Bar-code technology has been touted as an important tool for reducing errors and improving medication safety. But new research shows that problems with the design and implementation of bar-code technology force nurses to work around the systems. By doing so, they negate the very safeguards the technology is intended to provide.

In a study conducted in five hospitals, researchers evaluated about half a million instances where nurses and other staff scanned bar codes on patient ID bands and drug packaging. In what researchers call a remarkably high percentage of instances, nurses overrode the system for 4.2% of patients charted and 10.3% of drugs charted.

Researchers found 31 reasons why nurses overrode the systems, including:

* unreadable bar codes on the drugs

* unreadable or missing patient ID bands

* drugs that weren't bar-coded

* drugs in distant refrigerators

* loss of wireless connectivity

* problems with patients in contact isolation

* emergencies.

Nurses worked around problems or inconveniences by affixing extra copies of patient ID bar codes on computer carts, scanners, clipboards, doorjambs, even their belt rings. Some nurses also carried several prescanned patient drugs on carts.

Possible consequences of the workarounds include wrong administration of drugs, wrong doses, wrong times, and wrong formulations. Researchers call for better integration of bar-code technology with "real world clinical work flows" to ensure the correct use of safety features.

Source: Koppel R, et al., Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety, Journal of the American Medical Informatics Association, July/August 2008.