CRH608 Information Systems in Healthcare

Introduction

Bar Code Medication Administration (BCMA) can be described as a system which is designed to prevent errors in medication. Glenna Sue Kennick was the first person to design the barcode system. The prime aim of BCMA is a general online record, prevent errors and improve the accuracy of the medication administration. The main purpose of the topic is to highlight the issues like medication errors that led to the adverse drug events, a threat to the patient safety and BCMA served to prevent the medication errors. Medication safety is the prime goal of patient safety and the BCMA helps the nurses to ensure medication in a safe way ().

Bar Code Medication Administration

Every year around 7 thousand deaths take place due to the medication errors and these errors occur at every stage of the medication administration, dispensation, transcribing and ordering. Thus, a method was devised which helped in reducing errors in the medication administration and this novel process invention was the barcode medication administration. BCMA works along with the electronic medication administration record for the purpose of item specific identification. The adoption of the BCMA slowly and gradually caught pace and the different healthcare organization stated to implement the barcode medication management (Healthit.ahrq.gov, 2018). The main users of the system are the nurses and they are impacted profoundly by the implementation of BCMA as it is associated with the implementation of electronic medication administration record (eMAR). The integration of the BCMA and the eMAR is vital for supporting the nurses worldwide. This integrative system provides a cognitive support to the nurses and due to this, they gain a situational awareness in order to understand an activity. The usability of the BCMA and the eMAR can have a big impact on the nurse satisfaction, nurse productivity, patient safety. A proper situation awareness includes the information that is necessary for the nurses to take the necessary actions and appropriate decisions. It is important to mention that the situation awareness is a human factor and it requires the analysis of a situation at the 3 major levels: projection, comprehension and perception (Gann, 2015). The three levels can be described by the following way: the first level is the perception and it signifies the awareness of a nurse with respect to the activities and systems. This level highlights how a BCMA is operated and the ability of the nurses to perceive when a new medication is ordered; level 2 is called the level of comprehension and this level specifies that the nurses try to understand the meaning of a situation by gathering the different elements pertaining to an information. In this stage, a nurse understands that yesterday a new medication was ordered and today a patient is facing some trouble like nausea. Thus, it is important to mention that the at this level patterns can emerge and this allows a nurse to detect the issues. The final level is the level of projection and this describes the anticipation of a nurse pertaining to the future events and the and the anticipation of the potential consequences if no proper actions are taken. For example, a nurse will anticipate unless a new dopamine is ordered and thus hemodynamic failure of the patient can occur if the provider is not called (Staggers et al., 2015). Researches have indicated that there is a consistent lack of compliance with the procedures prescribed in BCMA and this includes the patients that have the wristbands with the barcodes are often not scanned properly. Studies have shown that the 10 percent of the administered medications actively bypassed the BCMA. Instead of the usage of the BCMA, papers are used. Such an incident occurred in health care facilities which lacked the computers in the patient's rooms, and the lack of the computers also affected the preparation of the meds prior to the visit to the patient room. Thus, proper implementation of the BCMA into the health care also requires infrastructure to accommodate the necessary the requirements (Hassink, Jansen & Helmons, 2012).

Example

A study was conducted at a quaternary hospital that has 6 pilot units and consisted of 3 adult ICUs, and three medical-surgical. The hospital implemented the BCMA system and on the 4^th of June 2013. All the pilot units had the medication room and the mediation was received from an automated medication dispensing system and it was integrated with a stationary computer that displayed the MAR. According to the test procedure, a nurse after leaving a medication room will be required to take a workstation on wheels (WOW) directly into the patient's room. Inside the patient's room, the administered medication is to be documented on the MAR through the usage of WOW. The study reports have indicated that among the 70 medication events, only 40 medication events had the implementation of the bar code procedure. The results suggested that the reported errors occurred due to the errors in medication, time, route and dose. While the most common type of medication error was the wrong time. This signifies that the BCMA does not have the provision of giving alerts for conducting medication at the wrong time. The technology thus lacks the advocacy and vigilance of the nursing staff (Bowers et al., 2015).

Personal experience

Being a nurse, there is a huge responsibility to deliver medication to a patient in a proper way. The BCMA is a novel technology which is capable enough to reduce the medication errors that I previously used to make. The technology has helped me personally to keep a track on the issue of the drug package, medication information, transcription errors and patient identification. One of the positive sides is that I was able to properly my duty of medication management. While one of the negative sides is that the I was unable to keep a track in the time I was giving the medication. I still have to manually enter the time and it is sometimes tedious when I handle several patients at the same time.

Conclusion

 From the above discussion, it can be concluded that the medication error was one of the big issues previously but it is now under control with the new technology called the BCMA. BCMA, when integrated with the electronic medication administration report, has helped several nurses to properly deliver the medication to the patients. The purpose of the topic is to highlight the positive sides of the usage of BCMA and the limitation attached to it. The newfound insight will probably help me in properly dispensing the nursing care. I will now be able to keep a track on plenty of medication information which was previously not feasible when done manually.

Reference

Angel, V. M., Friedman, M. H., & Friedman, A. L. (2016). Integrating bar-code medication administration competencies in the curriculum: implications for nursing education and interprofessional collaboration. Nursing education perspectives, 37(4), 239-241. doi: 10.1097/01.NEP.0000000000000038

Bowers, A. M., Goda, K., Bene, V., Sibila, K., Piccin, R., Golla, S., ... & Zell, K. (2015). Impact of bar-code medication administration on medication administration best practices. CIN: Computers, Informatics, Nursing, 33(11), 502-508. DOI:10.1097/CIN.0000000000000198

Gann, M. (2015). How informatics nurses use bar code technology to reduce medication errors. Nursing2018, 45(3), 60-66. doi: 10.1097/01.NURSE.0000458923.18468.37

Hassink, J. J. M., Jansen, M. M. P. M., & Helmons, P. J. (2012). Effects of bar code-assisted medication administration (BCMA) on frequency, type and severity of medication administration errors: a review of the literature. European Journal of Hospital Pharmacy: Science and Practice, ejhpharm-2012. DOI: https://dx.doi.org/10.1136/ejhpharm-2012-000058

Healthit.ahrq.gov. (2018). Bar-coded Medication Administration | AHRQ National Resource Center; Health Information Technology: Best Practices Transforming Quality, Safety, and Efficiency. Retrieved from https://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/bar-coded-medication-administration

Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar code medication administration technology: a systematic review of impact on patient safety when used with computerized prescriber order entry and automated dispensing devices. The Canadian journal of hospital pharmacy, 69(5), 394. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5085324/

Staggers, N., Iribarren, S., Guo, J. W., & Weir, C. (2015). Evaluation of a BCMA’s electronic medication administration record. Western journal of nursing research, 37(7), 899-921. DOI: 10.1177/0193945914566641