Bar-Coded Medication Administration Systems

Medication errors may have tragic consequences for patients. While that is bad enough, they also damage the reputations of healthcare organizations, the nursing profession and the cost is quite expensive. A good portion of adverse drug events (ADEs) are preventable. They can occur during the ordering, administration, transcription or dispensing stages, but a good share of ADEs are committed at the point of administration. With bar-coded medication administration (BCMA) systems, the likelihood of committing a medication administration error is decreased because the system checks all of the aspects of the medication and verifies that each of them are correct. Unfortunately, even though BCMA systems have been around for over 3 decades now, they are still not implemented as often as one would think they would be, and there are many reasons for that. However, those reasons for not implementing a BCMA system seem less important when one realizes how effective they are.

Bar-coded medication administration (BCMA) systems were created to electronically reduce the number of medication errors. These systems verify what Shah, Lo, Babich, Tsao, and Bansback (2016) of the Canadian Journal of Hospital Pharmacy call the “5 rights of medication administration—right patient, right dose, right drug, right time, right route” (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 394). BCMA systems make it possible for the verification to take place at the patient’s bedside before administering the medication. The way it works is that a nurse planning to administer medication scans the bar code on his or her identification badge, the bar code on the patient’s wristband, and the bar code on the medication. The bar code scans are sent to a computer software program where algorithms check through databases and generate warnings or approval (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 394). Most of the time, the BCMA system works quickly so nurses are not waiting around for the approval, and patients are not suffering in pain or discomfort waiting for their medication while the BCMA system functions. The following diagram from Cummings, Ratko, and Matuszewski (2005) of Patient Safety and Quality Healthcare (PSQH) illustrates how a BCMA system works.

Impression of BCMA

The idea of having multiple checkpoints for medication administration seems like a good way to improve patient safety, protect the organization’s reputation, decrease litigation costs, and preserve the image of the nursing profession. Cummings, Ratko, and Matuszewski (2005) were writing about this type of system 14 years ago, and it seems that some healthcare organizations have adopted them, but with mixed results. Cummings, Ratko and Matuszewski (2005) explain, “The adoption of barcode technology by hospitals has been slow. The first prototype systems were developed in the early to mid-1990s and began to be disseminated in the late 1990s. . . .The rate of implementation is climbing, though it is still probably in the range of 5% to 10% of hospitals” (Cummings, Ratko, & Matuszewski, 2005). One would think that 14 years later more BCMA systems would have already been implemented in hospitals.

BCMA systems have been implemented, but slowly and with measured success. Siwicki (2017) of Healthcare IT News says, “Only 30 percent of 1,859 measured hospitals fully meet the . . . patient safety standard for use of bar code medication administration technology, but a significant 74 percent fully meet the group’s patient safety standard for use of computerized physician order entry systems to minimize medication errors” (Siwicki, 2017). The BCMA system involves nurses, who are the healthcare providers who most frequently administer medications. The system used should be the one that fully meets the safety standards of those who most often administer medications. Physicians may make medication errors also, but they do not administer medication at the same rate of frequency as nurses do.

The reasons for the slow adoption of BCMA systems are many. Some fear that the electronic gadgetry will not work correctly. Others fear that those who would be using the systems will be unfamiliar and afraid of the new technology. Shah, Lo, Babich, Tsao, and Bansback (2016) say, “Other than cost, one of the barriers to widespread adoption of BCMA technology is the lack of definitive evidence that BCMA actually reduces preventable medication errors, especially in hospitals that are already using other safety systems, such as computerized prescriber order entry (CPOE) and automated dispensing devices (ADDs)” (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 394). On the other hand, Sakowski and Ketchel (2013) report, “Hospitals have reported experi