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Williamson 1

Alexander Williamson
Professor Salgat
ENG 111-02
November 18, 2014

Scanning to Success
All across America there are mistakes made every day in hospitals. These mistakes can
be minor or extremely severe to the point it causes death. One of the main reasons for these
mistakes are incorrect medication administration due to either fatigue of a nurse or just
overlooking the name on the bottle of medication. The print on the bottles can be hard to read
sometimes and quite a few of the names can be similar or close. The nurses working can
sometimes also get their patients mixed up also allowing a chance for error. There are so many
opportunities for errors and the list goes on and on.
Therefore a solution needs to be put in place to reduce errors made by incorrect
medication administration. There are a couple ways in which this can be done from training
nurses to double and triple check the medication or assigning a nurse that would only administer
medications so that they could focus on one task. However, the best solution to the issue at hand
would be to implement a barcode administration system into the hospital. A barcode medication
administration system is used when a patient requires medication. Before the nurse administers
the medication they have to scan the bottle, the patients wristband, and the computer to log in the
system that the medicine has been administered. This is a relatively easy application into a
hospitals already existing policies and procedures. By implementing this system it will have easy
to use equipment, decrease errors, lower the workload on nurses, and will overall reduce the cost
in the long run.


The system itself is actually

relatively easy to use and implement
into an already existing hospital. By
implementing the system it assists
the nurse in confirming the patients
identity, dose, time, and form of
medication (Bennet). The way the
system can do this varies depending

Fig. 1. BCMA & Nursing Informatics

on how thorough the hospital wants to be. The system is always computerized and uses an either
a portable or fixed system. The portable system is more of a handheld scanner device while the
fixed is usually set on a cart as it is more like a computer system (Bennet). The system comprises
of a scanner, barcodes, and a computer database (Bennet). The barcode that is required to be
scanned can be placed in multiple spots. The most common barcode locations are on the
medicine bottle and on the patients wristband (Fig 1).
However, this can be an extremely thorough process if the hospital wants to ensure the
highest accuracy rate possible. Hospitals should be focused on obtaining the highest accuracy
rate possible. This can be done using many various changes in the system. There can be a
barcode that can be added to the nurses keycard which would verify that the correct nurse is
administering the medication (Bennet). This will make sure that not only the nurse is performing
their job but also it will help build a memory of the medication that patient needs in turn
lowering the error rate as well.
To get a full understanding of how the process works lets say that Mr. Richards is due
for his blood pressure medicine. An alert might pop up on the barcode administration system


which reminds the nurse it is time for Mr. Richards medication. The nurse enters and then pulls
out the scanner and he/she scans the medicine bottle, the patients wristband, and their ID. The
system would then either verify that this is the correct medication and log it as administered or
state that it is the incorrect medication and state the correct medication. The nurse then leaves
and moves on to the next room. The system is extremely easy to use and training should not be a
limiting factor as to why it should not be implemented into a hospital.

A big reason why the barcode medication administration system should be implemented
into every hospital across America is to reduce errors. The ramification of an error in the
healthcare industry can be extremely costly and complicated due to the legal consequences
thereof. So naturally the main concern of the hospital should be reducing the amount of error.
There were quite a few studies performed on the amount of errors made in hospitals. One study
done by Seibert, Maddox, Flynn, and Williams focused on the effects of barcode technology and
how by implementing the system in St. Josephs/Candler Heath System yielded some positive
results (Seibert, Maddox and Flynn).
To start off the definition of a medication error, as defined by the study, is any
discrepancy between a prescribers interpretable medication order and what was administered
(Seibert, Maddox and Flynn). The group then began to study the amount of errors made
throughout a twelve month period. They had monitored in total, before the integration of the
barcode administration system, six months of medication administration. What they had found
was that the overall accuracy rate was 93% (Seibert, Maddox and Flynn). When the lives of
individuals are at risk an error rate of 7% is quite a lot. It can be extremely discouraging to the


patients to choose that hospital in particular and it is also dangerous to patients recovery and
stay if there are that many medication errors.
After the first 6 months, the group then installed the barcode administration system. After
teaching the staff how to use the system they then continued to monitor them over another 6
month period marking down any sort of medication error. At the end of the period they had
found that it had increased accuracy and also efficiency. The total number of errors had
decreased and the accuracy rate had increased by 3% totaling at a 96% accuracy. This may not
seem like a large improvement however the system had just been introduced into this hospital
system. If the nurses had a longer time to completely get familiar with the technology and work
out any technical difficulties in the system the accuracy rate would potentially increase.
The amount of stress a nurse is put under is unbelievable. There are studies that stated
that a nurse is put under so much stress that they show symptoms similar to PTSD of soldiers
returning from war (The American Institute of Stress). The amount of things that nurses have to
do throughout the day in their job is almost impossible. To start off they usually work a twelve
hour shift about three days a week. During this shift they are required to remember a lot of things
such as medications, patient names, and how a patient is acting from when they last saw them.
The amount of physical labor put in every shift is demanding as well. A nurse might have to
move the same patient about 12-30 times a day.
All of this stress and physical exertion can leave a nurse severely fatigued. Yet, there
expected to be able to effectively and correctly administer medicine to their patients. This is
quite a task and when fatigued a persons decision making skills drop by quite a bit. Therefore it
would make sense to implement the barcode medication administration system into the hospital
to reduce the workload put on nurses. One nurse that was interviewed talked about their believed


benefits of implementing a barcode medication administration system and how it could reduce
the workload put on her. Darlene Lum stated that the efficiency and safety would increase (Lum
and Lum). Darlene had also stated that she hasnt used the barcode medication administration
before however she had done it by hand and had honestly administered incorrect medication
(Lum and Lum). It would reduce the amount of workload making her more efficient and able to
focus on other important things.
Another Interviewee was Don Lum, Darlenes wife, he works at Havenwick Psychiatric
Hospital and the BCMA system is not implemented. Don had stated that he knew of the barcode
medication administration system however he has never used it also (Lum and Lum). He has
however been in Henry Ford Hospital and they used the system (Lum and Lum). He felt that it
made him feel safer and that everything ran a bit smoother because of the system (Lum and
Lum). He also stated that if the system was implemented in Havenwick it would run more
efficiently lowering the workload on him and his colleagues.
The two nurses stated that the overall system would be extremely helpful and beneficial
to the patients, hospital, and themselves. It would reduce the overall workload and make
everything run more efficient. So based on the amount of stress a nurse goes through and
showing how the barcode medication administration system helps reduce the workload further
supports implementing the system into every hospital in America.
There are a lot of positive things about implementing this system into a hospital.
However a common argument pops up whenever looking into actually installing it into the
procedures of a hospital. The argument is that nurses will find ways to work around the barcode
scanning due to not accepting the new technology. The big reason why they would do this


because it may give a false sense of them not being good enough so the hospital had to step in
and monitor them.
There are quite a
few various workarounds
that a nurse can use, such
as scanning the
prescription from the
medicine drawer without a
check of medication list,
name, and dose (Koppel).
Another workaround is
that the nurse may not
verify that the medication
is up to date on the system
and administer incorrect
medicine (Koppel). The

Fig 2 Barcode Medication Administration System Workarounds

nurse can also disable the

audio alarms on the system so that it will not warn the nurse when an error is made (Koppel).
This violates the five rights of medication administration which are the right drug, right
dose, right route, right time, and the right patient (Bennet). These rights are extremely important
to be followed. If they are not it can lead to a serious error which can cause the patient their life.
However there can be less severe workarounds which involve simply putting in the seven digit


barcode number because its faster on the computer (Debono). This method just shows that the
nurse does not want to accept the change in procedure and believes that it is a waste of time.
There are many ways a nurse can work around the system and the list goes on. However,
would a nurse do that? When a nurse enters the field they have to swear the Hippocratic Oath.
The oath is a guide of morals and ethics of those who work in the health care field. One line in
the oath states And I will not give a drug that is deadly to anyone if asked [for it], nor will I
suggest the way to such a counsel (Miles). This means that the nurse swore to never give any
medication that would cause harm or, to do something that would cause the wrong medication
administered in this case.
If the moral ramification is not enough of an argument then what about the legal
ramifications. A nurse, if caught, bypassing procedure could have a few different outcomes. The
first ramification being losing their job at that hospital. This is not as bad of an outcome for
breaking protocol however it can increase in punishment such as losing a medical license. Then
one could also have some legal issues such as a case. The outcome could range anywhere from a
fine to jail time.
There are few consequences that discourage nurses from actually working around the barcode
medication administration system. So this should not be considered as a sole reason why the
system should not be implemented into a hospital. The users of the system that douse
workarounds will eventually get caught and be placed under review for not following safety
In summary, the barcode medication administration system needs to be implemented in
hospitals throughout America. The benefits of implementing this system is proven through quite


a few studies. There are a few other hospitals that have this system implemented already and
have been very successful in decreasing errors and improving efficiency. The fact that it
improves the patients experience by making medication administration safer and efficient should
be the reason why it is implemented.
However, if the patients improved safety is not enough, then there is also the fact that the
equipment is extremely easy to use and implement into a hospitals already existing protocols.
There will be minimal training needed to teach the users how to operate the system quickly and
effectively. Also the decreased workload on nurses by implementing this system will help with
how smooth the hospital will run. With a nurse having to focus on one less thing and having the
system able to help make sure the correct patient, medication, and dose is administered is
extremely helpful.
Finally, the opposition that nurses would try to work around is not very valid due to the
potential legal ramifications of breaking protocol. Darlene also stated in the interview from
earlier that the only time she would use a workaround would be in a life or death situation (Lum
and Lum). This just shows that nurses are thinking more of the patients and less of how to get
tasks done in the fastest way possible. Based on all the facts that have been barcode medication
administration systems should be used in every hospital across America. They have numerous
positive benefits that will greatly improve the quality and safety of a patients stay at the hospital.
That is what health care is all about.


Works Cited
Bennet, Sally. "The relationship between barcode medication administration satisfaction and the
use of workarounds among registered nurses." UMI Dissertations Publishing (2012). 4-6
Debono, Deborah. "Nurse's Workarounds in acute healthcare settings: a scoping review." BMC
Health Research Services 13.175 (2013): 17. Web
Koppel. "Barcode Administration System Workarounds." Journal of the American Medical
Informatics Association 15.4 (2008): 16. November 2014. Web
Lum, Darleene and Don Lum. Telephone Interview. 16 November 2014. Document.
Miles, Steven H. Hippocratic Oath and the Ethics of Medicine. Cary, NC: Oxford UP, 2005.
Seibert, Heather, et al. "Effect of barcode technology with electronic medication administration
record on medication accuracy rates." AM J Health-Syst Pharm 71 (2014): 9. Web
The American Institute of Stress. The American Institute of Stress. n.d. Web. 5 October 2014.