ScienceDaily has picked up on a new report that documents flaws in the wireless and wired barcode systems increasingly used to match the right patient with the right dose of the right drug.
The full report is in the current Journal of the American Medical Informatics Association (JAMIA). The study was designed to examine when, how and why nurses sidestep (or "workaround") the limitations of these systems, which typically include handheld scanners, barcodes on patients and drugs, a wireless networks, and interfaces to other patient care applications.
The intriguing point is that the workarounds, and the reasons for them, are in effect symptoms of such things as poor system design or implemention, or workflow processes. Correcting these flaws, which the study said are "hiding in plain sight," reduces the workarounds, because it becomes easier to use a well designed systems and work process than to work around it.
The study covered about 500,000 instances in 5 hospitals of nurses scanning patients and drugs. In about 4.6& of the patients, and 10.3% of the drugs, nurses over-rode the scanner technology with one of about 15 common workarounds, or efforts to compensate for various percieved shortcomings in the bar code systems.
The study found 31 "causes" for these workarounds. These causes covered a wide range of issues: poor device and software design, "unreadable medication barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient-ID-wristbands (chewed, soaked, missing); non-barcoded-medications; medications in distant refrigerators, lost wireless connectivity; problems with patients in contact isolation, and emergencies."
Depending on the circumstances, such overrides might or might not have an affect on patient safety, and could improve safety as well as potentially worsen it.
"Bar-coding is still under development," says one of the study's authors, Ross Koppel, Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine and the Sociology Department at the University of Pennsylvania. "Administrators and vendors may expect it to be fool-proof, but users know it's not. It's a very promising technology that still requires constant refining and careful observation of on-the-floor workflow to get it right."
That last sentence could be the motto for every IT deployment in the 21st century.
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