Thank you for asking: Exploring patient perceptions of barcode medication administration identification practices in inpatient mental health settings

BACKGROUND Barcode medication administration systems have been implemented in a number of healthcare settings in an effort to decrease medication errors. To use the technology, nurses are required to login to an electronic health record, scan a medication and a form of patient identification to ensure that these correspond correctly with the ordered medications prior to medication administration. In acute care settings, patient wristbands have been traditionally used as a form of identification; however, past research has suggested that this method of identification may not be preferred in inpatient mental health settings. If barcode medication administration technology is to be effectively used in this context, healthcare organizations need to understand patient preferences with regards to identification methods. PURPOSE The purpose of this study was to elicit patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Insights gathered can be used to determine patient-centered preferences of identifying patients using barcode medication administration technology. METHODS Using a qualitative descriptive approach, fifty-two (n=52) inpatient interviews were completed by a Peer Support Worker using a semi-structured interview guide over a period of two months. Interviews were conducted in a number of inpatient mental health areas including forensic, youth, geriatric, acute, and rehabilitation services. An interprofessional team, inclusive of a Peer Support Worker, completed a thematic analysis of the interview data. RESULTS Six themes emerged as a result of the inductive data analysis. These included: management of information, privacy and security, stigma, relationships, safety and comfort, and negative associations with the technology. Patients also indicated that they would like a choice in the type of identification method used during barcode medication administration. As well, suggestions were made for how barcode medication administration practices could be modified to become more patient-centered. CONCLUSION The results of this study have a number of implications for healthcare organizations. As patients indicated that they would like a choice in the type of identification method used during barcode medication administration, healthcare organizations will need to determine how they can facilitate this process. Furthermore, many of the concerns that patients had with barcode medication administration technology could be addressed through patient education.

[1]  L. Davidson,et al.  “I don't know how to find my way in the world”: Contributions of User-Led Research to Transforming Mental Health Practice , 2010, Psychiatry.

[2]  M. Sandelowski Sample size in qualitative research. , 1995, Research in nursing & health.

[3]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[4]  D. Hilton,et al.  Peer support: a theoretical perspective. , 2001, Psychiatric rehabilitation journal.

[5]  J. Marquard,et al.  Re-examining the requirements for verification of patient identifiers during medication administration: No wonder it is error-prone , 2013 .

[6]  Onur Asan,et al.  Capturing the patients' voices: Planning for patient-centered electronic health record use , 2016, Int. J. Medical Informatics.

[7]  G. Dickens,et al.  An observational study of medication administration errors in old-age psychiatric inpatients. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[8]  C. Gaskin,et al.  Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during medication administration. , 2011, International journal of mental health nursing.

[9]  Helvi Kyngäs,et al.  The qualitative content analysis process. , 2008, Journal of advanced nursing.

[10]  B. Franklin,et al.  The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study , 2007, Quality and Safety in Health Care.

[11]  F. Crane,et al.  Preventing Medication Errors in Hospitals through a Systems Approach and Technological Innovation: A Prescription for 2010 , 2006, Hospital topics.

[12]  J. Innes,et al.  Medication-administration errors in an urban mental health hospital: a direct observation study. , 2015, International journal of mental health nursing.

[13]  Ronald Piscotty,et al.  Barcode Medication Administration Work-Arounds: A Systematic Review and Implications for Nurse Executives , 2013, The Journal of nursing administration.

[14]  Aviv Shachak,et al.  Computers in the clinical encounter: a scoping review and thematic analysis , 2016, J. Am. Medical Informatics Assoc..

[15]  M. Slade Personal Recovery and Mental Illness: A Guide for Mental Health Professionals , 2009 .

[16]  R. Pratt,et al.  Developing peer support worker roles: reflecting on experiences in Scotland , 2010 .

[17]  K. Shojania,et al.  National Patient Safety Goals. , 2006, Bulletin of the American College of Surgeons.

[18]  R. D. Paoletti,et al.  Using bar-code technology and medication observation methodology for safer medication administration. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[19]  M. Sandelowski Focus on Research Methods Whatever Happened to Qualitative Description? , 2022 .

[20]  B. Schneider Participatory Action Research, Mental Health Service User Research, and the Hearing (our) Voices Projects , 2012 .

[21]  Jane M Carrington,et al.  A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record , 2015, Nursing administration quarterly.

[22]  H. Turunen,et al.  An observational study of how patients are identified before medication administrations in medical and surgical wards. , 2015, Nursing & health sciences.

[23]  Andrew K. Shenton Strategies for ensuring trustworthiness in qualitative research projects , 2004, Educ. Inf..

[24]  Kate Herd,et al.  The application of mHealth to mental health: opportunities and challenges. , 2015, The lancet. Psychiatry.

[25]  Joan M Ching,et al.  Using lean "automation with a human touch" to improve medication safety: a step closer to the "perfect dose". , 2014, Joint Commission journal on quality and patient safety.

[26]  Carol A. Keohane,et al.  Effect of bar-code technology on the safety of medication administration. , 2010, The New England journal of medicine.

[27]  K. Boydell,et al.  Effects of client interviewers on client-reported satisfaction with mental health services. , 1999, Psychiatric services.

[28]  Philippa Collin,et al.  Participatory design of evidence-based online youth mental health promotion, intervention and treatment , 2012 .

[29]  Michael C. Mosier,et al.  Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. , 2010, The New England journal of medicine.

[30]  The medication process in a psychiatric hospital: are errors a potential threat to patient safety? , 2013, Risk management and healthcare policy.