Ideas That Work: Caution Urged Around Barcode Medication Administration Workarounds

Practical pearls from your colleagues

As the year comes to an end and facilities take stock of their practices in 2024, it’s helpful to review concerns expressed by patient safety groups and consider the recommendations they’ve made to alleviate them.

ECRI, the nonprofit patient safety group, included the issue of workarounds when using barcode medication administration (BCMA) systems in its “Top 10 Patient Safety Concerns 2024” report, saying, “BCMA systems are important tools for preventing medication errors. However, scanning or labeling errors may lead staff to develop workarounds, which can compromise patient safety and have serious or even deadly consequences.”

The report notes that staff could employ workarounds when a barcode cannot be scanned or is difficult to scan; when the barcode is missing, hidden or damaged; or when a medication has not yet been added to the system. Use of workarounds can also be an indicator that staff wasn’t sufficiently trained to use the systems.

Examples of unsafe BCMA practices include administering a medication even though the barcode will not scan; back-charting after a medication is administered; proxy scanning barcodes from sources other than the medication itself; and administering medication after seeing, but not understanding, a system alert indicating a medication isn’t on a patient profile or it’s not the correct time to administer it.

ECRI recommends that facilities take the time to review their practices that might lead to BCMA workarounds and develop a process for what to do when a barcode won’t scan. The process should include steps for how and when to report scanning issues, an explanation of why proxy scans are dangerous and the designation of a person responsible for monitoring barcode issues.

The report recommends that serious issues should be reported to the manufacturer, the FDA, ECRI and the Institute for Safe Medication Practices.

“BMCA systems are valuable tools that reduce medication administration errors, but only when used correctly,” says the report. “Staff must be trained on proper use of the system, and procedures must be established to quickly address problems.” OSM