Objective: To identify the types and extent of workaround strategies with the use of Bar Code Medication Administration (BCMA) in acute care and long-term care settings. Background: Medication errors are the most commonly documented cause of adverse events in hospital settings. Scanning of bar codes to verify patient and medication information may reduce medication errors. Method: A prospective ethnographic study was conducted using targeted observation. Fifteen acute care and 13 long-term care nurses were directly observed during medication administration at small, medium, and large Veterans Administration hospitals to detect workaround strategies. Results: Noncompliance with recommended practices was observed in all settings and facilities. A larger proportion of acute care nurses than long-term care nurses scanned bar-coded wristbands to identify patients (53% vs. 8%, p = .016). A larger proportion of acute care nurses than long-term care nurses administered barcoded medications immediately after scanning (93% vs. 23%, p < .001). Conclusion: Workaround strategies were employed with BCMA that increased efficiency but created new potential paths to adverse events. There was a significant difference in the rate of use of workaround strategies between acute and long-term care. Application: The extent of workaround strategies varied by care setting and facility. BCMA should be tailored to the long-term care setting, including increasing the efficiency of use. Hospitals implementing bar coding should facilitate the intended use through equipment procurement, implementation, and quality improvement strategies.
Get full access to this article
View all access options for this article.
References
1.
Andrews, L. B., Stocking, C., Krizek, T., Gottlieb, L., Krizek, C., Vargish, T., et al. (1997). An alternative strategy for studying adverse events in medical care. Lancet, 349, 309–313.
2.
Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., & Sheridan, T. (2001). Reducing the frequency of errors in medicine using information technology. Journal of the American Medical Informatics Association, 8, 299–308.
3.
Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Locallo, A. R., Lawthers, A. G., et al. (1991). Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I. New England Journal of Medicine, 324, 370–376.
4.
Cook, R. I., & Woods, D. D. (1994). Operating at the “sharp end”: The complexity of human error. In S. Bogner (Ed.), Human error in medicine (pp. 255–310). Mahwah, NJ: Erlbaum.
5.
Ericsson, K., & Simon, H. (1993). Protocol analysis: Verbal reports as data.Cambridge, MA: MIT Press.
6.
Gerety, M. B., Cornell, J. E., Plichta, D. T., & Eimer, M. (1993). Adverse events related to drugs and drug withdrawal in nursing home residents. Journal of the American Geriatric Society, 41, 1326–1332.
7.
Hutchins, E. (1995). Cognition in the wild.Cambridge, MA: MIT Press.
8.
Johnson, C. L., Carlson, R. A., Tucker, C. L., & Willette, C. (2002). Using BCMA software to improve patient safety in Veterans Administration medical centers. Journal of Healthcare Informatics Management, 16, 46–51.
9.
Leape, L. L., Bates, D. W., Cullen, D. J., Cooper, J., Demonaco, H. J., Gallivan, T., et al. (1995). Systems analysis of adverse drug events: ADE Prevention Study Group. Journal of the American Medical Association, 274, 35–43.
10.
Leape, L. L., Brennan, T. A., Laird, N., Lawthers, A. G., Localio, A. R., Barnes, B. A., et al. (1991). The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II. New England Journal of Medicine, 324, 377–384.
11.
Meredith, S., Feldman, P. H., Frey, D., Hall, K., Arnold, K., Brown, N. J., et al. (2001). Possible medication errors in home healthcare patients. Journal of the American Geriatrics Society, 49, 719–724.
12.
Patterson, E. S., Cook, R. I., & Render, M. L. (2002). Improving patient safety by identifying side effects from introducing bar coding in medication administration. Journal of the American Medical Informatics Association, 9, 540–553.
13.
Puckett, F. (1995). Medication-management component of a point-of-care information system. American Journal of Health-System Pharmacy, 52, 1305–1309.
