Medication administration is one of the most error-prone processes in health care delivery. Many errors, including lethal errors, still occur when practitioners firmly believe that they have verified the five rights before administering a medication. How can this happen? Practitioners involved in such incidents report that they are sure that they verified the product they selected, when according to human factors researchers, what they experienced was a misperception that occurs when products look too similar.
While our eyes, with proper eyesight, have the capacity to take in all information, our mind learns to screen out information that it considers less useful to prevent information overload. Additionally, as we gain experience, we develop a picture in our mind of items in our environment. Many hospitals have implemented bar code medication administration BCMA as a method of decreasing medication errors. BCMA was developed to specifically decrease the following types of errors: unauthorized drug, wrong form, wrong dose, wrong route, extra dose, and omission.
While adoption of BCMA technology has increased, few studies have been conducted to establish its effects on reducing medication error rates. Helmons, Wargel and Daniels conducted a study to evaluate medication administration practices one month before and three months after BCMA implementation in two medical-surgical units and two intensive care units ICUs at a bed academic teaching hospital in southern California. There were fewer omitted medications and a decrease in the number of medications that were not available on the unit.
However, total medication errors were not affected by BCMA implementation and, unfortunately, the observers determined that more distractions occurred and the nurses spent less time explaining the medication to the patient. Most BCMA implementations do not confirm that the correct pump is used for the selected mini-bag or that the mini-bag selected matches the mini-bag it is replacing, particularly when the patient is receiving multiple mini-bag medications.
Several studies have highlighted work-around strategies that nurses have created to accomplish medication administration using BCMA when work-flow was not adequately considered in policy development. Nurses are a resilient group of professionals who will create solutions to overcome barriers to efficiently and effectively deliver care to their patients; they are often praised and take pride in their ability to do so.
For example, a technology approved with a decision for Appropriate access enforcement and physical security control must also be implemented. The version numbers 3. References The following reference s are associated with this entry: Type Name Source Description There are no references identified for this entry. Technology Components Note: This list may not be complete.
No component, listed or unlisted, may be used outside of the technology in which it is released. The usage decision for a component is found in the Decision and Decision Constraints. Name Description No components have been identified for this entry. General Analysis Adoption Benefits This is a mature technology. This technology is not portable as it runs only on Windows platforms. Go to site. Barcode Point of Care BPOC is an electronic solution that enables physicians, nurses, and other healthcare professionals to record medication administration and documentation electronically offline.
This technology has not been assessed by the Section Office. The Vendor Release table provides the known releases for the TRM Technology, obtained from the vendor or from the release source.
Decision Constraints. BCMA enhances efficiency and accuracy of medication administration; however, when BCMA design does not reflect nursing practice, blocks in workflow occur. These blocks require nurses to problem solve in order to complete medication administration tasks in a timely manner. Therefore, an extensive review of the literature was performed to investigate the impact of such workarounds compared to properly performed barcode medication administration on medication safety. Five studies were retrieved and the research findings for each study were synthesized to provide evidence for answering this question.
The conclusion drawn from the research findings is that workarounds do impact medication safety. When a workaround is used the verification of one or more of the five rights of medication administration is bypassed, impacting medication safety by putting the patient at a significant risk for an unintended medication error occurring. Therefore, it is imperative that nurse educators are aware and assist in providing on-going education and assessment, while advocating for further research to study the effect of barcode medication administration workarounds on medication safety.
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Type Information. Category Information. Evidence Level Keywords barcode medication administration ; workarounds ; medication errors. Conference Information. Rights Holder. All permission requests should be directed accordingly and not to the Sigma Repository.
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