As already discussed, barcode medication administration (BCMA) systems, while valuable tools for preventing medication errors, can be vulnerable to staff developing workarounds when encountering scanning or labeling issues. These workarounds, while sometimes perceived as helpful, can compromise patient safety and lead to serious consequences.
As mentioned previously, examples of unsafe BCMA practices include administering a medication despite a non-scanning barcode, retroactively charting after medication administration, scanning barcodes from sources other than the medication, and ignoring BCMA system alerts.
Possible solutions to these issues are not easy. Recommendations include a multidisciplinary approach to address BCMA workarounds, including reviewing the (well intended? or efficiency demands?) practices that lead to them, developing modifications and configurations to support safe workflows, encouraging reviews of the technology to ensure it functions as intended, implementing a just culture approach to address staff behaviors, and developing an escalation process for non-scanning barcodes. Patients and families should also be educated on the importance of BCMA scanning and encouraged to speak up if this task is not completed.
Ultimately, BCMA systems are most effective when used correctly, and organizations need to prioritize staff training, equipment configuration, and system monitoring to prevent the use of workarounds.