An Evaluation of the Impact of Barcode Patient and Medication Scanning on Nursing Workflow at a UK Teaching Hospital

Abstract

Barcode medication administration (BCMA) is advocated as a technology that reduces medication errors relating to incorrect patient identity, drug or dose. Little is known, however, about the impact it has on nursing workflow. Our aim was to investigate the impact of BCMA on nursing activity and workflow. A comparative study was conducted on two similar surgical wards within an acute UK hospital. We observed nurses during drug rounds on a non-BCMA ward and a BCMA ward. Data were collected on drug round duration, timeliness of medication administration, patient identification, medication verification and general workflow patterns. BCMA appears not to alter drug round duration, although it may reduce the administration time per dose. Workflow was more streamlined, with less use of the medicines room. The rate of patient identification increased from 74% (of 47) patients to 100% (of 43), with 95% of 255 scannable medication doses verified using the system. This study suggests that BCMA does not affect drug round duration; further research is required to determine the impact it has on timeliness of medication administration. There was reduced variability in the medication administration workflow of nurses, along with an increased patient identification rate and high medication scan rate, representing potential benefits to patient safety.

Barcode medication administration technology use in hospital practice: a mixed-methods observational study of policy deviations

“…In the study of Barakat and Franklin, the BCMA led to less variability in how nurses undertake medication administration. 29 Some of this difference may be explained by safety culture differences, for example, if the BCMA technology is not used by all nurses, such as found in our study, it could result in being a burden to the workflow rather than a safety initiative. Lyons et al 31 have also described a similar performance variability among nurses within the use of other medication administration technologies, and addressed that this adaptive behaviour could be a source of resilience, compensating for the weaknesses of the system, but raised concerns that it could also lead to unsatisfactory outcomes.…”

“…28 In a recent observational study of BCMA at a UK hospital, Barakat and Franklin registered scanning rates for medications of 83%, scannable doses of 95% and patient verification of 100%. 29 Although Barakat and Franklin had a smaller sample size, their study was undertaken with a similar ward-stock dispensing process and BCMA technology design to our study, which makes the rates broadly comparable.…”

Nurses' Perceptions of Using Personal Digital Assistants in Tertiary Hospitals

“…A spaghetti diagram of a BCMA ward also showed a decreased walking pattern of nurses between patient beds and the medicine room of a nursing station than in a spaghetti diagram of a non-BCMA ward. 15 Most walking in a BCMA ward took place between patient beds. This indicated advantages to patient safety and nursing workflow.…”

Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology?

“…For example, if the barcoded patient identification band does not match the selected electronic medication chart, an alert will notify the user of the mismatch and prompt them to check they have the right medication for the right patient, potentially avoiding a 'wrong patient' error. 1 11 While BCMA technology can reduce some medication errors by streamlining workflow and improving medicine and patient identification rates, 17 it can exacerbate others or even cause new types of error to occur. [11][12][13] The literature presents a complex picture of unintended consequences following BCMA implementation, indicating that the overall effect of a new HIT, such as BCMA, is often difficult to predict.…”