Barcodes have been around for awhile now in hospitals – on patient wristbands, medication labels, medical charts, and lab samples. Early on, it was hoped that barcodes could make patients safer by adding an extra safety check for nurses who administer drugs according to “the five rights.” (Right patient, right medicine, right dosage, right administration method, right time.)
Unfortunately, even though barcodes are now ubiquitous, medication errors have NOT disappeared. Whether you’re a floor nurse, a nurse manager, or a nurse informatics specialist responsible for implementing a barcoding system, it’s important to be aware of the stumbling blocks that can render barcodes less effective and put your patients at risk. Here’s a rundown of some common problems.
- Non-compliance: the failure to scan. When a system doesn’t work well, there’s a temptation not to use it. Sometimes compliance issues can be resolved through focused staff input. For example, if floor nurses are constantly running up against annoying technical glitches – dead batteries, missing cables, unreliable wireless connectivity – a system of preventive maintenance may be an easy fix.
- The urge to override an alert. All medication dispensing systems have an over-ride feature, so medicine can be administered in an emergency without formal orders. But sometimes staff can get a bit too comfortable with this feature. For example, let’s say a nurse is unaware that pharmacy orders have changed on a patient’s insulin dose. She does the scan and gets an alert that the dose is wrong. But she’s administered this same dose before and it seems right to her, so she overrides the alert without investigating and administers the drug anyway.
There’s also a risk when alerts go unnoticed. If a nurse has to leave a cart in the hall and enter the patient’s room with only a hand-held scanner, she may administer the wrong drug and not even know it until she returns to the cart to see the “wrong dose” alert on the monitor. It’s crucial that audible or visual alerts be impossible to miss, and that floor nurses don’t view them as an unnecessary annoyance.
- The matter of workarounds. We’re going to define “workaround” as an alternative method of accomplishing a task when the standard process is not working well. It’s a temporary solution, but it may indicate that the standard process is in need of improvement.
One of the most common workarounds in barcode scanning is to have a second set of patient wristbands in an another location – on the medication cart or attached to a neonate’s crib, for example. If there are logistical issues that make scanning processes inconvenient, they should be resolved rather than ignored. Floor nurses need to feel comfortable pointing out these areas in need of improvement, and nurse managers should always be striving to identify workarounds and work with IT departments to correct them.
- Dangerous distractions. When an accepted workflow process is interrupted, rather than all steps being performed in sequence, there’s an opportunity for errors to occur. Consider this scenario: After scanning and verifying the patient’s meds, a nurse sets the drugs back down on the cart and walks away with a colleague who is requesting her help. Five minutes later, she returns to the cart – and administers the drugs to the wrong patient.
It’s become clear that many barcoding systems have limited functionality or features that create inefficient workflow processes. As a nurse, you have a choice – when the technology isn’t working for you, you can create your own workarounds or you can speak up and advocate for improved technologies and processes. It’s clear that improvements should be made – and who better to provide input than you, the frontline provider?
And if you’re really interested in technologies that increase patient safety, why not consider specializing in nursing informatics? Health care is in need of nurses who can analyze technologies from both the bedside and IT perspectives. An online MSN degree in nursing informatics is the perfect way to improve your knowledge, skills, and value to your organization.