Abstract
A medication error is one of the most threatening issues in the healthcare system and a significant factor contributing to death among patients. Several medication error cases arising from incorrect doses and wrong patient are reported each year in the United States. Therefore, this research explores and argues for the implementation of barcode scanning to help reduce medication errors in inpatients. The research finds that the efficacy of the technology is debatable due to inconsistency in some prior studies. Nonetheless, the study also finds that facilities can overcome some of the technology challenges by improving security protocols, ensuring that nurses use the barcode scan and printing tool appropriately, and conducting frequent technology maintenance. The fact that practitioners can overcome the majority of the barriers to technology leads to the conclusion that barcode scanning is the most effective way of reducing medication errors in healthcare facilities.
About Medical Fields
Medication errors are among the most threatening issues in the healthcare system and a significant factor contributing to death among patients. Studies reveal that almost in 44 to 98 thousand deaths, 7000 occur due to medication errors (Gorgich et al., 2016). These numbers are slightly lower, considering the thousands of patients who develop complications, including being disabled because of drug administration mistakes. Several strategies have been proposed and tested over the years to combat this problem, which costs the United States millions of dollars each year. Among these strategies is implementing barcode scanning in medical facilities to assist in reducing the high incidences of medical errors, which is the central point of discussion in this research paper. While barcode scanning could be costly and prone to the risk of malfunction and cybercrime, this technology has promising outcomes in reducing medication errors during administration by ensuring that the right patient, dose, drug, time, and route are used among inpatients.
Literature Review
The National Coordinating Council of Medication Error Reporting and Prevention (NCCMERP) is one of the independent bodies tasked with overseeing the safe use and reporting of medication errors in the United States. This body defines medication errors as “preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer” (Patel et al., 2016, p.168). Over the years, NCCMERP has reported a rise in medication errors occurring at either the ordering, documenting, transcribing, or dispensing phase. Studies also show that approximately 7,000 people die annually due to these errors, and additional hundreds of thousands experience adverse reactions and other complications related to medication (Tariq et al., 2020). This alarming frequency of medication errors has led to implementing strategies such as barcode scanning to minimize the issue in inpatients.
Testing of the efficacy of barcode scanning has been piloted in several healthcare facilities in the United States. For example, in one study conducted by Thompson et al. (2018), the researchers rolled out the technology in four of the five units in a Magnet organization to assess its impact on the rate of medication administration errors in the inpatient setting. Results from the study showed a significant reduction in medication administration errors by 43.5%. Furthermore, the incidences of harmful medication errors declined from 0.65 to 0.29 per 100,000 medications in pre-and post-intervention, respectively, leading to 55.4% in actual patient harm events in the organization (Thompson et al., 2018). In essence, the study proved the efficacy of consistent use of barcode scanning in decreasing incidences of medication administration errors.
Findings from Thompson et al.’s study are also supported by a systematic review conducted by Shah et al. to examine barcode technology’s impact on patient safety. Conclusions of the review revealed that three studies testing the technology found a reduction in medication errors from 1.0% to 0.4%, wrong dose errors from 2.0% to 1.1%, wrong route of administration errors from 0.3% to 0.1%, and administration documentation errors from 2.9% to 0.6% (Shah et al., 2016). These studies confirmed that integrating the technology in the inpatient setting can help reduce medication errors in the two phases of intervention; during administration and at the ordering stage.
Despite multiple studies showing a significant decline in medication administration errors following barcode scanning technology implementation, some studies have shown some inconsistency in these findings. Most notably, some studies note that the implementation of barcode scanning may fuel an increase in error rates or lack a significant impact in inpatients settings. For example, the rate of administration errors in a study conducted by Truitt et al. (2016) remained unchanged after implementing the technology. The scholars argued that this inconsistency might have been triggered by the identification of more administration errors during the use of the technology. Findings by Truitt et al. are also supported by a pilot study conducted by Bowers et al. to test the impact of barcode medication administration on medication errors. Like Truitt et al., Bowers et al. (2015) found that medication errors did not decrease after implementing the technology. Instead, there were still errors related to the wrong dose, route, and medication. Findings from the study also revealed that wrong time medication remained a common medication error during the study despite the use of the technology. Bowers et al. (2015) attributed the prominence of this error to configuration issues that limited the technology’s ability to produce alerts when nurses administered medication at the wrong time.
Furthermore, studies conducted by FitzHenry et al. (2011) and Sakowski et al. (2008) also created a controversy of barcode scanning’s efficacy in reducing medication errors. Most notably, FitzHenry et al. (2011) found that despite the barcode technology generating alerts for medication errors, only a small proportion of the alerts were clinically significant. Similarly, a study by Sakowski et al. (2008) revealed that a majority of the medication errors detected by the technology were judged to be benign and would pose minimal safety risks in practice. Findings from these studies pose a discussion on the efficacy of barcode technology in reducing medication errors that pose safety risks in inpatients.
Main Body
Despite the discussion posed by inconsistency in prior studies, barcode scanning technology has promising outcomes of reducing medication errors because it targets the most fundamental aspect of patient safety. As argued by Salyer (2014), patient identification is the bedrock of patients’ safety. Barcode scanning helps achieve patient safety by enabling nurses to identify patients more accurately than manual cross-checking, which can sometimes be erroneous.
Patient safety and medication error reduction are achieved in multiple ways when using barcode scanning technology, including helping validate the right patient. As noted by Truitt et al., 2016), patients are issued with the barcode wristband upon admission to the hospital, and each time, the nurse scans the armband and barcode before administering medication. Suppose the scanned patient is incorrect; the barcode technology sends an alert to the nurse, allowing them to correct the error. This aspect may not be achieved using manual cross-checking, which is limited to the human’s ability to identify and correct a mistake in time before it causes harm to the patient. Unfortunately, caregivers may not recognize this manual-error on time because of the multiple patients that nurses attend to. Additionally, the practitioners may only discover the mistake after the harm is done. Therefore, this information technology is ideal in helping reduce medication errors by ensuring that the nurse administers the drug to the correct patient.
Improved barcode scanning also helps reduce medication errors by enabling caregivers to ascertain that the correct patient is administered the right dose. The issues of incorrect doses may, notably, be prevalent among pediatric and elderly patients whose physiology may constrain their ability to communicate to the nurses and express concerns about drug dosages. For example, Al-Ramahi et al. (2017) note that in pediatrics medicine, drug doses are administered based on patient’s age, weight, and clinical condition; thus, increasing the opportunities for dosing errors in such settings. The workload may also compound this issue in some units, which exerts pressure on nurses and increases errors. However, a quick scan using the barcode technology can help minimize these errors by sending alerts to the nurse in the event of a potential dosage error.
Besides dosage error, barcode scanning technology is ideal for use in the inpatient setting because it helps ensure that the right drug, time, and route are observed during drug administration. As noted by Ruiz and Montoto (2018), there are multiple routes of drug administration, and each course affects the drug bioavailability, which, in turn, determines the start and duration of pharmacological effect. For example, some drugs are most effective when administered through the parental route, while others work best through the nasal pathways. Administering medication using the appropriate route at the right time can ensure that the drug reaches the desired systemic circulation. Conversely, administering the incorrect medicine using the wrong route and incorrect time can have adverse outcomes on the patient. Fortunately, a barcode scanner can help reduce these medication errors by alerting nurses of the route, time, and drug administered to a patient.
Despite barcode scanning technology having promising outcomes in reducing medication errors, some argue against its use in the inpatient setting due to a few of the challenges associated with information technology. Most notably, Thomas et al. (2017) argue that the working of all software is a function of an underlying human-made program, whose susceptibility to error is also high. This issue is exemplified in prior research where the use of a barcode scan led to patient misidentification. For example, Snyder et al. (2010) note that a single barcode generated as many as three incorrect patient identifiers during their study. These incorrect identifiers can be a threat to patient safety because they can lead to medication errors.
However, practitioners can easily overcome the identified limitation of information technology within the clinical setting. For example, Snyder et al. (2010) suggest that medical practitioners’ careful control of barcode scanning and printing equipment specifications can help minimize such errors. Therefore, while it is undeniable that barcode scanning may be prone to errors, such issues are easily identifiable and correctable, making the technology an ideal tool for validating drug administration.
Other concerns posed by opponents of barcode scanning is its susceptibility to malfunction and cybercrime. These issues are exemplified in a study conducted by Rack et al., which shows that more than half of the nurses in the clinical setting failed to scan the patients and the medications during medication administration due to technology failure, malfunctioning software, damaged labels, and patient’s isolation precautions (cited by Naidu & Alicia, 2019). Furthermore, there are growing concerns about the technology’s susceptibility to cyberattacks, which can slow down work in a facility. While there is a possibility of the highlighted issues occurring, they can all be combatted by strengthening the facility’s information system’s security protocols and ensuring that frequent technology maintenance is conducted to boost the efficiency of the barcode scanning system.
Furthermore, some parties may oppose the integration of barcode scanning technology in a facility because of its high costs. For example, Naidu and Alicia (2019) argue that barcode scanning is “an exclusive innovation that incurs an excessive cost to many organizations” (p.519). The cost of acquiring and maintaining the technology can be high, notably to small-sized clinical facilities. Nonetheless, the majority of public hospitals can overcome this barrier by requesting government funding for additional developments (Naidu & Alicia, 2019). Furthermore, private hospitals can seek grants from other organizations to integrate technology in practice. In essence, most of the issues related to the use of barcode technology in the clinical setting are manageable; thus, they do not nullify the technology’s ability to reduce medication administration errors.
Conclusion
In summary, the synthesis of information gathered from this research confirms that improved barcode scanning is the most effective way of reducing medication errors despite some of the technology’s challenges. For example, it is estimated that the technology can reduce medication administration errors by up to 55.4%, as revealed in prior studies. The technology can most notably help reduce these errors by ensuring that the right patient, dose, time, route, and drug is administered at the bedside. Furthermore, the research findings reveal that barcode scanning has been empirically tested and verified to be effective in most previous studies. However, the study also shows that there are shortcomings associated with the use of this technology. Nonetheless, medical practitioners and facilities can overcome the majority of these technical challenges to enhance the technology’s efficiency and efficacy. Some of the ways to overcome these challenges include installing security protocols to prevent cyberattacks and conducting frequent maintenance on the system to enhance its effectiveness.
References
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