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Fundamentals of Nursing Informatics Paper: Barcoding

Leah J. Dahlstrom, Jeffrey F. Dimdiman, Payton S. Eggering

Division of Nursing, University of Mary

NUR 242 01: Nursing Fundamentals

Susan Weigum, MSN, RN

March 8, 2021
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Introduction

When becoming a nurse, there are certain philosophies and ideologies that are integral to

providing a client with holistic care. One of these philosophies is ensuring the safety of the client

with all nursing interventions performed. By implementing a system such as barcoding, it is

imperative that a nurse not only understands the system, but knows the intended purpose of

utilizing it, how it affects client care, and how to avoid errors when using the system. By being

educated and properly trained on using barcoding systems, nurses can avoid wastes of up to $3.5

billion annually as well as prevent errors that put about 1.5 million people in danger every year

(Da Silva & Krishnamurthy, 2016). In order to avoid such large numbers of medication errors,

one first must understand how barcoding works. What this system allows health care team

members to do is ensure that the right client is receiving the right medication in the right dose,

through the right route, at the right time. By having a system that checks these five rights, it will

show the nurse that there is some sort of inconsistency to stop any medications that violate those

rights. It is integral to have a system that does this, as it further emphasizes the importance of

keeping errors to a minimum and protecting the information of clients.

The Scope of Technology

Client safety is one of the significant priorities in every healthcare facility. Over the

years, the discovery of Barcode Medication Administration (BCMA) made a significant impact

in preventing medical errors. This technology primarily focuses on client and medication

identification. BCMA is widely used across different healthcare facilities in the United States

and progressively develops in other countries. It gained popularity because of its ease of access

and instant verification approach. According to The Pharma Innovation, barcodes are used for

client identification, medication management, and tracking of medical supplies in hospitals (Alli,
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2021). Client identification is a vital constituent of client safety before providing any medical

intervention. Upon admission to hospitals, clients are given barcode bands which are an essential

part of the identification process in BCMA. It contains integrated data of the client and is

connected to the client's medical database. For the BCMA to work, the nurse needs to scan the

client's barcode band and the medication's barcode before medication administration. Once

scanned, the system electronically verifies the "5 rights" of medication administration -- right

client, right dose, right drug, right time, right route -- at the client's bedside (Shah et al., 2016).

After the data is validated, the system notifies the nurse if the medication or the client is

incorrect, providing the nurse a chance to review and fix the error before proceeding to the

medication administration (Truitt et al., 2016). This statement would signify the importance of

making ethical and evidence-based judgments as a medication administrator. System errors

would still be possible to occur at any moment. Aside from mitigating medication errors, BCMA

increases the efficiency of medication administration. The connection between BCMA and the

client's electronic health record (EHR) makes it easier for the healthcare providers to monitor the

client's progress and medication intake with proper documentation. In the documentation

process, health care providers can utilize the system to leave notes and coordinate with other

health care members as to what changes were made.

Consideration to Protect Confidentiality

There are several security purposes in place in order to keep sensitive client information

from those who are not meant to access that information. This is a concept that is incredibly

important to nursing and the care nurses give to clients in their care. So, when barcoding systems

came into the healthcare world, there needed to be precautions in place to prevent security

breaches. There needs to be proper training on the subject, so the staff utilizing the system know
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potential security breaches and tracking to see who is accessing what files at what time. Cinahl

Information Systems released an informational paper to explain the important facts about

barcoding, specifically stating that “training should be thorough” as a means of being

comfortable with usage to eliminate mistakes (Woten & Karakashian, 2017). To actually use the

technology, nurses are required to login to a client’s electronic health record and scan not only

their barcode, but the medication being given to them, allowing the nurse to ensure the

medication being given is the right one (Strudwick et al., 2017). This would imply that, had the

nurse logged into the right EHR in the wrong room, the information would be protected, as the

barcoding system would alert them that the client barcode that was scanned was not the same one

in the EHR they are looking at. By having the feature of needing to be logged in to a particular

client’s record, it avoids the mistake of a nurse seeing a client’s information that is not theirs.

There are certain programs in place by companies, such as EMS Barcode Solutions, that track

when a particular nurse is using the barcoding system and on what item (EMS Barcoding

Solutions, 2021). This is another way that, if there is some breach in security, there can be a

record of what nurse it was recorded under in the system to narrow down who is not following

HIPAA regulations. There are other very simple, very manageable ways that health care

members can be conscientious of the information that is meant to stay private. One example is

ensuring that there is no one behind the computer when getting into the EHR. Not only is it a

good habit to have when administering medication, but in general will ensure the client’s

information is protected whenever the EHR is open, as it contains a plethora of sensitive

information. By ensuring healthcare staff is well-trained, understands the system, and is

conscientious of vulnerable moments in accessing client information would allow for the

barcoding systems to maintain client confidentiality.

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Error Prevention and Patient Safety

One of the major benefits of BCMA is it reduces the number of medication errors. This is

because BCMA provides a simple technological solution to improve safety in the preparation

and management of administering medication. It acts as a barrier that can prevent adverse events

by aiding the nurse in checking the five rights of medication administration: the right client, the

right medicine, the right dose, the right route, and the right time (Daus et al., 2017). One way

BCMA does this is by certifying the barcode of the medication matches the identification tag of

the client. This ensures that medications are safely administered to the correct client. BCMA also

protects clients and helps nurses provide quality care by preventing human errors that can arise

from lack of concentration and fatigue. With the implementation of BCMA, the rates of harmful

medication errors decreased from 0.65 per 100,000 medications before the intervention to 0.29

per 100,000 medications after the intervention (Thompson et al., 2018). Another benefit of

BCMA is it enhances infection control practices. This is because non-touch technique

verification with handheld devices is utilized and can be conveniently disinfected with alcohol

wipes because of their small size. This eliminates the need to bring mobile carts into the room as

they can be stationed outside of a client’s cubicle to prevent exposure to infectious diseases and

cross-contamination to other clients (Naidu & Alicia, 2019). Although barcode medication

administration is beneficial to nurses in providing safe care to clients, it also has disadvantages.

One weakness of BCMA is it is susceptible to cybersecurity issues. This is because BCMA

cannot be utilized without an electronic medication administration record (e-MAR). An e-MAR

contains client’s information online which exposes it to cyber-attacks and ransomware. Hackers

could use this information to hold medical data hostage until they receive money. This results in

slowing down of work and violation of a client’s privacy and confidentiality. Another
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disadvantage of BCMA are the technical difficulties that can arise. For example, some barcodes

on medications could be mislabeled, wristbands could be difficult to scan, or confusing computer

screen displays can result in technology-related adverse healthcare events. Along with this, as

BCMA is implemented, unanticipated technological issues could arise that would need to be

solved with the assistance of the vendor. All of these threaten the quality care and safety of the

client (Woten & Karakashian, 2017).

Nurse Involvement in Barcoding

Barcode medication administration was developed in 1994 by a registered nurse named

Glenna Sue Kinnick. She piloted this idea with the intention of improving client safety by

reducing medication errors. It was an idea that stemmed from a rental car check-in system that

she observed in 1992 (Sherman, 2013). In 1997, BCMA was being utilized in all VA hospitals,

and in 2003, the FDA recommended the implementation of BCMA in all hospitals throughout

the United States. Over the years, BCMA has evolved from a portable radio terminal paired with

ultra-high frequency band radio waves to graphical user interface combined with wireless

connectivity (Indian Health Service, 2021). This development in technology was impart to

disciplinaries working together such as pharmacy, nursing, and information technology

specialists. From this, it is evident that nurses have had a vital role in the development of BCMA

over the years. Regarding implementation and evaluation, BCMA helps nurses identify

problems, devise plans for improvement, and track improvement over time, all of which helps

nurses serve as strong client advocates. Before administering a medication, the nurse scans both

the armband and the barcode on the medication. BCMA technology certifies that the nurse

administers the medication correctly to the correct client. If the medication or client is incorrect,
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the nurse is notified, giving the nurse opportune time to correct the error before administering the

medication (Truitt et al., 2016).

Conclusion

By implementing the barcoding system into healthcare, there is a significant decrease in

medication errors as a result due to eliminating the chance for human error. The system can also

alert the healthcare team to any violations to the client’s five rights of medication administration

for further review from the team member. Before the team is able to utilize the system, there

must be training that ensures workers understand the purpose of the system, how it works, and

why each alert should be paid attention to no matter what. There does need to be further research

in order to keep protected information from being accessed, whether it be within the people on

the floor or through cybersecurity breaches. While those are pressing issues with the current

system in place, there is still significant impact on the nursing role and integration of client care.

By having a system that checks the client’s rights of medication administration alongside the

nurse, as well as a system that assists with documenting the information with accuracy due to it

being a program. BCMA allows to cut out the error that comes with being human, ensuring the

utmost safety for the clients that come into a nurse’s care.
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