Medication Safety Behaviours
Human Factors in Medication Safety
Medication errors pose a serious threat to patient safety, with an estimated 237 million such errors occurring annually in the NHS in England. These errors can have devastating consequences, contributing to 1700 deaths per year at a financial cost of £98.5 million. Clearly, improving medication safety is a critical priority for healthcare organizations.
A key strategy for reducing medication errors is the use of barcode technology, known as barcode medication administration (BCMA). BCMA automates the verification of the “five rights” of medication administration – right patient, right drug, right dose, right route, and right time. By scanning barcodes on the patient’s wristband and the medication, BCMA helps ensure these safety checks are performed consistently.
However, even when BCMA systems are in place, their full potential is often not realized. Scanning rates can be surprisingly low, with many nurses circumventing the technology and instead relying on manual checks. Understanding the human factors behind these behaviours is crucial for unlocking the safety benefits of BCMA.
Designing for User Needs
A central tenet of human factors is designing technology to match the needs and capabilities of the end users. When it comes to BCMA, this means deeply understanding the workflows, priorities, and pain points of nurses administering medications.
Observational studies have revealed a range of workflow disruptions caused by poorly designed BCMA systems. For example, bulky medication carts can make it difficult for nurses to scan barcodes at the bedside, leading them to skip this step. Likewise, if barcodes are missing or difficult to scan, nurses may revert to manual checks to save time. Addressing these design flaws through an iterative, user-centered process is key to driving consistent BCMA adoption.
Improving Medication Labeling
Beyond the BCMA technology itself, the design of medication packaging and labeling plays a critical role in supporting safe administration. Medications without clear, scannable barcodes create unnecessary barriers to BCMA use. Efforts to standardize and improve barcode placement, font size, and other labeling elements can significantly enhance the usability of BCMA systems.
The pharmaceutical industry has a responsibility to ensure their products are designed with end-user safety in mind. Collaboration between medication manufacturers, technology vendors, and healthcare providers is needed to establish labeling guidelines that enable seamless barcode scanning and verification.
Barcode Technology in Healthcare
Barcode Scanning Processes
At its core, the BCMA process involves two key steps: scanning the patient’s identification barcode and scanning the medication barcode. This seemingly simple workflow can become disrupted by a variety of factors.
Observational research has found that nurses often prioritize scanning the medication but skip scanning the patient ID. This can happen when nurses are pressed for time, when barcodes are hard to access, or when they feel confident they have the right patient. While this “partial” use of BCMA may seem harmless, it leaves room for patient identification errors that could lead to serious medication errors.
Barcode Design Considerations
The design of barcodes themselves can also impact scanning behaviours. Barcodes that are poorly placed, small, or difficult to read will frustrate nurses and discourage consistent use of BCMA. Factors like barcode size, placement, print quality, and interference from packaging materials must all be considered.
Integrating BCMA seamlessly into the medication administration workflow is critical. If the scanning process feels cumbersome or time-consuming, nurses will be more likely to find workarounds. Designing BCMA to be as streamlined and efficient as possible, without compromising safety, should be a top priority.
Integrating Barcodes into Workflows
Beyond the mechanics of scanning, the integration of BCMA into broader medication administration workflows is a key determinant of its success. If BCMA creates significant disruptions or delays, nurses will be tempted to bypass the system, even if they recognize its safety benefits.
Careful process mapping and human factors analysis can identify opportunities to embed BCMA into existing workflows in a way that minimizes friction. For example, ensuring medication carts are ergonomically designed and stocked to support bedside scanning, or automating data entry to reduce duplicate steps.
By understanding and designing around the real-world needs and constraints of nurses, BCMA can be positioned as an enabler of their work, rather than an additional burden.
Behavioural Aspects of Medication Safety
Clinician Perspectives on Barcode Use
Even when BCMA systems are well-designed, clinician attitudes and behaviours can still undermine their effective use. Interviews with nurses have revealed a range of perspectives on BCMA, both positive and negative.
Many nurses appreciate the enhanced safety and accuracy that BCMA provides, feeling more confident that they are giving the right medication to the right patient. However, others perceive BCMA as time-consuming or disruptive to their workflow, leading them to bypass the system.
Organizational culture and leadership also play a key role. In units with a strong culture of safety and clear accountability for BCMA use, nurses are more likely to embrace the technology. Conversely, in environments where there are no consequences for non-compliance, BCMA scanning rates tend to suffer.
Patient Engagement in Medication Safety
Engaging patients as active partners in medication safety is another crucial, yet often overlooked, aspect of BCMA effectiveness. Patients who understand the purpose of barcode scanning and feel empowered to remind nurses to perform this step can reinforce the importance of the process.
However, some patients may be hesitant to question nurses or feel uncomfortable with the additional steps involved in BCMA. Proactive education and communication strategies are needed to help patients understand how BCMA protects them and feel comfortable participating in the process.
Organizational Culture and Safety Norms
Beyond individual clinician and patient perspectives, the broader organizational culture surrounding medication safety is a key determinant of BCMA success. In healthcare settings with a strong culture of safety and a commitment to continuous improvement, BCMA is more likely to be embraced and optimized.
Conversely, in environments where medication errors are seen as inevitable or where there is a lack of accountability, BCMA may be viewed as an unnecessary burden. Building a culture that prioritizes medication safety and empowers all stakeholders to participate is essential for realizing the full benefits of barcode technology.
Implications for Practice
Multidisciplinary Collaboration
Improving medication safety through BCMA requires collaboration across multiple disciplines. Technology vendors must design systems that are intuitive and well-integrated with clinical workflows. Pharmaceutical companies must ensure their products have clear, scannable barcodes. Healthcare organizations must thoughtfully implement BCMA while cultivating a safety-oriented culture.
No single stakeholder can solve the medication safety challenge alone. Cross-functional teams bringing together clinicians, informaticists, human factors experts, and other key stakeholders are essential for identifying and addressing the multilayered barriers to effective BCMA use.
Evaluation and Continuous Improvement
Implementing BCMA is not a one-time event, but rather the start of an ongoing process of evaluation and optimization. Healthcare organizations must closely monitor scanning rates, observe workflow impacts, and solicit feedback from nurses and patients. This data can then inform iterative improvements to technology, processes, and organizational policies.
Proactive risk assessment is another valuable tool, allowing teams to anticipate potential failure modes and design mitigations before problems arise. By taking a systems-level view and involving frontline staff, these assessments can uncover hidden vulnerabilities and identify creative solutions.
Future Directions in Medication Safety
As technology and clinical practices continue to evolve, the opportunities to enhance medication safety will only expand. Emerging innovations like smart infusion pumps, electronic medication administration records, and patient-facing medication management apps all hold promise for improving safety and engaging patients.
However, realizing the full potential of these technologies will require ongoing human factors research and a relentless commitment to user-centered design. Only by deeply understanding the needs, behaviours, and constraints of all stakeholders can we create solutions that are both highly effective and seamlessly integrated into the clinical ecosystem.
Ultimately, improving medication safety is a never-ending pursuit. But by embracing a human factors mindset and fostering multidisciplinary collaboration, healthcare organizations can steadily chip away at this critical patient safety challenge, one barcode scan at a time.
