Factors associated with workarounds in barcode-assisted medication administration in hospitals.
Willem van der Veen, Katja Taxis, Hans Wouters and 3 others
PMID 32043705WHAT IT FOUND
Nurses skipped barcode scanning steps in 62.7% of medication administrations.
Workarounds were most common when one nurse cared for six or more patients, during evening rounds, and when giving non-oral drugs.
Key findings
01One or more workarounds were observed in 62.7% of the 5,793 medication administrations.
02A patient-to-nurse ratio of 6:1 or higher was strongly associated with workarounds compared to 5:1 or lower.
03Workarounds were significantly more likely during the 6 p.m. to 10 p.m. medication round than during the 6 a.m. to 10 a.m. round.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Observation bias cannot be ruled out, as observers may have missed some workarounds or nurses may have altered their behavior because they were being watched, although the Hawthorne effect is reported to be small. The study only included adult patients (18 years and older) on internal medicine and surgical wards, so results may not apply to pediatric or other specialty units. The selection of risk factors was based on existing literature, so other potential causes of workarounds may have been missed.
Declared interests
No specific conflicts of interest or funding sources are explicitly declared in the provided text.
The easy way to misread this
Do not interpret the high workaround rate as evidence that nurses are careless or untrained. The study shows that workarounds are strongly linked to workload, such as high patient-to-nurse ratios and busy evening shifts, suggesting that system and staffing factors are the primary drivers rather than individual nurse performance.