The use of electronic medication carts and other pharmacy technologies in long-term care has increased in recent years, but a new report out this week illustrates ongoing safety worries about the ability to quickly scan and deliver patient prescriptions.
ECRI, a national nonprofit organization dedicated to patient safety, identified workarounds with barcode medication administration systems as one of its two most urgent safety concerns for 2024.
The systems, in which nurses use an electronic scanner to sync packaged drugs with patient and electronic medication administration records, are designed to put more safeguards around medication delivery. But complications with technology or labeling mistakes undercut the value of the systems, ECRI said.
“Scanning or labeling errors may lead staff to develop workarounds, which can compromise patient safety and have serious or even deadly consequences,” its 2024 report said. “Staff may employ workarounds when a barcode cannot be scanned or is difficult to scan; when the barcode is missing, hidden, or damaged; or when a medication has not yet been added to the system.”
Use of an electronic medication cart and failure to scan a medication when it was delivered to a patient were two concerns broached by prosecutors who convicted Tennessee nurse RaDonda Vaught of criminally negligent homicide in 2022.
The systems have been popular in hospitals for years, but their relatively high cost has long limited their use in nursing homes. That has changed, however, especially in larger facilities that see the carts as a way to make multiple daily medication passes more efficient.
Pressured to improve med pass
A study published in the Journal of the American Pharmacists Association this month found replacing manual emergency medication kits with an automated dispensing cabinet “improved workflow efficiency” in both a long-term care pharmacy and two studied long-term care facilities. It also significantly reduced unscheduled drug deliveries and increased the availability of medications commonly used by residents.
A 96% reduction in the cost of unscheduled medication deliveries saved $8,900 and reduced medication retrieval time by 71% across the two nursing homes over a 90-day period.
“Minutes matter when it comes to getting the right medication to the right patient at the right time,” said Idal Beer, MD, medical director and vice president of Medical Affairs for Medication Management Solutions at BD. “This is especially true in long-term care settings, where patients have increasingly complex needs and nursing staff are managing high patient-to-provider ratios. While the adoption of technology has traditionally lagged in long-term care settings, the results of this landmark study make a clear case for the power of automation to enhance patient care and alleviate labor challenges.”
Short cuts and nursing concerns
The ECRI called the electronic management systems “valuable tools that reduce medication administration errors, but only when used correctly.”
“Staff must be trained on proper use of the system, and procedures must be established to quickly address problems,” the report said.
Workarounds may indicate that an individual system is not configured to support a safe clinical workflow or that staff members “do not appreciate the safety value of the technology, or that they do not understand that BCMA workarounds can cause medication errors and compromise patient safety.”
Whether it’s due to lack of experience or willful neglect of best practices, the human element must be consistently better, authors intimated.
They called out unsafe practices such as administering a medication even if a barcode won’t scan, charting a medication after it is administered (back-charting), and not understanding a system alert but administering a medication anyway.
The only safety concern to top the use of the medication technology for 2024 was related to onboarding new clinical staff — including some 400,000 new nurses — whose training may have been disrupted by the pandemic.
“Without sufficient preparation, support and training throughout the transition into practice, new clinicians can experience loss of confidence, burnout, and reduced mindfulness around culture of safety,” the report said. “The coalescence of these factors may lead to a failure to recognize and rescue patients from preventable harm, and/or contribute directly to patient harm events.”
The report recommended healthcare providers focus on developing “a total systems safety approach” and allow those newly trained to help identify issues, feel safe reporting their concerns and participate in finding solutions.
Some other concerns named in the ECRI top 10 relevant to long-term care providers include:
- Unintended consequences of technology adoption
- The decline in physical and emotional well-being of healthcare workers
- The complexity of preventing diagnostic errors
- Providing equitable care for people with physical and intellectual disabilities
- Care delays related to drug, supply and equipment Shortages
- Misuse of parenteral syringes to administer oral liquid medications
- Preventing patient falls
