Technological Educational Institute of Larissa, Greece. This article has been cited by other articles in PMC.
Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change practice.
Medication errors in hospital settings lead to devastating consequences for both nurse and patient that can be reduced significantly through the use of technology that improves patient care and saves time for busy nurses.
Bar-coded medication administration is one type of technology that uses a scanning device to compare bar codes on patient identification bands with bar codes on prescribed medications, electronically verifying the medications against the medication records, thereby reducing medication errors significantly.
Keywords Change management, Lewin change theory, Medication errors, Bar-coded Medication Administration Introduction Medication safety has been identified by the Institute for Safe Medication Practices Canada ISMPC as a priority among hospitals and long term care facilities since medication errors in hospitals are a serious threat to patient safety.
The ramifications of medication errors affect all healthcare organizations, resulting in consumer mistrust, increased healthcare costs, and patient injury or death Carroll, Bar coded medication administration is one such tool that has the potential to reduce medication errors significantly, when used correctly Carroll, ; Dennison, The current system of medication delivery and administration at our facility involves old medication carts in poor repair and relies on manual checks to ensure the right drug is given to the right patient at the right time, route, site and dosage by the nurse.
The psychiatric facility in question is now planning a complete overhaul of the pharmacy system and is incorporating automated dispensing machines, along with electronic medication records and bar coding of medications to modernize their care and improve patient safety.
This large project will have the greatest impact on front line nurses, many of whom are skeptical of change or lack confidence in their ability to adapt to new technologies, therefore careful implementation of this project is imperative.
Without a framework for guidance, new technologies can result in workarounds that threaten patient safety. Medication errors are a common occurrence in healthcare facilities around the globe, with serious consequences resulting in death or harm, increased inpatient days in hospital, erosion of trust between consumer and healthcare organizations, and a great deal of economic expense Carroll, ; Dennison, The economical impact of medication errors is estimated to be around five thousand dollars per error unless there is legal litigation, when the costs can skyrocket into the millions Dennison, No less important, but certainly less discussed, is the harm to nurse morale after being involved in a medication error, potentially leading to lost time from work Dennison, While medication errors can occur at any stage in the process, the nurse is often the last line of defense for catching mistakes due to the nature of the administration of meds at the bedside.
The ISMPC has worked closely with hospitals, pharmacies and drug companies to address many preventable occurrences ranging from medication reconciliation programs to the standardization of drug names and labeling.
The introduction of automated pharmacy dispensing machines, bar-coding and scanning of medications is a national project throughout Canada, aimed at reducing medication errors and ultimately improving patient safety.
The technology involved in bar-code scanning also integrates electronic medication records EMR and computerized physician order entry CPOE into practice, thereby reducing paper documents and the possibility of transcription errors, ineligible handwriting or missed signatures.
BCMA technology consists of bar coded medication packets and bar codes on patient identification bands as well as a scanner attached to a medication cart. With added distractions, complexities of care, and faced paced environments, nurses may inadvertently overlook inconspicuous errors or fail to catch packaging errors, leading to medication mishaps that could have serious consequences.
The introduction of BCMA technology at our psychiatric facility can improve patient safety and also decrease time spent on medication administration, thereby allowing more time for patient contact.
Currently nurses use old medication carts that have worn wheels, broken drawers and some are health and safety hazards. The nurses use paper medication records and must double check medications against the MAR sheets before administering.
The facility has recently introduced new computerized swipe access carts that are bar code scanner friendly with the intent to introduce bar coding once the pharmacy department converts to electronic medication dispensing and electronic medication records.
While many nurses will welcome this time-saving change, others will feel overwhelmed by the magnitude of the change; therefore careful planning and support on the part of the organization will lessen the stress associated with the implementation. Managing change has always been challenging in health care facilities, and new technologies often incite resistance from nurses who already cannot find enough time in their shift to complete patient related tasks.
One barrier that could impact the implementation at our psychiatric hospital is the possibility of a patient refusing to wear identification bands, which are necessary for BCMA to work.
Other barriers include short cuts that some nurses have adopted to save time, such as pre pouring medications, which contravenes Canadian nursing standards of practice. Workarounds are common and are a unprofessional attempts to circumvent computer failures or save time.
They come about through frustration on the part of the nurses when they are unable to find a solution to an immediate problem.
For successful implementation of a project as large as bar-coding, careful planning and identification of all barriers are imperative. Not all nurses are comfortable with technology in the work environment, thus they may be resistant to changing practice, or be afraid of failure Bozak, It is important to recognize the different educational needs of the various nurses and acknowledge the varying attitudes and stresses the nurses might have.
When health care organizations fully understand what behaviours drive or oppose change, then work to strengthen the positive driving forces, change can occur successfully Bozak, Unfreezing involves identifying key players that will be affected by the change and gathering them together to communicate ideas and create lists of all driving and static forces that will affect the project.
In this stage, implementation of the project produces the change desired, so it is important to continue to keep lines of communication with the nursing staff open.
Key components of this step are communicating with all stakeholders including frontline nurses, managers and administration. The inclusion of front line staff in planning groups and key decision — making processes promotes a feeling of empowerment that helps to overcome their resistance to the change and enables them to understand the importance of the project and how it will beneficially affect client care.
During the unfreezing stage, round table discussions with the purpose of teasing out the driving and restraining forces will help identify barriers that may need to be overcome.
In this facility some restraining forces might be; staff resistance to using computerized devices, the possibility of workarounds, lack of computer experience, lack of trust in the organization, and aversion to using a new system. Driving forces would be the forces that will help move the project to completion such as; adequate financial investment, support from upper level management, potential for ease of use and better time management.
The important point here is that this exercise actively engages all parties to work towards accentuating the positive driving forces and diminishing the restraining forces so that BCMA is successfully adopted without the use of dangerous workarounds with full nursing investment in the outcome.
Moving Stage The moving stage represents the period of actual change including the planning and implementation stages of the project.
Implementing bar coding across the facility will require sustained effort from various teams, some of which include; information technology ITpharmacy, clinical information services CISnursing, program managers, clinical nurse educators and administrators.
A project of this magnitude will affect all of these departments in different ways, so planning an effective roll out with the assistance and inclusion of all stakeholders is imperative.A research paper, Communication in Nursing Practice, found that nurses who display courtesy, kindness and security to their patients — through both their actions and words — are generally more successful in establishing a good rapport.
The paper suggested that nurses must go beyond simply demonstrating these niceties though. Nursing Articles by Topic: Leadership and Management Blog spotlight: CAUTIs still a problem Nurse Leader Insider, Issue 17, April 30, A. A1C A form of hemoglobin used to test blood sugars over a period of time.
ABCs of Behavior An easy method for remembering the order of behavioral components: Antecedent, Behavior, Consequence. Feb 20, · Good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient.
To achieve this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Our Master of Science in Nursing program was recognized by SR Education Group, a leading education research publisher, as one of the most affordable, and Baker was recognized as a top college for value.
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