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Changes in workflow and tasks need to be assessed when introducing bar code medication administration into nurses' work

Bar code medication administration (BCMA) technology is being implemented slowly in hospitals across the United States. The BCMA technology consists of a medication network server and handheld devices that connect to medication administration record data through a wireless radio frequency link.

The software system enables users to document the administration of medications at the bedside or other points of care in real time. When hospitals introduce a new technology like BCMA, they should study how the technology will change nurses' workflow and tasks as well as the safe administration of medications, according to a new study.

A human factors engineer and a pharmacist observed use of BCMA technology during medication administrations to identify work system factors that affected nurses' use of and interaction with the technology when they administered medications. Nurses varied in the order in which they performed steps of the medication administration process, with a total of 18 different sequences identified.

Some of these sequences were contrary to hospital policy and the original design of the medication administration process. In addition, they could be considered workarounds or potentially unsafe acts, notes Pascale Carayon, Ph.D., of the University of Wisconsin-Madison. Interruptions and patient factors typically were precursors to medication errors and workarounds. For example, in 32 percent of observations, nurses were interrupted by the needs of patients and their families, nurses were interrupted by another provider or the nurse initiated an exchange with another provider, or interruptions were caused by equipment, technology, or medications.

Patient factors like unique patient populations (children, the disabled, or the critically ill) or contact isolation requirements also affected medication administration. These factors may not have been taken into consideration during the development of BCMA technology, note the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS14253).

See "Evaluation of nurse interaction with bar code medication administration technology in the work environment," by Dr. Carayon, Tosha B. Wetterneck, M.D., Ann Schoofs Hundt, Ph.D., and others, in the March 2007 Journal of Patient Safety 3(1), pp. 34-42.

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