Health Informatics - Bar Code Medication - Research Paper Example

Introduction Nurses often deal with several technologies designed to enhance their work practices. Most times, these interventions are IT related andmay involve other professionals as well. Bar code medication administration is a technology designed to improve efficiency in medication administration. It can lead to reduction in medication errors and thus boost quality and safety of care. It may also enhance nursing workflows by providing more time at their disposal. However, as with any technology, system challenges can prevent nurses from realizing these benefits. Some may bypass system alerts or find its use too cumbersome thus neutralizing the very purpose of installing it. The purpose of this paper is to establish whether bar code technology achieves its intended purpose, which is to increase patient safety by reduction of medication errors. The most effective way of analyzing this is by studying real-life examples of institutions that have implemented the technology and measured their quality, workflow or inter-professional after implementation. This is what the paper will focus on in subsequent sections. Significance of issue Barcode medication is increasingly becoming common among several hospitals in the country. It is critical to examine its impact on nursing workflows. Nurses need to spend their time on patients’ direct care. Therefore, if medication administration is eating up most of their time, then it will be difficult for them to provide quality services. This paper will examine whether or not bar code medication has an effect on nursing workflow as well as quality of care in institutions. Perhaps the most critical issue in the analysis of this technology in medical administration is its impact on patient safety. Errors in the medical profession could lead to further complications in treatment; they may prevent patients from recovering as quickly as they might have if the right procedures were followed. Additionally, they may cause new conditions or diseases which harm patients. In essence, they may do the exact opposite of what hospitals intend to do to patients when they visit them. Errors increase healthcare costs to patients, insurance providers as well as institutions. The latter may lose their clientele owing to a tainted image or costly malpractice litigations. Most importantly, errors in administration of drugs could be lethal and may lead to the loss of life. This paper will contribute towards the minimization of medical errors in drug administration by looking at the effectiveness of one solution. Bar code technology has been proposed as a potential solution for solving this problem. It is critical to examine its impact in the medical profession and this ascertains whether more institutions should consider it as a worthwhile investment. If the literature is unanimous concerning its usefulness, then this will be stated in the paper and institutions ought to consider adopting it. Literature Review The information in the paper is obtained from journal articles on bar coding technology in medication administration. The papers needed to be peer-reviewed as this ensures that their assertions are in line with best practices in the field. It also ascertains that investigations are carried out scientifically by ascribing to rigorous method of data collection, testing and data analysis. All the papers had to belong to scientific journals with some specializing in nursing while others belonged to related industries like pharmacy or information technology. In order to determine the best papers for the study, a search on Google scholar was done after typing the key words “impact of bar code medication”. Thereafter, a number of books, journals and other web documents appeared. Only those that seemed to have adhered to the correct procedures were selected for the analysis. They needed to look at general ideas on bar code literature and then make a significant contribution to the subject through their own primary research. Furthermore, their explanations for findings that deviated from the norm or null hypotheses had to be satisfactory. Impact on quality and safety Medication errors appear to be some of the most prominent in the nursing profession. Helmons et.al. (2009) noted that 34% of all medical errors occur at the administration phase thus indicating that there is a need for certain interventions to reduce this quantity. Bar code medication administration (BCMA) was introduced to directly increase patient safety during the administration of drugs. It works by confirming the patient’s medication form, time, and dose as well as their identity. When a technology targets this specific area of practice, it is critical to analyze its effect on the instances of error occurrence as well as the quality of care provided after adoption of the tool. BCMA technology is designed in a way to enhance patient safety by focusing on certain aspects of the administration process. It usually targets patient identity, where it will check and confirm it. In this case, if the right patient is identified then chances of giving unauthorized drugs will be minimized. This technology also reduces the chances of giving drugs in the wrong form or dose. If a nurse administers it, she needs to the use the right route as well. The technology minimizes chances of giving drugs at the wrong time. Nurses will also report less cases of unavailable medication due to the method. Helmons et. al. (2009) did an investigation in which they wanted to determine the effect of a BCMA system on accuracy of medication administration. They were concerned with the number of errors that took place in intensive care as well as in general practice. It was an analysis done prior to implementation of the technology and three months after its implementation. They measured the number of errors using the California nursing outcomes indicator. An error was defined as any discrepancy between what had been ordered in medical recorded and what had been administered. The authors found a staggering decrease in the number of medication error rates within the surgical units as well as the intensive care units. It was noted that 58% of the errors reduced after implementation of bar code technology. However, this figure excluded the number of time-related errors or drugs that had been administered at the wrong time. In essence, fewer nurses forgot to administer medications generally. There was also a decrease in unavailable medications within the institution. Overall errors of omission in medical surgical units stood at 3.8% but they reduced to 1% after implementation of the device. In the same area, unauthorized drug administration errors were at 8% but eventually became 1.1% after the technology. Furthermore, use of the wrong dose was at 7.3%, but it became 2.8% after implementation. Different figures were recorded in the intensive care unit although these also minimized significantly. Observations made in the analysis were dependant on the type of errors initially present in the medical units. If few baseline figures for a specific type of medication error exist, then chances are that BCMA technology will have minimal impact on its prevalence in the future. This explains why error reduction was so great when the latter authors eliminated wrong time errors from their study. Some challenges may also occur due to the method of data collection as observation has been shown to alter behavior. However, experienced and non judgmental nurses may minimize these. Impact on nursing Poon et al. (2006) carried out an analysis in an institution that had implemented bar code medication administration technology. They observed nursing activities for three hours and then categorized them into medication administration and non medication administration activities. These authors looked at activity levels both post and pre implementation of bar code technology. They found that nurses used to spend 26.5% of their time on medication administration before the introduction of the technology. This quantity reduced to 24.5% after implementation. However, when they determined the quantity of time dedicated to other activities involving direct care it was found that the quantities remained unchanged. The latter study indicates that in terms of time, nurses will spend less time on the administration of medication when bar code technology is available. This implies that they have more time available to spend on other care activities. Although the study found no significant increase in the amount of time spent on direct care activities, it could be that nurses chose to spend it on their profession. As a result, they may end up becoming better care providers in the future even though this was not measurable in terms of the time they spent. Huang and Lee (2011) also carried out an analysis in Taiwan where they wanted to analyze the effect of this technology on activity patterns. They carried out qualitative interviews as well as 4950 observations of nurses who either used or refrained from using the technology. It was found that the use of this technology facilitated nursing work flow. Since medication administration had been streamlined, then nurses tended to spend more time on indirect care as well activities related to their unit. These findings thus augment the ones found by Poon and others. They indicate that barcode technology does provide extra time to nurses who then use it to improve their profession. It facilitates workflow and thus makes them more efficient at doing their job in other areas. One should also note that the above two studies were carried out during the adoption phase and a few weeks after adoption. The points of concern revolved around these moments. It is likely that if they had studied an institution that had implemented the technology years ago, then findings may have even be more in favor of other direct care issues. Impact on inter professional care One finding indicated that nurses may not be satisfied by the technological interventions. Gooder (2011) carried out an analysis in which the level of satisfaction that this tool caused among nurses was analyzed. Most of the professionals reported no significant difference in the rate of medication errors encountered before or after implementation of bar code technology. Furthermore, a number of them felt that they were less satisfied with the medical administration process in their institution prior to the technology than after. These surprising findings were attributed to reduced visibility of medication use in handheld devices. It was postulated that software used as well as screen size may have had a role to play in this. However, after the investigation, nurses had more problems with the software than the hardware of BCMA. It was thus noted that inter-professional collaboration was dramatically minimized due to the challenges in the technology. Nurses are the primary professionals that use this device; however, they often collaborate with pharmacists, IT professionals and doctors in realizing its benefits. If nurses are excluded in the development of the technology from the beginning, then chances are that they will not derive satisfaction from it. Inter-professional care mostly rests on nurses’ ability to derive benefits from the system. Kerr et. al. (2010) note that it is imperative to involve all professionals, including ordering physicians and pharmacists in the use of this technology. Anticipated future It is likely that more hospitals will implement BCMA. Statistics indicate that only 5% of US hospitals had the technology in 2002. Helmons et. al. (2009) found that 40.2% of all hospitals had the technology in 2007. This is likely to increase as time wears on. Several medical professional bodies support its adoption including the Institute for Safe Medication Practice as well as the Healthcare Information and Management Systems Society. They have all stated that bar codes in medical administration are a mature technology that will continue to be implemented. Concerns about the technology itself have been noted by certain authors who believe that it is critical to address implementation issues as they proceed. More research conducted in this area is likely to demystify some of the problems associated with its use. It is likely that software and hardware challenges will be streamlined. Conclusion Most of the literature indicates that bar code medication has a positive effect on nursing as a profession; it works on streamlining workflows. Additionally, it enhances quality and safety by reducing medication errors. Issues have been noted with regard to inter-professional care but these are likely to be streamlined with greater involvement of nurses in care. Further research on institutions that implemented the technology will be critical in highlighting long term impacts. Essentially, this is a worthwhile investment for institutions. References Gooder, V. (2011). Nurses perceptions of a (BCMA) Bar-coded Medication Administration System. Online Journal of Nursing Informatics, 15(2), 1. Helmons, P., Wargel, L. and Daniels, C. (2009). Effect of bar code assisted medication administration on medication administration errors and accuracy in multiple [patient care areas. American Journal of Health Systems in Pharmacy, 66(1), 1202-1211. Huang, H and Lee, T. (2011). Impact of bar code medication administration on nursing activity patterns and usage experience in Taiwan. Computer Infrom. Nurs., 29(10), 554-63. Kerr, G., Heelon, M. and Higgins, T. (2010). Bar code technology to reduce medication errors. New England Journal of Medicine, 363, 698. Poon, E., Keohane, C. and Gandhi, T. (2006). Technology on how nurses spend their time on clinical care. AMIA, 3, 1065. Read More