Electronic Medication Administration with Barcoding

Medication errors are some of the commonest sources of patient safety risks in the United States currently. Annually, the food and drug administration records more than 100,000 cases of suspected medication errors or those related to medication errors in the US (U.S. Food and Drug Administration, 2019). These rates have exponentially been increasing over the past years and have partly been associated with improved reporting systems and awareness. However, there is still a need to improve the prevention of medication errors.

Electronic Medication Administration with Barcoding

Technology has played an essential role and still has room to improve this prevention. The use of barcode technology was borrowed from other sectors to improve healthcare prevention. I selected this Barcode Medication Administration (BCMA) because it is novel in most health organizations, including primary care settings that I have seen and it can be used at the bedside to verify the five ‘rights’ of medication administration, and nursing station, pharmacy and other points of medication administration.

I also selected this technology because it directly affects nursing practice and requires direct nursing input in daily clinical activities. The purpose of this paper is to present an annotated bibliography of scholarly literature sources informing about the use of barcode technology to improve medication error prevention.

Literature Search

The literature acquisition process involved the identification of database sources, search key terms, and search strategies. This search was conducted in the Cochrane Library, BioMed Central (BMC), and PubMed databases for articles. Key search terms were bar code, barcode, medication administration, BCMA, medication errors, and bar code. These key terms were joined by ‘AND’ and ‘OR’ as the key Boolean operators as appropriate and meaningful to narrow the search in the three databases.

To filter the search results further, the article results were narrowed down using article methodology, language, age, and availability as full-texts. Therefore, the search limited the final count of articles to those published in the past five years, in the English language, and available as full texts, not just abstracts. Review reviews, meta-analyses, randomized controlled trials, and other experimental studies were prioritized. Thereafter, six articles were manually handpicked based on their currency and relevance to the topic under study.

Literature Synthesis

This article was a comparative study that focused on the outcomes of barcode medication administration (BCMA) implementation in an intervention ward and control ward. The outcomes were the duration of rounds, the duration of medication administration, and general workflow. The author of this source reported that BCMA doesn’t affect round duration despite increasing the duration of medication administration.

I chose this source because the use of a control group makes the findings of this study reliable. However, this article does not focus on the patient safety aspect of education administration. Its relevance to nursing practice is work efficiency and workflow.

The authors of this source focused on pertinent outcomes before and after the implementation of BCMA technology in the ED but with no use of a control population. I chose this article because it directly addressed the reduction in medication errors as the primary outcome. The authors found that BCMA reduced medication errors by 74.4% after implementation. The sample size was relatively reasonable (676) but the lack of a control group leaves room for confounders.

Nevertheless, this source provides an actual practice implementation framework for BMCA in nursing and healthcare. It documents a model that any nursing care setting can adopt to set up, implement, and evaluate BCMA technology to improve patient care quality and nurse satisfaction.

The authors of this resource focused on the types of alerts that BCMA technology generates. In this resource, the authors synthesized research findings from primary sources. I chose this source because it is a systematic review and thus, high-level evidence. This resource found that BCMA had an alert generation frequency of about up to 42% of the time. Patient mismatch alerts and wrong disease are the commonest alerts.

Sometimes, alerts from this technology are not clinically meaningful. This finding is important to nursing because it reinforces that this technology is not 100% sensitive and specific in medication error prevention; thus need for complementary strategies.

I chose this source because it answers my research problem in its entirety. The article addresses patient harm as a result of medication errors and how the implementation of BMCA influenced this outcome. This article reported a 43.5% reduction in actual medication errors. This source emphasized the consistency in the use of BCMA to improve patient outcomes.

This is important to nursing practice and interdisciplinary teams because no technology is currently foolproof in medication error prevention and other sources of medication error such as prescription and monitoring can still cause patient harm.

I chose this systematic review because it addressed usability, enabler, and barrier factors in the implementation and evaluation of BCMA. The authors of the article reviewed primary sources for mediating factors in the successful use of BCMA. This study recommended a collaborative approach between designing and utilization of BCMA. This is important in nursing because the efficiency of care will depend on the nurses’ ability to navigate and use BCMA technologies successfully.

A usable system will also promote patent safety because errors due to ineffective design will be minimized. This source emphasized the interdisciplinary approach in system design and implementation and use, thus appropriate to current nursing paradigms and care approaches. However, gaps still remain in the technologies’ consistency of use among nurses.

This systematic review did not only focus on BCMA but also on Automated Dispensing Cabinets (ADCs) and closed-loop Electronic Medication Management Systems (EMMS). I chose this article because it not only focused on medication safety but also the work process and drug diversion in a non-primary care setting. The authors of this source reviewed 16 primary articles that met their inclusion criteria.

This source found that BCMA implementation reduces medication error rates. However, BCMA technology can also contribute to medication errors through wrong barcoding and unreadable barcodes. Thus, this resource emphasized the need for complementary technologies to supplement BCMA even in closed and well-monitored systems.


Generally, BCMA technology is being widely adopted in various primary and referral care settings to improve patient care. The key outcome is a reduction in potential and actual medication errors that lead to or have the potential to cause patient harm. Like any other healthcare technology, BCMA technology requires systematic sourcing, implementation, and evaluation.

Human and technological factors such as usability, efficiency, and timeliness are key. Preexisting resources such as electronic health records and computerized physician order entries (CPOEs) are complementary to successful BCMA technology implementation. When successfully implemented, this technology can improve patient care safety, nurse satisfaction, patient satisfaction, and care efficiency. Therefore, this technology remains essential in the campaigns to promote patient safety.

Electronic Medication Administration with Barcoding References

  • Barakat, S., & Franklin, B. D. (2020). An evaluation of the impact of barcode patient and medication scanning on nursing workflow at a UK teaching hospital. Pharmacy (Basel, Switzerland)8(3), 148. https://doi.org/10.3390/pharmacy8030148
  • Owens, K., Palmore, M., Penoyer, D., & Viers, P. (2020). The effect of implementing bar-code medication administration in an emergency department on medication administration errors and nursing satisfaction. Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association46(6), 884–891. https://doi.org/10.1016/j.jen.2020.07.004
  • Sloss, E. A., & Jones, T. L. (2019). Alert types and frequencies during bar code-assisted medication administration: A systematic review. Journal of Nursing Care Quality35(3). https://doi.org/10.1097/NCQ.0000000000000446
  • Thompson, K. M., Swanson, K. M., Cox, D. L., Kirchner, R. B., Russell, J. J., Wermers, R. A., Storlie, C. B., Johnson, M. G., & Naessens, J. M. (2018). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings. Innovations, Quality & Outcomes2(4), 342–351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001
  • U.S. Food and Drug Administration. (2019, August 23). Working to reduce medication errors. U.S. Food and Drug Administration; FDA. https://www.fda.gov/drugs/information-consumers-and-patients-drugs/working-reduce-medication-errors
  • Williams, R., Aldakhil, R., Blandford, A., & Jani, Y. (2021). Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology? BMJ Open11(7), e044419. https://doi.org/10.1136/bmjopen-2020-044419
  • Zheng, W. Y., Lichtner, V., Van Dort, B. A., & Baysari, M. T. (2021). The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Research in Social & Administrative Pharmacy: RSAP17(5), 832–841. https://doi.org/10.1016/j.sapharm.2020.08.001

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