, E. G. (2007). Nurses satisfaction with medication administration point-of-care technology. The Journal of Nursing Administration, 37(7/8), 343-349.

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. T. (2008). Workarounds to barcode medication administration. Journal of the American Medical Informatics Association, 15(10), 408-423.

Work, M. (2005). Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital. Patient Safety and Quality Healthcare. Retrieved from

Evidence Based Practice Paper Grading Rubric

Name: ___________________________________

|DESCRIPTION AND ANALYSIS OF PRACTICE ISSUE |POINTS POSSIBLE |POINTS AWARDED |

|Clear Introductory Description of Practice Concern/Interest: Describes reason for |10 | |

|interest or concern and description of issue. | | |

|Practice Environment: |5 | |

|Provides clear description of practice area. | | |

|Causal Factors: Personal Perspective and Description/Analysis of Possible Contributing |10 | |

|or Causative Factors for the Concern | | |

|Defined Area of Research Search: Narrows down and defines a specific area for research |5 | |

|review and provides a clear statement of same. | | |

|RESEARCH REVIEW | | |

|Research Findings: Shares the findings of a minimum of 3 original research studies from | | |

|professional journals on the selected topic. Briefly describes the research approaches |20 | |

|and findings of each. | | |

|Critique of the Research: Attempts to point out any research limitations/credibility of |5 | |

|the studies. | | |

|Implications For Practice: Identifies potential practice implications of research. This |5 | |

|goes beyond implications included in the study itself, to include perceptions of | | |

|implications for personal practice. | | |

|Critical Reflection: Identifies a nursing theory that this practice concern/research |10 | |

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|integrating research into practice. | | |

|STANDARDS & APA CRITERIA | | |

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|(5-6 pages of typed content excluding the reference page, abstract, and title page). | | |

|Writing: Development of a clear, logical, well-supported paper. Overall presentation: |15 | |

|Grammar, punctuation, clean and legible. | | |

|TOTAL POINTS |100 | |

|CHECK | |

|DATE, TIME, & |PROOFREAD FOR: APA ISSUES |

|INITIAL | |

| |1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. |

| |40)] |

| |2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title|

| |of the Running head in all caps? Is it 1” from the top of your title page? (Should be a few words from the title of your |

| |paper). [p. 229 and example on p. 40] |

| |3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of |

| |the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a |

| |summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract |

| |and know what to find in your paper. [p. 25 and example on p. 41] |

| |4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a |

| |heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and |

| |example on p. 42] |

| |5. Margins: Did you leave 1” on all sides? [p. 229] |

| |6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in |

| |special circumstances. This includes the reference page. [p. 229 and example on p. 40-59] |

| |7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] |

| |8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions. |

| |9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a |

| |person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. |

| |[p. 87-88] |

| |10. Typeface: Did you use Times Roman 12-point font? [p. 228] |

| |9. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111] |

| |11. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing |

| |many times…this is what you are supposed to be doing! [p. 170] |

| |12. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this: |

| |“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, |

| |2007, p. 1). |

| |Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion |

| |of page number, etc. Do all direct quotes look like this? [p. 170-172] |

| |13. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172] |

| |14. Paraphrase: A paraphrase citation would look like this: |

| |Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007). |

| |Do all paraphrased citations look like this? [p. 171 and multiple examples in text on p. 40-59] |

| |15. Headings: Did you check your headings for proper levels? [p. 62-63]. |

| |16. General Guidelines for References: |

| |A. Did you start the References on a new page? [p. 37] |

| |B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often |

| |they are not and must be adapted. Make sure all fonts are the same. |

| |C. Is your reference list double spaced with hanging indents? [p. 37] |

| | |

| |PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE |

| |13. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out |

| |where you addressed each section.) |

| |14. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you |

| |become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did|

| |you do this? |

| |15. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit? |

| |16. Conversational tone: Don’t write as if you are talking to someone in a casual way. For example, “Well so I couldn’t |

| |believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone? |

| |17. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out? |

| |18. Did you check to make sure there are no hyphens and broken words in the right margin? |

| |19. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.? |

| |20. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they” or “them”. Also, in referring |

| |to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should |

| |be “The nurse who gave the injection…” Did you check for subject agreement? Likewise, don’t refer to “us”, “we”, “our”, |

| |within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical|

| |data to support ….” . Instead say “The nursing profession uses empirical data….. |

| |21. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities |

| |that I was not happy with.” Instead, “I witnessed activities with which I was not happy.” |

| |22. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck? |

| |23. Did you have other people read your paper? Did they find any areas confusing? |

| |24. Did you include a summary or conclusion heading and section to wrap up your paper? |

| |25. Do not use “we” “us” “our” “you” “I” etc. in a formal paper! Did you remove these words? |

| |26. Does your paper have sentence fragments? Do you have complete sentences? |

| |27. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is showing possession and then be|

| |sure it is in the correct location. The exception is with the word it. It’s = it is. Its is possessive. |

Signing below indicates you have proofread your paper for the errors in the checklist:

Sarah DeLaat

________________________________________________________DATE:_03/11/2010___________

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

Sarah Keena

________________________________________________________DATE:03/09/2010______________

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