NR 360 Week 2 Barcode Scanner Technology Evaluation Example

Evaluating One Barcode Scanner on One Medical-Surgical Unit: Safety, Time, Accuracy and Burden

Student Name

College of Nursing, Chamberlain University

NR 360: Information Systems in Healthcare

Instructor Name

Month Day, Year

Evaluating One Barcode Scanner on One Medical-Surgical Unit: Safety, Time, Accuracy and Burden

The Tool and What It Promises

This evaluation examines one piece of technology: the handheld wireless barcode scanner used for medication administration on an adult medical-surgical unit of 30 beds, a composite, paired with the electronic medication administration record. Before giving a medication, the nurse scans the patient's wristband and then the barcode on each medication package. The system checks the match against active orders and alerts the nurse to a wrong patient, wrong drug, wrong dose or a dose given too early. The scanner was introduced on the unit three years ago, replacing a system in which nurses checked medications against a printed record by sight.

The tool promises two things that should be evaluated separately. The first is safety: fewer medications given to the wrong patient or in the wrong dose. The second is efficiency: faster documentation, since scanning records the administration automatically. The published evidence and the unit's experience answer those two promises differently, which is why the evaluation uses criteria set before any verdict.

The Criteria

Four criteria are used, in this order: safety, meaning whether the tool reduces medication errors that reach patients; time, meaning whether it adds or removes minutes from the medication pass; accuracy, meaning whether the record it produces reflects what actually happened; and burden, meaning what the tool demands of nurses beyond the time it takes, including interruptions, workarounds and frustration. Each criterion is judged with published evidence where it exists and with observation from the unit where it does not.

Safety

The published evidence on safety is strong, and the need is well documented: a national report on medication errors estimated that hospitalized patients experience, on average, at least one medication error per day and recommended bedside technologies that verify the right patient and the right drug (Aspden et al., 2007). In a study at a large academic medical center comparing units before and after barcode technology was introduced with the electronic medication administration record, Poon et al. (2010) found a substantial reduction in medication administration errors other than timing errors, and a reduction of about half in potential adverse drug events from those errors. The study was not randomized, but it was large, measured errors by direct observation rather than by incident reports, and compared units with and without the technology over the same period. On the unit evaluated here, the pharmacy's quarterly report shows that scanner alerts stopped several wrong-patient and wrong-dose administrations each month, which is consistent with the published finding, although the unit does not measure errors by observation and cannot say how many errors reach patients now compared with before.

Safety depends on the scan actually being done at the bedside. Koppel et al. (2008) documented 15 types of workarounds to barcode medication administration systems across several hospitals, such as scanning a copy of a patient's wristband taped to a computer cart, scanning medications after administration or overriding alerts without reading them, and identified more than 30 causes, many of them related to the technology or the environment rather than to nurses' carelessness. Each workaround removes some of the safety the tool provides.

Time and Accuracy

On time, the tool's promise is weaker. Scanning is fast when it works, but on this unit three conditions slow it down: wristbands that are wet, wrinkled or placed on a swollen arm and will not scan on the first try; medications from pharmacy with barcodes that are missing or unreadable, which must be manually overridden; and a wireless signal that drops in the two rooms at the end of the east hallway, where nurses scan in the hallway and walk back. A nurse on the unit timed her own medication pass on two shifts and found that scan failures added about ten minutes to a pass of five patients. Any time saved by automatic documentation is partly spent recovering from failed scans.

On accuracy, the record is better than the paper system in one way and worse in another. Administration times are now recorded exactly when the scan happens, which improves the accuracy of the timing record. But when a medication is scanned after administration, or when a dose is documented through an override, the record shows a scan-verified administration that did not happen the way the record implies. The record looks more reliable than it is whenever workarounds are used.

Burden and the Workaround as Evidence

The workarounds on this unit are the most useful evidence about burden. Nurses in the east-hallway rooms sometimes scan the patient's wristband at the doorway, then walk in and give the medication, because the scanner loses its connection by the bed. Some nurses keep a spare printed wristband label for patients whose bands will not scan. These workarounds are not signs of careless nurses. They are reports about where the tool does not fit the work, and each one points to a fix: a wireless access point in the east hallway, a wristband replacement protocol, and a feedback loop to pharmacy for unreadable barcodes. The burden of the tool, in other words, is concentrated in a few predictable failure points rather than spread across every administration.

Verdict

On the four criteria, the verdict is mixed but clear. On safety, the scanner is worth keeping, with strong published evidence and consistent local signals that it stops errors. On time, it does not deliver the efficiency it promised on this unit, largely because of scan failures that are fixable. On accuracy, it improves timing records but can produce a false sense of verification when workarounds are used. On burden, the costs are concentrated in identifiable failure points. The recommendation is to keep the scanner and fix the three failure points, the wireless dead zone, wristband replacement and unreadable pharmacy barcodes, and to measure scan compliance, the proportion of administrations with both patient and medication scanned at the bedside, rather than assuming that the presence of the tool means it is being used as intended.

Scan compliance can be pulled from the medication administration record's own audit data, which records whether each administration was scanned or overridden, so measuring it asks nothing new of nurses. A falling override rate after the three fixes would show that the failure points, not the nurses, were driving the workarounds.

References

Aspden, P., Wolcott, J., Bootman, J. L., & Cronenwett, L. R. (Eds.). (2007). Preventing medication errors. The National Academies Press. https://doi.org/10.17226/11623

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616

Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, J. M., Kachalia, A. B., Hayes, J., Churchill, W. W., Lipsitz, S., Whittemore, A. D., Bates, D. W., & Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698-1707. https://doi.org/10.1056/NEJMoa0907115