Health Information Technology

Hospital processes are the usual causes for workarounds to medication barcode scanning systems

Most hospitals rely on electronic systems to ensure the right patient receives the right medication in the right dosage at the right time. Clinicians often perform workarounds when it comes to these barcoded medication administration (BCMA) systems.

To identify the reasons for workarounds, a team of researchers observed and interviewed staff, attended staff meetings, and analyzed override data at a 470-bed hospital in the Midwest and a 929-bed health care system on the East Coast from 2003 to 2006. They identified three categories of workarounds. The first type of workaround was omission of process steps. It included actions such as providing medication without first confirming the patient's identity or scanning the medication without reviewing the medication list, its name, or the dosage. Steps performed out of sequence comprised the second type of workaround. It included using the BCMA system to document the medication as administered either long before or long after it actually was given. The final workaround, unauthorized process steps, included adding new steps in the process or changing how a step was performed, such as putting a patient's barcode on a clipboard and scanning it from there. Causes determined for the workarounds were technology related, task related, organizational, patient related, and environmental.

The most common causes for workarounds were organizational, in which workflow policies were incompatible with safety. Examples included having medications and patients with no barcodes, multiple barcodes on medications, or labels obscuring barcodes so that scanners could not record the data. Most workarounds resulted from poor process design, such as having to wake a patient to scan a wristband when providing IV medication. Because of the prevalence of workarounds, the authors recommend that hospitals revise their protocols so that adhering to policy is easier than deviating from it. This work was funded in part by the Agency for Healthcare Research and Quality (HS11530 and HS14253).

See "Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety," by Ross Koppel, Ph.D., Tosha Wetterneck, M.D., M.S., Joel Leon Telles, Ph.D., and Ben-Tzion Karsh, Ph.D., in the July/August 2008 Journal of the American Medical Informatics Association 15(4), pp. 408-423.

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