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HSR&D 2004 National Meeting Abstracts


1046. Differences in Workaround Strategies with BCMA in Acute and Long-term Care
Emily S Patterson, PhD, VA Getting at Patient Safety Center, Cincinnati VAMC and Ohio State University, ML Rogers, A Getting at Patient Safety Center, Cincinnati VAMC, RJ Chapman, A Getting at Patient Safety Center, Cincinnati VAMC and Ohio State University, ML Render, A Getting at Patient Safety Center, Cincinnati VAMC and University of Cincinnati

Objectives: Scanning bar codes to verify patient and medication information has been advocated to reduce medication errors. Nursing “workaround” strategies limit the effectiveness of this intervention. Our objective was to assess the extent of “workaround” strategies with BCMA use in acute and long-term care.

Methods: Prospective ethnographic study of 15 acute and 13 long-term care nurses at a small, medium, and large hospital to observe patient identification and medication administration strategies.

Results: We observed at a small (24 hours), medium (24 hours), and large (31 hours) hospital in acute (42 hours) and long-term (37 hours) care. Workaround strategies were prevalent in both settings. A larger proportion of acute care nurses scanned barcoded wristbands than long-term care nurses (53% vs. 8%). Barriers included: 1) tethered scanners, 2) stationary locations for medication carts, 3) battery replacement, 4) dirty, wet, twisted, torn, or missing wristbands, 5) perceived low “wrong patient” risk. A larger proportion of acute care nurses administered barcoded medications immediately after scanning than long-term care nurses (93% vs. 23%). Barriers included: 1) efficiency, 2) avoidance of documentation of late administration.

Conclusions: “Workaround” strategies were observed in both settings, but were more prevalent in long-term care.

Impact: 5/10 high priority, 2/9 medium priority, and 1/8 low priority changes have been made to the BCMA software. The addition of an overview “cover sheet” is under consideration. Fifteen “best practices” for the implementation and use of BCMA have been recommended. Context of use should be considered during system design and implementation.