At my hospital, we use a computerized bar-code medication administration (BCMA) system, but some physicians aren't interested in having access to the system or learning how it works. When a physician administers a drug without using the BCMA, what's the best way for nurses to document this?

In our old paper-based medication administration record (MARs), the nurse would document such a dose as "medication administered by Dr. XXX" or "medication given by Dr. XXX, as reported to me by YYY" if the nurse didn't observe it. I believe that it's important that the electronic MAR (eMAR) be as accurate as possible and that leaving the record blank would appear as if the medication wasn't given at all. Your opinion, please.-T.S., KAN.

You're asking how nurses can keep patients safe by properly documenting administration of a drug by someone else on an eMAR. The real problem here is that physicians are intentionally bypassing the system that was instituted to prevent patient harm from medication administration errors.

Work-arounds for the BCMA circumvent the system's safety checks. These checks verify that the right drug is being administered to the right patient in the right dose by the right route at the right time. When a physician bypasses the bar-coding system, the technology doesn't let the nurse properly record the dose administered on the eMAR, which could result in double dosing.

Furthermore, the system provides important information at the point of care, such as the patient's recent history, including his allergies and weight, and up-to-date drug information from online medication reference libraries. This information could include usual dosages, contraindications, adverse reactions, other safety warnings, pregnancy risks, and administration details. Finally, many BCMA systems capture the charge for medications that are stocked outside an automated dispensing cabinet.

For facilities using an eMAR, the Food and Drug Administration states, "before a health care worker administers a drug to the patient, the health care worker scans the patient's bar code."1 Each facility's pharmacy and therapeutics committee should review its current policies (or lack of policies) about physician administration. The policy and procedure must be standardized throughout the institution and strictly adhered to. In the meantime, an ad hoc committee of nurses, pharmacists, physicians, and the BCMA vendor should address the safest way to document medications administered by physicians, whether in patient-care units or other units where patients undergo various interventions, such as endoscopy and cardiac catheterization.

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