Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas

Purpose. The effect of a commercially available bar-code-assisted medication administration (BCMA) technology on six indicators of medication administration accuracy and nine types of medication administration errors in distinct patient care areas were studied. Methods. This prospective, before-and-after, observational study was conducted in two medical-surgical units, one medical intensive care unit (ICU), and one surgical ICU of a 386-bed academic teaching hospital. Nursing staff were observed administering medications one month before and three months after implementation of BCMA technology. Observations were conducted by two pharmacists and four pharmacy students on weekdays and weekends. Medication administration accuracy was measured using the accuracy indicator of the California Nursing Outcomes Coalition. Results. The majority of medication administrations occurred during the 9 a.m. medication round. After BCMA implementation in the medical-surgical units, improved adherence to patient identification policies was observed, but more distractions of the nursing staff occurred and the medications administered were less frequently explained to the patient. Although an increase in wrong-time errors was observed in the medical-surgical units, the total number of medication errors did not change. When wrong-time errors were excluded, the rate of medication errors decreased by 58%. In the ICUs, the charting of medication administration improved after BCMA implementation, but total medication errors and wrong-time errors did not change. Conclusion. Implementing BCMA technology decreased medication administration errors in medical-surgical units but not in ICUs when time errors were excluded. BCMA technology affected different types of medication administration errors in different patient care areas.