BCMA Final Project PDF

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BCMA: Final Project Amanda Pearson Botelho Nursing, Southern New Hampshire University Nur-305 Info Mgmt & Patient Care Tech Professor Maloney December 13, 2020

2 Introduction “Healthcare barcode solutions help streamline the patient admittance process, track medication and care admission, and identify patients throughout their entire stay. Barcode wristbands are typically created at the point of admission, and specific patient information is continually updated based on the patients’ needs. Medical records, medications and specimen samples are tagged with a barcode label for doctors and nurses to easily scan in order to trace critical patient information” (HMT Mag, 2012). I chose this topic because the hospital I work at uses this technology and is critical to ensure patient safety and the first step before performing any patient care. The main goal of barcoding is to improve patient safety. For example, when administering medication, the nurse or doctor must first scan the patients barcode on his/her wristband and then the medications barcode to confirm correct patient and medication. The implementation of the barcoding system has significantly reduced medication errors. After obtaining a specimen it is sent to the lab with the patients’ unique barcode attached to ensure correct specimen and patient. These unique barcodes allow patients information to be easily and instantly recorded in the patients’ medical record. Barcoding makes it possible for the healthcare team to work more efficiently allowing the hospital to save time and resources. Advantages and Disadvantages After some research, I have found there is much more advantages than disadvantages related to barcode scanning. Some advantages include its ability to collect real time data and eliminate the possibility of human error, barcodes are inexpensive to design and print making them more cost effective and easily implemented, track inventory levels, considered universal and can be read from basically any scanner, and aid in better decision making because data is obtained more rapidly and accurately (Top Eight Benefits, n.d.) rapidly and accurately. Some examples of the disadvantages of barcodes include susceptibility to environmental damage that can cause problems while scanning, items must be scanned

3 individually, can be easily replicated, barcodes are read only so information cannot be updated or added (Layton, 2015). Ethical and Legal Implications The term workarounds meaning deviations or shortcuts can be seen as an ethical and legal implication of barcode scanning. An example of a workaround that can cause harm would be if a patient status were deteriorating and required immediate intervention. The nurse gives a medication to a patient based on a doctor’s verbal order without scanning the patient or the medication. The nurse is bypassing every safety check put into place to do no harm making this action potentially harmful. Nurses have an ethical duty to do no harm. Major contributors of workarounds are related to time constraints and urgent situations. These workarounds can cause harm to our patients because we are overriding the system put in place for patient safety. "The Code of Ethics for Nurses' states it is the nurse’s responsibility to recognize and take action to address deviations in individual practice and systems that pose real or potential threats to patient safety" (Rushton, 2015). Impact on the Vulnerable Population In my opinion, the vulnerable population regarding the use of barcodes would be the nurses that have been around before the implementation of technology. These nurses tend to be stuck in their ways and resistant to change. This technology seems foreign and can be difficult to learn how to use. New nurses can even have difficulty learning these systems so I can imagine how frustrating it must be for older nurses to learn a completely new way of performing their job. Effects on Professional Nursing and Patient Outcomes Margaret Rouse define Barcode medication administration (BCMA) as is an inventory control system that uses barcodes to prevent human errors in the distribution of prescription medications at

4 hospitals. “Medication errors have been a national health care item since the Institute of Medicine’s (IOM) sentinel report, which states that annually 98,000 people die in hospitals due to medical errors. The Agency for Healthcare Research and Quality (AHRQ) estimates that approximately 7,000 people die from medication errors annually and that an error occurs in 19% of all doses administered, 7% of these errors have the potential to result in an adverse effect” (Ross, 2008). The goal of BCMA is to make sure that patients are receiving the correct medications at the correct time by electronically validating and documenting medications. The information encoded in barcodes allows for the comparison of the medication being administered with what was ordered for the patient. (Rouse, 2015). BCMA affects nursing practice greatly, it has proven to reduce medication errors, manage inventory, manage billing, and save time at the pharmacy and bedside. The vulnerable population can be considered any user, young and old. Although, “Nurses who were familiar with a keyboard and mouse learned the computerized barcode system more quickly. Those who had limited or no experience with either typing or computers required longer classroom instruction and additional follow-up support” (Ross 2008). Training was provided by nurse informatics specialist, staff educators and trained super users so all new users were able to feel comfortable using the system and troubleshooting is available 24/7 via IT if problems should arise. “Nurses do not tire of caring for patients; rather, they tire of dealing with inefficient systems. If nurses are satisfied with the system, procedures will be followed without "work-arounds," and the goal of decreased errors should be achieved” (Ross, 2008). During the implementation process policies were changed in order to increase the user’s familiarity with the system for ease of use. “The technology enhancements must be able to help nurses focus their time on direct patient care. Our users wanted an easy-to-use, lightweight, and portable device to provide point-of-care data entry and a system that had the capability of accessing other hospital applications” (Ross, 2008).

5 BCMA has been shown to improve time management, organizational skills, patient safety, and workflow. Nurses can save time at the bedside with the use of BCMA because the system requires nearly zero dosage math to be completed because the system automatically gives you the correct dose. There is also a feature when scanning a med called “Lexicomp”, allows nurses to look up all related drug information in just two clicks. The system also allows nurses to print off any drug information for patient education in almost any language. BCMA improves organizational skills by allowing the nurse to see exactly when a medication is due. This allows the nurse to prioritize patients during the medication administration process which in turn saves time. BCMA improves patient safety because of the amount of verification that happens before the medication reaches the patient. Medications are verified multiple ways starting with the physician putting in the order, to pharmacy confirming and releasing order, to finally nursing as the final check before administration. “Consistent with research on medications in general our findings showed that BCMA was associated with reductions in medication administration error’s (MAE’s) and preventable adverse drug events related to controlled medications” (Zheng, 2020). Also, the scanning of the patient before the medication also confirms the correct patient and correct drug. The system will notify the nurse if he/she scans the incorrect dose which forces the nurse to click “partial dose” and manually input the correct ordered dose. “BCMA technologies can potentially reduce errors, save time spent on clinical tasks and improve monitoring of controlled medications” (Zheng, 2020). “BCMA technology needs to be improved to minimize frequently detected errors and to assess high potential errors, such as the infusion rate and the technique of administration. This technological development can lead to an improvement in patient safety” (Macias, 2018). There is no for sure way for the system to know if a nurse inputs the correct drug, rate, or dose during an intravenous (IV) therapy. This is because there is no link of technology between the barcode scanning system and the IV pumps. “Nurse training and patient education are important for successful use of BCMA in clinical practice. 27

6 Previous studies have shown that workarounds performed by nurses while using BCMA can pose serious threats to the safe use of medications. For example, in one study, nurses prepared, scanned, and transported medications for more than one patient at the same time in order to save medication administration time” (Zheng, 2020). Nurse workarounds are difficult for the system to detect which in turn can cause harm and adverse sentinel events to our patients. Nurses are trusted to follow the policies put into place although workarounds do still exist in practice. “There was however evidence to suggest that damaged and unreadable barcodes, and medications labelled with incorrect barcodes led to problems, resulting in MAEs and confusion over whether the scanned medication was the correct medication to administer to the patient” (Zheng, 2020). Nurses must not solely rely on these systems because there can be flaws such as an unreadable barcode, or barcode that did not match the drug dispensed. Nurses must be diligent and check themselves with the help of the system because we are the final check before medication administration and our clinical judgement is better than any system out into place. Reflection I do not feel as though changes need to be made related to barcode scanning with vulnerable populations. I think that it is a very straight forward system because it just requires you to scan a barcode on that product. No one ha ever had issues with policies regarding the barcode scanner. From my personal ethical standpoint as a professional nurse, I do support the use of barcode scanners. Barcode scanners are able to control inventory, track materials, and patient/med validation. “A barcode-scanning system can be designed to automatically reorder products when they reach a specific inventory level or prevent surgical utensils from being left inside a patient. Barcodes can track a supply to a particular patient and also identify the clinician who used it with the patient. Additionally, barcodes can be used to track an item back to the manufacturer, allowing for defective items to be refunded by the distributor.

7 The most important validating function barcodes and barcode scanners provide is the ability to verify that the patient being treated is the right patient and that the treatment is appropriate” (Barcode Technology, 2020).

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References Barcode Technology in Healthcare: What You Need To Know. (2020). Wasp Barcode Technologies. Retrieved from http://www.waspbarcode.com/buzz/barcode-technologyhealthcare#:~:text=However%2C%20barcodes%20supply%20an%20easy-to-use%20and%20costeffective%20solution,implementing%20barcode%20scanners%20into%20your%20healthcare %20facility.%201. HMT Mag. (2012). The role of barcode technology in patient safety and identification. Healthcare Innovation. Retrieved from https://www.hcinnovationgroup.com/home/article/13005150/therole-of-barcode-technology-in-patient-safety-and-identification Layton, A. (2015). Barcode vs. RFID: Which is better? The Prognostore Blog. Retrieved on November 15, 2020 from https://www.prognostore.com/blog/barcode-vs-rfid#:~:text=The %20key%20disadvantage%20for%20barcodes,be%20read%20by%20a%20scanner Macias, M., Bernabeu-Andreu, F. A., Arribas, I., Navarro, F., & Baldominos, G. (2018). Impact of a Barcode Medication Administration System on Patient Safety. Oncology Nursing Forum, 45(1), E1–E13. https://doi-org.ezproxy.snhu.edu/10.1188/18.ONF.E1-E13 Margaret, R. (2015). Bar Coded Medication Administration (BCMA). TechTarget. https://searchhealthit.techtarget.com/definition/Bar-Coded-Medication-Administration Ross J. (2008). Collaboration -- integrating nursing, pharmacy and information technology into a barcode medication administration system implementation. CARING Newsletter, 23(1), 1–17.

9 Rushton, C., Stutzer, K. (2015). Ethical Implications of Workarounds in Critical Care. AACN Advanced Critical Care. Volume :26 Number 4, page 372 – 375. Top Eight Benefits of Barcodes. (n.d). Verified Label, Print & Promotions. Retrieved on November 15, 2020 from https://verifiedlabel.com/knowledgecenter/know_barcodes.aspx Zheng, W. Y., Lichtner, V., Van Dort, B. A., & Baysari, M. T. (2020). The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Research in Social and Administrative Pharmacy. https://doiorg.ezproxy.snhu.edu/10.1016/j.sapharm.2020.08.001...