HLTH 2120 Week 4 Barcode System Evaluation Example

Can Nurses Do the Work the Unit Exists to Do? Evaluating a Bedside Barcode Medication Administration System Against Four Criteria Chosen Before Looking

Student Name

Walden University

HLTH 2120: Health Informatics

Instructor Name

Month Day, Year

Can Nurses Do the Work the Unit Exists to Do? Evaluating a Bedside Barcode Medication Administration System Against Four Criteria Chosen Before Looking

What Is Being Evaluated and How

This evaluation looks at the barcode medication administration system used on a medical-surgical unit, the bedside end of the chain that begins with the admission weight. At the bedside, the software compares two scans, one from the wristband and one from each package, with the active order, and it warns before anything is given that does not match. The system has many features. This evaluation does not grade them. It asks whether the nurses who must use the system can accomplish the work the unit exists to do: giving the right medication, in the right dose, to the right patient, at the right time, without the system creating new risks.

Usability standards define usability as the extent to which specified users can achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use (International Organization for Standardization, 2018). Following that definition, I chose four criteria before collecting any evidence, so that the evidence could not shape the criteria. The evidence comes from observing 24 medication passes over three day shifts, with the nurses' permission, from the unit's monthly scanning compliance report and from published research. The unit and its figures are invented for this example, modeled on a typical student observation, and should be read as illustrative.

Criterion 1: Does the System Catch the Errors It Exists to Catch?

Evidence. In the 24 observed passes, the system stopped one wrong-time dose, an antibiotic scanned two hours early, and the nurse waited. The published evidence is stronger than any single unit's observation: when one academic hospital introduced bedside barcode checks together with an electronic administration record, researchers measured large drops in administration errors and potential adverse drug events (Poon et al., 2010).

Verdict. Met. When the scan is completed as designed, the system catches the errors it was built for.

Criterion 2: Can Nurses Complete the Scan Within the Task?

Evidence. In 19 of 24 passes, every item scanned on the first attempt. In five, at least one item would not scan: two because the wristband was wet or creased, two because a pharmacy label was printed over the barcode and one because the scanner's battery failed. In three of those five, the nurse typed the patient or medication number manually to override, which the system allows with a reason. The unit's report showed that about 93% of administrations were fully scanned in the last month, with the rest overridden.

Research has documented these patterns in detail. A study of barcode systems at several hospitals identified many types of workarounds, such as scanning a wristband taped to a computer cart instead of the patient, with causes rooted in technology, task and organizational factors (Koppel et al., 2008). Each workaround removes the protection the scan exists to provide.

Verdict. Partly met. The system works when the barcodes and equipment cooperate, and the gap between 93% and full scanning is mostly made of equipment and label problems, not nurse choice.

Criterion 3: Does the System Support Weight-Based Doses?

Evidence. For weight-based medications, the administration screen shows the dose and the order but not the dosing weight or whether that weight was measured. In two observed passes of a weight-based anticoagulant, the nurse had no way at the bedside to see that the dosing weight was a family member's estimate, which last week's data flow map identified as a risk. The system confirmed the right drug and the right patient, but it could not confirm that the dose rested on a reliable number.

Verdict. Not met. The system verifies that the dose matches the order; it does not help the nurse judge whether the order was based on accurate data.

Criterion 4: Does the System Add Time or Risk Elsewhere?

Evidence. The median observed pass took about the same time as the unit's informal estimate before barcoding, but failed scans added two to six minutes each. Nurses reported that alerts for minor timing differences were frequent and usually overridden, which risks training them to override all alerts. A nurse told me she now scans the wristband before entering the room when the patient is asleep, using the spare wristband kept at the door, a workaround of exactly the type described in the research.

Verdict. Partly met. The system adds time when it fails and creates a habit of overriding minor alerts, and at least one workaround removes the patient check entirely.

What Nurses Said About the System

Nurses' satisfaction, the third part of the usability definition, was not one of my four criteria, but it came up in every conversation. Most nurses said they trusted the system and would not want to work without it, which matches the published finding that it prevents errors. Their frustration was with the failures: a scanner that dies mid-pass, a label that will not read, an alert that fires for a dose that is fifteen minutes early. Several said the frustration came less from the extra minutes than from feeling that they were being asked to choose between following the system and getting their patients their medications on time. That feeling is where workarounds begin, and it is worth measuring directly in a follow-up survey.

Overall Verdict

The verdict is mixed, and it is a verdict. The system does what it was designed to do when the scan happens as intended, and published evidence supports its value. It does not yet allow nurses to complete the work reliably, because equipment and labeling problems push them into workarounds, and it is blind to the quality of the data behind weight-based doses. The most useful changes are not new features. They are replacing failing scanner batteries and wristbands, fixing the pharmacy label layout, removing spare wristbands from doors and adding the dosing weight and its method to the administration screen. If those changes were made, I would expect the scanning rate to rise and the riskiest workaround to disappear, and the unit could check both in its monthly report.

References

International Organization for Standardization. (2018). Ergonomics of human-system interaction: Part 11. Usability: Definitions and concepts (ISO Standard No. 9241-11:2018). https://www.iso.org/standard/63500.html

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616

Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, J. M., Kachalia, A. B., Hayes, J., Churchill, W. W., Lipsitz, S., Whittemore, A. D., Bates, D. W., & Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698-1707. https://doi.org/10.1056/NEJMsa0907115