Information Systems in Healthcare: BCMA Impact on Patient Safety

This report provides a comprehensive analysis of Bar Code Medication Administration (BCMA) systems in healthcare. It begins with an introduction to BCMA, explaining its purpose in preventing medication errors and improving patient safety, referencing Glenna Sue Kennick's design. The report details the BCMA process, its integration with electronic medication administration records (eMAR), and its impact on nurses. It explores the concept of situational awareness in nursing, highlighting perception, comprehension, and projection levels. The report then discusses the challenges of BCMA implementation, including non-compliance and infrastructure requirements. An example study from a hospital is presented, along with a personal experience from a nurse, discussing both the positive and negative aspects of BCMA. The conclusion emphasizes the significance of BCMA in controlling medication errors and its potential to enhance nursing care. The report references several sources and provides a critical analysis of BCMA technology.

Running head: INFORMATION SYSTEMS IN HEALTHCARE
Information systems in healthcare
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Table of Contents
Introduction......................................................................................................................................2
Bar Code Medication Administration..............................................................................................2
Example...........................................................................................................................................4
Personal experience.........................................................................................................................4
Conclusion.......................................................................................................................................5
Reference.........................................................................................................................................6

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Introduction
Bar Code Medication Administration (BCMA) can be described as a system which is
designed to prevent errors in medication. Glenna Sue Kennick was the first person to design the
barcode system. The prime aim of BCMA is a general online record, prevent errors and improve
the accuracy of the medication administration. The main purpose of the topic is to highlight the
issues like medication errors that led to the adverse drug events, a threat to the patient safety and
BCMA served to prevent the medication errors. Medication safety is the prime goal of patient
safety and the BCMA helps the nurses to ensure medication in a safe way ().
Bar Code Medication Administration
Every year around 7 thousand deaths take place due to the medication errors and these
errors occur at every stage of the medication administration, dispensation, transcribing and
ordering. Thus, a method was devised which helped in reducing errors in the medication
administration and this novel process invention was the barcode medication administration.
BCMA works along with the electronic medication administration record for the purpose of item
specific identification. The adoption of the BCMA slowly and gradually caught pace and the
different healthcare organization stated to implement the barcode medication management
(Healthit.ahrq.gov, 2018). The main users of the system are the nurses and they are impacted
profoundly by the implementation of BCMA as it is associated with the implementation of
electronic medication administration record (eMAR). The integration of the BCMA and the
eMAR is vital for supporting the nurses worldwide. This integrative system provides a cognitive
support to the nurses and due to this, they gain a situational awareness in order to understand an
activity. The usability of the BCMA and the eMAR can have a big impact on the nurse
satisfaction, nurse productivity, patient safety. A proper situation awareness includes the

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information that is necessary for the nurses to take the necessary actions and appropriate
decisions. It is important to mention that the situation awareness is a human factor and it requires
the analysis of a situation at the 3 major levels: projection, comprehension and perception (Gann,
2015). The three levels can be described by the following way: the first level is the perception
and it signifies the awareness of a nurse with respect to the activities and systems. This level
highlights how a BCMA is operated and the ability of the nurses to perceive when a new
medication is ordered; level 2 is called the level of comprehension and this level specifies that
the nurses try to understand the meaning of a situation by gathering the different elements
pertaining to an information. In this stage, a nurse understands that yesterday a new medication
was ordered and today a patient is facing some trouble like nausea. Thus, it is important to
mention that the at this level patterns can emerge and this allows a nurse to detect the issues. The
final level is the level of projection and this describes the anticipation of a nurse pertaining to the
future events and the and the anticipation of the potential consequences if no proper actions are
taken. For example, a nurse will anticipate unless a new dopamine is ordered and thus
hemodynamic failure of the patient can occur if the provider is not called (Staggers et al., 2015).
Researches have indicated that there is a consistent lack of compliance with the procedures
prescribed in BCMA and this includes the patients that have the wristbands with the barcodes are
often not scanned properly. Studies have shown that the 10 percent of the administered
medications actively bypassed the BCMA. Instead of the usage of the BCMA, papers are used.
Such an incident occurred in health care facilities which lacked the computers in the patient's
rooms, and the lack of the computers also affected the preparation of the meds prior to the visit
to the patient room. Thus, proper implementation of the BCMA into the health care also requires

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infrastructure to accommodate the necessary the requirements (Hassink, Jansen & Helmons,
2012).
Example
A study was conducted at a quaternary hospital that has 6 pilot units and consisted of 3
adult ICUs, and three medical-surgical. The hospital implemented the BCMA system and on the
4th of June 2013. All the pilot units had the medication room and the mediation was received
from an automated medication dispensing system and it was integrated with a stationary
computer that displayed the MAR. According to the test procedure, a nurse after leaving a
medication room will be required to take a workstation on wheels (WOW) directly into the
patient's room. Inside the patient's room, the administered medication is to be documented on the
MAR through the usage of WOW. The study reports have indicated that among the 70
medication events, only 40 medication events had the implementation of the bar code procedure.
The results suggested that the reported errors occurred due to the errors in medication, time,
route and dose. While the most common type of medication error was the wrong time. This
signifies that the BCMA does not have the provision of giving alerts for conducting medication
at the wrong time. The technology thus lacks the advocacy and vigilance of the nursing staff
(Bowers et al., 2015).
Personal experience
Being a nurse, there is a huge responsibility to deliver medication to a patient in a proper
way. The BCMA is a novel technology which is capable enough to reduce the medication errors
that I previously used to make. The technology has helped me personally to keep a track on the
issue of the drug package, medication information, transcription errors and patient identification.
One of the positive sides is that I was able to properly my duty of medication management.

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While one of the negative sides is that the I was unable to keep a track in the time I was giving
the medication. I still have to manually enter the time and it is sometimes tedious when I handle
several patients at the same time.
Conclusion
From the above discussion, it can be concluded that the medication error was one of the
big issues previously but it is now under control with the new technology called the BCMA.
BCMA, when integrated with the electronic medication administration report, has helped several
nurses to properly deliver the medication to the patients. The purpose of the topic is to highlight
the positive sides of the usage of BCMA and the limitation attached to it. The newfound insight
will probably help me in properly dispensing the nursing care. I will now be able to keep a track
on plenty of medication information which was previously not feasible when done manually.

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Reference
Angel, V. M., Friedman, M. H., & Friedman, A. L. (2016). Integrating bar-code medication
administration competencies in the curriculum: implications for nursing education and
interprofessional collaboration. Nursing education perspectives, 37(4), 239-241. doi:
10.1097/01.NEP.0000000000000038
Bowers, A. M., Goda, K., Bene, V., Sibila, K., Piccin, R., Golla, S., ... & Zell, K. (2015). Impact
of bar-code medication administration on medication administration best practices. CIN:
Computers, Informatics, Nursing, 33(11), 502-508.
DOI:10.1097/CIN.0000000000000198
Gann, M. (2015). How informatics nurses use bar code technology to reduce medication errors.
Nursing2018, 45(3), 60-66. doi: 10.1097/01.NURSE.0000458923.18468.37
Hassink, J. J. M., Jansen, M. M. P. M., & Helmons, P. J. (2012). Effects of bar code-assisted
medication administration (BCMA) on frequency, type and severity of medication
administration errors: a review of the literature. European Journal of Hospital
Pharmacy: Science and Practice, ejhpharm-2012. DOI:
http://dx.doi.org/10.1136/ejhpharm-2012-000058
Healthit.ahrq.gov. (2018). Bar-coded Medication Administration | AHRQ National Resource
Center; Health Information Technology: Best Practices Transforming Quality, Safety,
and Efficiency. Retrieved from https://healthit.ahrq.gov/ahrq-funded-projects/emerging-
lessons/bar-coded-medication-administration
Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar code medication
administration technology: a systematic review of impact on patient safety when used

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with computerized prescriber order entry and automated dispensing devices. The
Canadian journal of hospital pharmacy, 69(5), 394. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5085324/
Staggers, N., Iribarren, S., Guo, J. W., & Weir, C. (2015). Evaluation of a BCMA’s electronic
medication administration record. Western journal of nursing research, 37(7), 899-921.
DOI: 10.1177/0193945914566641