Barcode medication administration system use and safety implications: a data-driven longitudinal study supported by clinical observation.

Objectives: Barcode medication administration (BCMA) systems may improve patient safety with successful integration and use. This study aimed to explore the barriers and enablers for the successful use of a BCMA system by examining the patterns of medication and patient scanning over time and potential safety implications.

Methods: Retrospective longitudinal study informed by prospective clinical observations using data extracted from five hospital wards over the first 16 months after implementation to determine trends in medication and patient scanning rates, reasons for non-compliance and scanning mismatch alerts. Regression models were applied to explore factors influencing medication scanning rates across wards of different specialties.

Results: Electronic data on 613 868 medication administrations showed overall medication scanning rates per ward ranged from 5.6% to 67% and patient scanning rates from 4.6% to 89%. Reported reasons for not scanning medications were 'barcode not readable' and 'unavailability of scanners'. Scanning rates declined over time and the pattern of reason codes for not scanning also changed. Factors associated with higher scanning rates included a locally led quality improvement (QI) initiative, the medication administration time and the medication formulation, for example, tablets and liquids. Overall, 37% of scanning alerts resulted in a change in user action. Staff tried to comply with the BCMA system workflow, but workarounds were observed.

Discussion: Compliance with BCMA systems varied across wards and changed over time. QI initiatives hold promise to ensure sustained use of BCMA systems.

Conclusions: BCMA systems may help to improve medication safety, but further research is needed to confirm sustained safety benefits.