1

Informatics Project

Alyssa Evans

NUR 410: Nursing Informatics

Delaware Technical Community College-Dr. Pepper

04/16/2023
 2

Medication administration safety could be enhanced with an extra step added to the

medication administration process. Although the five rights have saved lives and aided in

medication administration, with evidence-based practice, it could be enhanced further.

Patient care safety in informatics is the process identified for improvement and

enhancement. Nursing informatics has been proven to enhance the safety of patient care by

monitoring the effectiveness and efficacy of tasks recorded during patient care interventions .

Reducing the incidence of medication errors and synergistic effects causing adverse reactions

from medication administration improves safety practices (Kumar et al., 2022). Patient safety

measures have increased significantly after the COVID-19 pandemic, making patient care

safety more robust for healthcare workers. Patient safety has taken on an even stronger

meaning and greatly added to the healthcare staff's daily routine burden.

 Focusing on medication errors decreasing and preventing sentinel events that could

lead to deaths. The use of electronic health records (EHR) with the advancements and

improvements evolved computerized record keeping and safety measures. Patient care safety

and reduced medication errors resulted from safety risks involving informatics and patient

information. Studies have explored the use of electronic tools in healthcare and the effects of

medication variations during the transition of care. According to Vaghasiya et al. (2023),

using technology for patient safety has answered most medication management questions and

concerns. During the transition of care, pre and post-pandemic, the use of standalone

electronic tools such as record flags for medication safety and medication reconciliation

because these tools prevent missing doses, overmedication, and adverse effects during the

transition of care.
 3

Furthermore, the potential risk of errors in the medication administration system utilizing

information technology can be a risk factor to explore. Godshall & Riehl (2018) stated that the

nursing informatics electronic medication administration record (eMAR) has a process that’s

built into the system and captures errors to prevent sentinel events. Still, nurses face the potential

risk of errors during medication administration while adhering to hospital informatics policies

and protocols; built-in electronic alerts and reminders identify patients susceptible to adverse

events, communicate critical changes in a patient's condition, and facilitate timely and

appropriate timely and appropriate treatments. Barcoded medication administration systems have

been linked to a reduction in medication errors. The hospitalized patient wears a wristband with a

unique barcode identification number to match the patient's information and medication.  

The problem with medication barcode scanning that can be changed is not the issue of

scanning patients' ID bands during the medication administration process, but adding a feature to

the nursing informatics platform where the identifiers for patient safety are captured could be a

major safety feature for nurses and patients. Health Information Technology (HIT) system

functions are built to reduce the risk of possible errors with built-in safety tools to reduce

medication dispensing and administration errors. Barcode technology includes electronic

medication administration and dispenser aids to prevent medication errors, adverse events, or

sentinel events. Advancing informatics by inserting a snapshot picture of the patient in the event

of incompetence could be a safety feature that would assist in preventing errors or death. EHR

assists in identifying patients in the clinical workflows. 

The scanning systems prevent medication errors by ensuring the right patient receives the

right medication at the right time and dose. The issue or problem to be revised would be adding

proof-positive patient identifiers, like a picture of the patient in the individual

 4

patient's eMAR. The nurse is legally required to obtain identifiers before giving the individual

patients medication. Patient identifiers include the patient's full name and date of birth, verbally

upon nurses’ demand, after scanning medical record numbers and ID bands used within the care

setting to identify a specific patient (McBride et al., 2018).  An ethical issue that can arise from

using a snapshot picture is the appearance change. Many patients are admitted to the hospital for

long periods, where they either lose or gain weight, grow facial hair, and can have facial changes

from trauma. This change can risk a patient receiving the wrong medication if unable to verbally

repeat their name and date of birth. In this common situation, this is where the patient

identification band will be utilized and resourceful.

Adding a patient identifier, like a snapshot picture of the patient, can be used to find and

identify those patients who are incompetent, confused, or comatose. Patients may have been

given the wrong wristband for identification on a busy shift, and the patient may be incompetent

and unable to answer identification questions which could pose a legal risk. Adopting the

barcode scanning methods while giving medication has reduced wrong medication, patient, time,

route, and dose errors. When used appropriately, barcode scanning can be a defensive backup to

those administering medications. Creating additional patient identifiers could safeguard

medication administration using snapshot photos on the eMAR.

  The safety of the patient and the security of personnel information is considered when

nurses administer medication to a patient helping to prevent errors that are unfortunately very

common in clinical practice. Because healthcare information security is a significant

responsibility for all healthcare organizations, innovative healthcare apps are vital to patient care

(Javaid et al., 2023). Float nurses who work on different units daily in 4-8 patient assignments,

only establishing an 8-12 hour rapport with the patient making facial recognition or
 5

remembrance almost impossible. Including photo recognition as a snapshot picture option could

decrease patient care incidents.  

Patient identifiers are used to complete the security measures for all nurses administering

medication and to maintain patient safety. Using barcode scanning as an identifier without a

snapshot picture of the patient must be more secure. A proposal to change the eMAR to reflect a

positive mark for a facial snapshot of the patient makes identifiers complete for the nurse

administering medication. Nurses would add this cognitive process to the five patient rights and

the two patient identifiers used when passing medications. 

Naidu and Alicia (2019) asserted that patient medication safety is improved with

computerization in healthcare when medications are administered to patients using barcode

medication administration (BCMA) and eMAR. The steps to start the BCMA begins with the

nurse scanning the barcode on the patient's wristband to secure the proper identification and

requesting the two identifiers from the patient (name and date of birth). The nurse confirms the

'five rights' as the right patient, right medication, right dose, right route, and the right time prior

to administration of medications (Mulac et al., 2021). When administering medication to a

patient, the current workflow plan protects the patient from any complications that can cause

harm and increase the nurse's workflow.

Next, errors can occur at any period during the medication use process phase but

normally take place at the point of administration, such as unscannable wristbands that are

damaged or smudged. BCMA technology requires the nurse to scan the patient's wristband to

ascertain the correct patient and the medication barcode to verify the correct medication, dose,

route, and time, recognized as the five rights. After would be to start, the scanning process for

identification and verification of the patient. This technology is used for verification by scanning
 6

the barcode on the patient identification wristband and individual medication, thus assisting the

nurses in verifying again. Workflow disruptions related problems can be caused by the slow

BCMA process or an error with the wristbands placed on the wrong patient as a mixed-up during

admission. 

 Moreover, if properly used, workflow maps can be like blueprints of care for the nurse to

administer medications to patients accurately (Perez, 2019). Nurses working in hospitals and

clinics, even urgent care, can benefit from this technical concept allowing patient identification,

medication verification, and general workflow patterns to merge, making medicating patients

secure and safe. The BCMA workflow plan does not disrupt the time spent giving medication

when following hospital policies; however, if complications occur, this will decrease time in the

medication administration (Barakat & Franklin, 2020). Using photo recognition software would

alleviate this problem and make even damaged wristbands used for scanning a nonviable issue.

The BCMA process increased nurse satisfaction and compliance, increased patient identification

rate, and decreased medication errors. The significant increase in active patient identification and

a high proportion of medications verified using the system represent potential benefits to patient

safety.
 7

Workflow Map One

Workflow process of barcode scanning patients for

medication administration.

Scan the patient's ID band, Ask the patient for their two
match the name and date of identifiers: name and date of
birth inside the eMar, and birth.
medication.

Positive response verbally to

two identifiers.

Positive ID marked in eMar, Five rights completed.

scan medication one at a time
with the patient, and teach on Next, administer medication
medication if possible. as prescribed.

Documentation captured in the electronic medication record

(eMar) of individual patient administration.
 8

Describing the change process that could help give identification to

patients in the method of a computer snapshot photographs as one of three patient identifiers.

Instead of two patient identifiers, the third will serve as a safety measure when administering

medication to patients who may be incoherent or whose identification bands are damaged or

smudged. The proposed change to the BCMA process to help prevent the stall in giving

medication and the chance of medicating the wrong patient. An individual patient photo will

be added to the BCMA platform for safety, a high priority for nursing medication

administration, with the safety checks built into the technology systems platforms ( Dunn &

Anderson, 2019). This uploaded photograph will be affixed to the medical record and appear on

the eMar screen whenever the patient’s wristband is scanned for medication or treatments

lowering the risk of misidentification that leads to errors.

A verification screen will feature a patient's photograph when the band is scanned by the

nurse giving medications. The photograph will appear on the upper right side of the computer

screen with clarity and must be renewed every two years. Nurses could positively identify

patients by a glimpse of a photo attached to the eMar. The use of BCMA is known to have

decreased medication errors tremendously since its existence. The successful use of BCMA

creates a better work environment and workflow because it ensures patient safety and methods to

reduce or eliminate these risk factors by improving the BCMA system.

Heikkinen (2022) expressed that finance must be considered for most institutions

requiring patient safety benefits, reducing costs from medication errors. Healthcare organizations

may be liable for financial damages and denial of payment from Medicare because of lawsuits by

patients harmed by errors, sometimes causing unnecessarily prolonged hospital stays from

misidentification leading to errors. The incidence of misidentification or unscannable

 9

identification bands of patients in hospital settings can create tremendous financial blows for an

organization because of non-documentation that leads to nonpayment. The financial benefit of

having the patient's photo on the verification screen would cause a decrease in patient

misidentification and increase patient identification and verification, causing a decrease in loss of

payment.

Nurses encounter patient identification errors occasionally while using the BCMA

system, which could lead to significant patient harm. Using the best practice of incorporating a

third patient identifier will work if the patient has impaired sensorium and will increase the

likelihood of misidentification (Pruitt et al., 2020). The usability of the verification screen with

patient photos on eMar can impact patient safety, nurse effectiveness, productivity, and

satisfaction. A workflow map could assist hospitals and other healthcare facilities by boosting

the confidence in medication administration staff. Reassuring nurses that there are other ways to

verify patient identifiers will lessen the stress of medication passes. This map will allow

healthcare workers to follow the medication administration process and be more confident in

giving medications to patients who are nonverbal, confused, or incoherent patients. That third

identifier will decrease medication errors and improve patient care safety.
 10

Workflow Map Two

Workflow process of barcode medication

administration (BCMA).

Scan the patient’s wristband band to

match the name and date of birth with
the eMar. Verify five rights.

Unable to make Positive

The patient is incoherent, and Identification due to damaged
the wristband is unscannable wristband. Positive Id from
from damage. Use the next the photo on eMar prevents
step for verification. the workflow from slowing
down.

Documentation captured in the electronic medication record

(eMar) of individual patient administration. The Barcode
medication administration process was completed.
 11

Barcode Scanning Medication Administration Patient Identification and Verification

I. Effective Date:
June 1st, 2022
II. PURPOSE:
To provide an effective process for administering medications to patients.
III. POLICY:
Barcode Scanning Medication Administration Patient Identification and Verification.
The barcode technology verification screen for patient identification and verification by photo
appearing on the eMar. Medication administration will include the following:
a. Incorporating findings from the medication history and medication reconciliation
process
b. Verifying medication orders with the patient's wristband and picture on eMar.
IV. PROCEDURE:
1. The Five Rights of Medication Administration will be observed:
2. A. Right patient
i. Check the name on the order and the patient.
ii. Use three unique identifiers.
iii. Ask the patient to provide two identifiers (name, date of birth)
iv. When available, use barcode scanning.
B. Right medication
i. Check the medication.
ii. Check the order.
C. Right dose
i. Check the order to confirm the dose.
ii. Confirm the appropriateness of the dose using a current drug reference.
D. Right route
i. Check the order and appropriateness of the route ordered.
ii. Confirm that the patient can take or receive the medication by the ordered route.
E. Right time
iv. Check the frequency of the ordered medication.
i. Double-check that the ordered dose is being given at the correct time.

V. RESPONSIBILITIES
RN, LPN, or a graduate or student nurse supervised by an RN. Instructor
VI. MATERIALS NEEDED:
Computer on Wheels with the scanner attached.
Appropriate supplies for medication administration route.
VII. REFERENCE:
The Join Commission
 12

VIII. SEARCH WORDS:

Barcode Scanning Medication, administration Verification Identification
IX. ENFORCEMENT:
Violations of this policy or associated procedures may result in appropriate disciplinary action
X. STAKEHOLDER APPROVAL:
On File
XI. COMMITTEE APPROVALS:
Nursing Standards Committee
Pharmacy and Therapeutics Committee
XII. FINAL APPROVAL:
Pending
XIII. REVISION HISTORY:
To be determined…
 13

References

Barakat, S., & Franklin, B. D. (2020). An Evaluation of the Impact of Barcode Patients and

Medication Scanning on Nursing Workflow at a UK Teaching Hospital. Pharmacy

(Basel, Switzerland), 8(3), 148.

Godshall, M., & Riehl, M. (2018). Preventing medication errors in the information  

age. Nursing2022, 48(9), 56–58.  

Javaid, M., Haleem, A., Singh, R. P., & Suman, R. (2023). Towards in sighting Cybersecurity

for Healthcare domains: A comprehensive review of recent practices and trends. Cyber   

Security and Applications, 100016. 

Kumar, Y., Koul, A., Singla, R., & Ijaz, M. F. (2022). Artificial intelligence in disease

diagnosis: a systematic literature review, synthesizing framework, and future research

agenda. Journal of Ambient Intelligence and Humanized Computing, 1-28.

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adults.

medical and surgical settings: a systematic review. Therapeutic advances in drug

safety, 11, 2042098620968309. https://doi.org/10.1177/2042098620968309

McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and  

addressing ethical issues with the use of electronic health records. Online J Issues  

Nurs, 23(1), 6–6. 

Mulac, A., Mathiesen, L., Taxis, K., & Gerd Granås, A. (2021). Barcode medication
 14

administration technology used in hospital practice: a mixed-methods observational study

of policy deviations. BMJ quality & safety, 30(12), 1021–1030.

https://doi.org/10.1136/bmjqs-2021-013223

Naidu, M., & Alicia, Y. L. Y. (2019). Impact of barcode medication administration and

electronic medication administration record system in clinical practice for an effective

medication administration process. Health, 11(05), 511.

Perez Arias, M. (2019). Increasing barcode medication administration (BCMA) to improve

patient safety.

Vaghasiya, M. R., Poon, S. K., Gunja, N., & Penm, J. (2023). The Impact of Electronic

Medication Management Systems on Medication Deviations on Admission

and Discharge from Hospital. International Journal of Environmental Research and Public

Health, 20(3), 1879.