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Nursing Informatics

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Final Project
Dr.Peggy Shipley
Shannon McKnight


According to the Institute of Medicine there are more than a million injuries and almost 100,000 deaths associated with medication administration errors every year in the healthcare profession. Administration of medication is a large part of every day nursing care. As the patient’s primary advocates, it is the nurse’s responsibility to make certain these medication errors do not occur and to uphold the patient’s safety. Hebda & Czar (2013) state, “The desire to reduce or eliminate medication errors focuses attention on computerized physician order entry (CPOE), Bar Code Medication Administration (BCMA), and e-prescribing”. With the growing amount of medication errors, many institutions are introducing the Bar Code Medication Administration System. This is a system that will aid in assuring the right patient is getting the right medication and reduce the risk for medication errors. Although BCMA will not be a remedy for medication errors, it can provide a safeguard that is not possible with manual method. The implementation of the Bar Code Medication Administration system has been highly proven reduce the number of medication errors, improve patient safety, and increase the nurse’s job satisfaction.


Barrier to the Implementation
Understanding the barriers to change is one of the first important steps in facilitating change to occur. With any change in routine comes the potential for hesitation and reluctancy. Most healthcare providers are very apprehensive about any changes that will directly alter the process in which they are used to. Often it is the unseen cultural barriers that hinder an organization’s best-laid plans, especially if they are not identified and addressed early on in the process. Some barriers identified are lack of awareness and knowledge of what needs, lack of motivation, personal beliefs and attitudes, lack of skills, lack of resources and other barriers that are beyond our control. All of which can lead to a failure in a successful adoption of any new technology.

When introducing new processes you need to develop a successful strategy for change, you need to understand the types of barriers faced in that facility. Once that hurdle is overcome you can develop a structured approach to overcome those barriers and encourage the staff to change their mindset and behaviors then ultimately engage them in the new system or equipment.

Listed below you will find an outline of the change process as stated by Dr. Spencer Johnson in “Who Moved My Cheese?: An Amazing Way to Deal with Change in Your Work and in Your Life” (2009).

|Management Support for|Case for Change |Employee Involvement |Communicating the |Implementation |Follow-up |Removing Barriers |Celebrate |
|Change | | |Change | | | | |
|It is critical that |A case for |All change efforts should |Communicating change |Once a change is |Whenever a change is|Employees may encounter|It is |
|management displays |change can come |involve employees at some |should be structured |planned, it is |made it is always |barriers when |important to|
|support for the |from different |level. Organizational |and |important to have |good to follow-up |implementing changes. |celebrate |
|upcoming changes to |sources. Using |change, whether large or |systematic. Employees|good communication |after implementation|Barriers can be with |successes |
|reassure staff of the |data is the best|small, needs to be |are at the mercy of |about the rollout |and assess how the |other employees, other |along the |
|need and positivity of|way to identify |explained and |management to inform |and implementation |change is working |departments, inadequate|way as |
|the changes. |areas that need |communicated, specifically|them of changes. When|of the change. A |and if the change |training, lacking |changes are |
| |to improve and |changes that affect how |there is poor |timeline should be |delivered the |equipment or supply |made. |
| |change |employees perform their |communication and the |made for the |results that were |needs. Sometimes |Celebrating |
| |initiatives |jobs. Whether it is |rumor mill starts |implementation and |intended. Sometimes|management also needs |the small |
| | |changing a work process, |spreading rumors about|should make changes|changes exceed |to deal with resistant |changes and |
| | |improving customer |change, it can create |in the order that |target expectations |employees. It is |building |
| | |satisfaction or finding |resistance to the |affect the process |but there are |management’s |momentum for|
| | |ways to reduce costs, |change. Being |and the employees |occasions that |responsibility to |bigger |
| | |employees have experiences|proactive in |who manage the |changes just don’t |ensure that employees |changes are |
| | |that can benefit the |communications can |process. An |work as planned. |can implement change |what makes |
| | |change planning and |minimize resistance |effective timeline |When this is the |without obstacles and |employees |
| | |implementation process. |and make employees |will allow for all |case, management |resistance. |want to |
| | |Since employees are |feel like they are |new equipment, |should acknowledge |Unfortunately, |participate |
| | |typically closest to the |part of the process |supplies or |that it didn’t work |sometimes employees |in the |
| | |process, it is important | |training to take |and make adjustments|need to move on in |process. |
| | |that they understand the | |place before fully |until the desired |order to successfully | |
| | |why behind a change and | |implemented. |result is achieved. |implement a needed | |
| | |participate in creating | |Implementing | |change. | |
| | |the new process | |without a logical | | | |
| | | | |order can create | | | |
| | | | |frustration for | | | |
| | | | |those responsible. | | | |

The following timeline will give an estimated timeframe from the date of presentation to the hospital to the date of the go live.

|Jan-14 |Discussions with hospital regarding need for updated barcode system. |
|Feb-14 |Meetings with possible vendors. |
|Mar-14 |Present vendor information to hospital. |
|Jul-14 |Vendor chosen, bid sent to corporate for approval. |
|Aug-14 |Corporate approval. |
|Nov-14 |Signage posted and postmaster sent to staff for upcoming barcode transition. |
|Dec-14 |Installation begins. |
|Mar-15 |Staff training sessions begin. |
|May-15 |System go-live. |


There are three stages in the first phase of the implementation process. Needs assessment, strategic planning and steering committee.

In the first stage, the needs assessment is defined by Hebda & Czar (2013) as, “The purpose of the needs assessment is to determine the gap between an organization’s current state and the overall needs of the organization with consideration to the strategic plan”. With the current process of paper MAR’s (Medication Administration Record) and the increase in medication errors, it would be beneficial to convert the current process to the barcode scanning. This will help ensure the correct patient is receiving the correct medication.

The second stage is choosing the steering committee. This is an instrumental part of the process. These members are who you will depend on to drive the project. Members of this committee should include consultants, nurses, pharmacy staff, clinicians, information technologist, a member from the biomedical department, and other essential staff decided by the project leader.

The final stage of the first phase is the strategic planning which is the process of determining what an organization’s mission is and the process it will take to get there. The goal is to reduce the amount of medication errors and in turn will help increase patient safety. These goals and objectives will layout how the mission will be accomplished.

Once a decision is made that a change is needed in the medication administration process, we will then proceed to phase two of the BCMA implementation process. The system selection criteria as stated by Hebda & Czar (2013) are as follows: the overall cost, which is how much it will cost to purchase the hardware, software and network. The cost to implement the change over and the support and cost to maintain the system. Next pick a vendor with a reputable reputation and that are well experienced and have knowledgeable consultants. Be sure to make sure the software features are easy to navigate and are user friendly along with them being able to provide the functions needed. Usability test can be done to clarify the requirements needed for the system. Also, be aware of the environmental issues, the energy consumption of equipment and the recycling and e-waste options once the equipment is outdated.

Once the system is selected the next phase is to implement the system. The barcode system is installed on the appropriate computer system, and then on any client workstations that requires it. If needed, form an implementation committee to help assist in this. An informatics nurse specialist should also be included in this group along with other clinical staff. This will also aid the process of getting the information out the rest of the staff efficiently about the upcoming transition. Your next step would be the system installation and the conversion of all eMARs to the barcode system. Once the staff begins to use the barcode scanners for documentation it may take some time for all staff to be completely familiar with the equipment. Allow more time for one on one user training and have staff available to answer questions they have during this phase.


Once the barcode system is up and running, feedback from the staff will be a vital aspect in the maintenance of the system. System maintenance requires monitoring, evaluation and sometimes modification of the barcode computer system. As stated by Hebda & Czar (2013), “A technical maintenance is a large portion of ongoing maintenance and is related to technical and equipment issues”. Some of these issues may include debugging, system backups, building and maintaining interfaces and installing system upgrades. As users and support staff work with the new system, they may be able to point out what does and does not work and they may able to help identify possible resolutions to these issues.

Once the new barcode system is implemented, we will need to put into place an ongoing training plan to ensure that all new hospital staff receives the appropriate training on the system as part of their new hospital nursing orientation and the existing staff members will receive yearly competency training. Training as stated by Hebda & Czar (2013), “focuses on acquiring practical knowledge and skilled behaviors and is an organized approach to providing large numbers of staff and healthcare workers with knowledge needed to use and information system in a clinical setting. Staff recommended for these training session can be from the vendor themselves, super-users such as nurses or pharmacy staff. Printed handouts or small pocket sized reference sheet may also aid in the training.

Keep always in mind the patient’s privacy, confidentiality and security. This can be done by following the hospital’s guidelines for the proper process to use the barcode scanner and also by abiding by HIPAA’s regulations. Measures must be in place to ensure that any confidential information printed out is disposed of properly. Another key aspect would be to make sure that the user is logged off once the task is completed.

Benefits of the Technology Summary

The barcode medication administration system ultimately will another level of verification process of the “five rights” of medication administration: the right medication is given to the right patient at the right time and the right dose through the right route of administration. The result is improved patient safety. The benefits of improved patient safety have been backed up by a study that was done by the Agency for Healthcare Research and Quality (AHRQ), and was published in The New England Journal of Medicine, which agrees that using the barcode medication administration scanner with an eMAR substantially reduces transcription and medication administration errors as well as potential drug-related adverse effects.


Medical errors are widely acknowledged as a major threat to patient safety. Medical errors result in 44,000–98,000 deaths per year—more deaths than those caused by highway accidents, breast cancer, or AIDS combined. Having the barcode system in place can provide a reduction in errors related to the transcription of the medication, giving the medication to the wrong patient, times the medications are given, and the wrong doses given. The use of the barcode system can prevent medication administration errors and enhance the medication administration process.



Hebda, Toni, and Patricia Czar. Handbook of Informatics for Nurses & Healthcare Professionals. Boston: Pearson, 2013

Johnson, Spencer. Who Moved My Cheese?: An Amazing Way to Deal with Change in Your Work and in Your Life. New York: Putnam, 1998.

Kohn, Linda T., Janet Corrigan, and Molla S. Donaldson. To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy, 2000.

Lotich, Patricia. "8 Steps to Implementing Successful Organizational Change." The Thriving Small Business RSS. Dr. Spencer Johnson, 2 July 2010. Web. 25 June 2014.

Weckman, H., Janzen, S. "The Critical Nature of Early Nursing Involvement for Introducing New Technologies" OJIN: The Online Journal of Issues in Nursing, Vol. 14, May 13, 2009

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