Impact of use of barcode scanners in medication administration: An integrative review

by Mark Garette Tiu, RN

Thierryfritz Isulat, RN

Pearl Jean Ballarta, RN

May Salas, RN

Kimberly Ann De Leon, RN

Roison Andro Narvaez, MSN RN

St. Paul University Philippines

Citation: Tiu, M.G., Ballarta, P. J., De Leon, K. A., Isulat, T., Narvaez, R. A. & Salas, M. (2025). Impact on use of barcode scanners in medication administration: An integrative review. Canadian Journal of Nursing Informatics, 20(1). https://cjni.net/journal/?p=14288

Abstract

Background: Medication errors are a significant concern for patient safety, particularly in nursing. Barcode medication administration (BCMA) systems have been implemented in recent years to reduce these errors and improve the accuracy of medication verification during administration.

Objective: This review aims to assess the impact of BCMA on enhancing medication safety and healthcare efficiency.

Methods/Design: An integrative review

Results: A total of 16 studies were analyzed. Findings indicated that BCMA systems reduce medication administration errors, increase nursing efficiency, and improve patient identification and verification. However, operational challenges remain, including increased workload and staff workarounds, which can undermine the system’s safety benefits.

Conclusion: The review underscores the benefits of BCMA, including fewer medication errors, enhanced patient safety, and more efficient documentation. Nonetheless, successful implementation depends on sufficient training, adherence to protocols, and system design improvements to mitigate workarounds. 

What is already known about this topic:

• Barcode Medication Administration (BCMA) systems are widely used to reduce medication errors and improve patient safety during the medication administration process.
• Studies have shown that BCMA can reduce medication errors significantly, ranging from 23% to 56%, by ensuring correct patient identification and proper medication administration.
• While BCMA systems are effective, challenges such as increased workload, staff circumventions, and system usability issues remain, which can limit their potential benefits.

What this review adds:

• This review confirms that BCMA not only reduces medication errors but also improves nursing efficiency and streamlines patient identification and verification processes.
• It highlights that operational challenges, including the tendency for staff to bypass safety protocols, can diminish the safety benefits of BCMA, calling for improvements in system design and staff training.
• This review suggests the need for further research into the implementation of BCMA systems in low- and middle-income countries, where operational challenges may be different, and calls for continuous system evaluation to optimize safety outcomes.

Background

Medications are chemical substances that are used to efficiently manage, prevent, or stop diseases, relieve symptoms, or assist in diagnosing illnesses. Medical experts carry out thorough research and clinical trials to create these medications, which are subsequently subject to FDA evaluation. In recent years, the adoption of barcode scanners in medication has gained growing popularity. Giving medications is a crucial activity for nurses that, if done incorrectly, can result in life-threatening mistakes. In order to reduce medication errors and improve the verification of medicine-administered rights, new technologies, such as barcode medication administration, have been developed (Darawad et al., 2019). To ensure accurate patient identification, drug selection, and dosage, hospitals must adopt bar code medication administration. By allowing nurses to concentrate on other important activities, this technology transforms drug safety while also greatly increasing nurse productivity (Barakat et al., 2020).

A significant technological advancement that has greatly supported nurses in their daily practice is the implementation of barcode medication administration (BCMA) systems. Through electronic scanning, nurses can verify a patient’s electronic medical record by scanning the patient’s wristband, simultaneously confirming their five medication administration authorizations. Based on observational studies, barcode administration systems have been shown to reduce medication administration errors (Hanson et al., 2022). Research has shown that Barcode Medication Administration systems significantly reduce the chances of errors and their severity. Utilizing these systems in the onco-hematology day hospital is an efficient method for confirming the proper medication delivery in terms of the “five rights.” Additionally, it may afford nurses more time to focus on patient care-related tasks (Macias et al., 2018).

The utilization of Barcode Medication Administration protocols is a valuable means of ensuring that patients receive safe and efficient care. Merely instructing personnel to adhere to these procedures is inadequate. Regularly scrutinizing and rectifying the practical implementation of barcode drug administration is crucial to prevent medication errors. This study lays the foundation and offers recommendations for healthcare institutions, healthcare professionals, and barcode medication administration vendors to achieve their objectives of enhancing patient safety and efficacy. (Koppel et al., 2019). Based on promising results, barcode verification has found application in inventory management, preparation, and dispensing procedures. Despite the considerable body of research supporting the effectiveness of barcode verification systems, implementing this technology in real-world settings can present specific operational challenges that limit its potential advantages. For instance, the increased workload resulting from scanning may lead to workarounds, where barcode scanning is entirely bypassed, particularly when integrated into manual order selection processes where pharmacy staff manually pick items from static shelves (Merola et al. 2018).

Barcode scanners play a critical role in medication administration, with several primary goals focused on improving patient safety and healthcare efficiency. (1) These scanners are purposefully designed to enhance the verification of medication administration by comparing the barcode on the medication packaging with the patient’s electronic health record, guaranteeing that the correct patient receives the accurate medication in the proper dosage. (2) This serves as a preventive measure against medication errors, which can result in significant consequences. (3) Additionally, barcode scanners facilitate the real-time documentation of medication administration, which is vital for maintaining precise and current patient records. This objective ensures that healthcare providers have prompt access to a patient’s medication history, including details on when medications were administered, thereby contributing to well-informed decision-making and continuity of care.

Method

Design

This research study applied an integrative literature review process in its design (Whittemore & Knafl 2005). This is a scientific and strategic step-by-step procedural analysis of relevant literature utilizing a combination of conventional and non-conventional approaches in research that can enhance evidence-based practice in nursing. Thus, the literature review clearly explains and focuses specifically on the presentation, analysis, and evaluation of previously gathered data.

Search Strategy

This review was conducted from July 2023 to August 2023, utilizing Google Scholar, Scopus, Elsevier, Wiley, and PubMed databases as primary electronic resources to gather articles and research studies related to barcode scanners in medication administration. Keywords used in the search included “Barcode Medication Administration,” “Barcode Scanner AND Medication,” and “Medication Errors.”

Figure 1 shows the PRISMA diagram illustrating the review process, starting with an initial search that identified 524 articles from various platforms. After screening the abstracts, 96 articles were considered potentially relevant. Further, 29 full-text articles were reviewed in detail to determine their suitability. Ultimately, 16 articles were included in the final review, having met all the inclusion criteria. This diagram provides a clear, transparent account of the study selection process and ensures methodological rigour in the systematic review.

Figure 1.

PRISMA Flow Diagram of Impact on use of Barcode Scanners in Medication Administration

Inclusion Criteria

This study focused on peer-reviewed journals, medical abstracts, and articles available through Google Scholar and PubMed Central that pertained to barcode medication administration. Only those sources that met these criteria were considered for inclusion.

Exclusion Criteria

The review excluded articles focusing on the types and causes of medication errors from the perspective of nurses. Additionally, studies related to barcode scanners used in other healthcare settings (such as ambulatory surgical centers, nursing homes, dialysis centers, and urgent care facilities) and other types of AI technologies (including pen wands, slot scanners, charge-coupled device (CCD) scanners, image scanners, and laser scanners) were omitted. Also excluded were topics concerning medication availability and inventory at pharmacies, as well as the accuracy and speed of medication dispensing in pharmacy settings.

Data Evaluation/ Quality Appraisal

To thoroughly investigate the various machine learning techniques used in nursing for the safe administration of medication, the researcher utilized specific search terms to gather scholarly articles and literature. The focus of the study was on medication errors from the perspective of nurses, while excluding duplicate articles and other AI tools, such as pen wands, slot scanners, CCD scanners, image scanners, and laser scanners used in different healthcare settings. The researchers employed the Level of Evidence (LOE) framework by Melnyk & Fineout-Overholt (2023) to independently and manually assess each study, to evaluate its design and methodology, credibility, relevance, and implications for health service delivery. This method facilitated the selection of appropriate studies for review. Additionally, the researcher sought feedback from nursing experts to refine the integrative review, enhancing its depth and impact through expert guidance.

Results

Table 1 summarizes the sixteen studies related to Barcode Medication Administration used in this review. Research studies were conducted in the United States of America (n=8), United Kingdom (n=3), Canada (n=2), Taiwan (n=1), Spain (n=1), and Norway (n=1), between 2007 and 2023. Study designs used were Quantitative (n=5), Before and After (n=3), Qualitative (n=2), Observational (n=2), Quasi-experimental (n=1), Comparative (n=1), Controlled Randomized (n=1), and Descriptive (n=1). Levels of evidence for the corresponding studies were LOE II (n=1), LOE III (n=2), LOE IV (n=7), LOE V (n=1), LOE VI (n=5).

Table 1.

Summary of Studies using Barcode Medication Administration

Studies by Franklin et al., (2007), Helmons et al., (2009), Poon et al., (2010), Higgins et al., (2010), Seibert et al., (2014), Truitt et al., (2016), Macias et al., (2018) and Barakat et al., (2020) showed that errors were significantly reduced during bar-coded medication administration thus improving the efficiency in the medical process. Also, the study by Tseng et al (2012) showed that the barcode medication administration system proved effective in correctly identifying patients and delivering medications. Studies by Sakowski et al., (2008), Tsai et al., (2010), Maaskant et al., (2015) and Mulac et al., (2021) led to a substantial decrease in harm to patients and promoted safety. And with regards to employing barcode scanning technology, studies by Berdot et al., (2019) and Chew et al., (2023) led to long-lasting enhancements in the safety, administration, and documentation of medications.

Regarding nurses’ attitudes toward barcode medication administration (BCMA), the study by Lunt et al. (2020) found generally positive perceptions in areas such as behavioral intention, anxiety reduction, and self-efficacy. However, more negative attitudes were reported concerning overall views on technology and performance expectancy. Despite these concerns, adapting the work system to effectively integrate BCMA has been associated with improved patient safety outcomes.

Discussion

Barcode scanners are integral to modern medication administration, serving to significantly enhance patient safety and healthcare efficiency. The primary goals of implementing these scanners are threefold: improving the accuracy of medication administration, preventing medication errors, and ensuring timely documentation. By comparing barcodes on medication packaging with patient records, barcode scanners help confirm that the right medication is given to the correct patient in the precise dosage. This technological advancement aims to mitigate the risk of medication errors, which can lead to severe adverse outcomes. Additionally, barcode scanners facilitate the real-time documentation of medication administration, ensuring that patient records are accurate and up to date, which supports effective clinical decision-making and continuity of care.

Research, such as the study by Franklin et al., (2007) demonstrated that barcode medication administration (BCMA) systems significantly reduce medication errors. By automating the verification process, BCMA technology minimizes human error and ensures that medications are administered according to prescribed protocols. This reduction in errors is crucial as medication mistakes can have serious repercussions for patient health. The implementation of BCMA has shown a considerable decrease in errors related to drug dosage, route, frequency, and timing. Berdot et al., (2019) further supported these findings, indicating that BCMA systems enhance the overall safety of medication administration and improve documentation practices. This evidence underscores the importance of BCMA in safeguarding patients and streamlining medication management.

Despite their benefits, BCMA systems are not without challenges. Koppel et al. (2008) highlighted that these systems can inadvertently introduce new hazards, such as deviations from established protocols, which may undermine their safety benefits. Issues such as system design flaws and the need for interruptions to scan barcodes can create obstacles. The research identifies several workarounds and circumventions, categorized into technological, organizational, patient-related, task-related, and environmental factors. For instance, problems such as misread or missing barcodes and staff overestimation of the system’s capabilities can impact the effectiveness of BCMA. Addressing these issues requires ongoing evaluation and improvement of both the technology and its implementation processes.

The study by Mulac et al. (2021) confirmed that when properly implemented, BCMA technology significantly enhances patient safety by verifying the ‘five rights’ of medication administration: correct patient, medication, dose, route, and time. Hospitals have increasingly adopted BCMA to reduce medication errors and their negative effects. However, Naidu & Alicia (2019) emphasized the importance of evaluating the impact of BCMA on medication administration errors, especially those resulting in harm. While BCMA technology has improved patient safety by reducing adverse drug events and transcription errors, Sakowski et al. (2008) noted that there is still room for improvement. Ensuring comprehensive training for staff and addressing system limitations are essential steps in maximizing the benefits of BCMA.

Continued research is necessary to understand the complexities of BCMA use and to refine its implementation. The studies reveal that many circumventions are driven by system limitations and contextual factors rather than intentional malfeasance. Exploring these workarounds can lead to better system designs and more effective training programs. Furthermore, while observational studies provided valuable insights, they have limitations compared to randomized clinical trials. A multimodal and qualitative approach is essential for gaining a deeper understanding of how BCMA systems interact with various elements of the healthcare environment. By addressing these challenges and focusing on improvements, BCMA technology can continue to enhance patient safety and healthcare efficiency.

Implications for Practice

The adoption of barcode scanners in medication administration has significant implications for clinical practice, primarily aimed at improving patient safety by ensuring that medications are administered accurately. This technology helps guarantee that the correct medication is given to the right patient, in the appropriate dosage, and at the proper time. By reducing medication errors, such as incorrect drug or dosage administration, barcode scanners enhance overall efficiency by automating data entry and verification tasks. This efficiency allows healthcare providers to allocate more time to direct patient care and less to administrative duties, leading to improved workflow. The integration of barcode scanners in medication administration is essential for both patient safety and effective medication management. Nurses and patients both contribute to the accurate and safe use of medications through this technology. Barcode Medication Administration (BCMA) supports nurses by streamlining documentation and adherence to medication administration rights. As patient safety is paramount, BCMA addresses this concern effectively. The use of BCMA has led to lasting improvements in safety, administration, and documentation of medications, and has significantly reduced errors in medication administration.

Limitations and Recommendations

The researchers acknowledge several limitations in this review. Firstly, the review only includes studies published between 2007 and 2020, potentially overlooking significant research published outside this timeframe. Furthermore, most studies are centered in high-income countries, resulting in a lack of data from middle- and low-income nations. Barcode Medication Administration (BCMA) systems are crucial in healthcare settings, significantly enhancing patient safety by reducing medication errors. However, these systems are not without challenges. One notable issue is the potential for barcode scanning errors, such as misinterpretation or misalignment, which can lead to incorrect medication administration. Additionally, healthcare professionals may face difficulties adapting to new technologies, and resistance from staff can hinder the effective implementation and utilization of BCMA systems.

To address these issues, researchers should consider the study’s target population and the training and profile of observers, as these factors can impact the quality of data collected. Implementing control groups is also recommended to ensure consistent results. Future research should explore various types of errors affecting BCMA, including incorrect medication, dosage, route of administration, timing, and dose omission. Healthcare organizations should prioritize comprehensive staff training programs to minimize human error and improve BCMA system efficiency. Fostering a collaborative and open culture among healthcare personnel can also help overcome resistance to new technologies and promote positive attitudes towards BCMA implementation. Finally, extending study observation periods can yield more uniform results, and monitoring nurses’ attitudes and behaviors, knowing they are being observed, can offer valuable insights.

Conclusion

The use of barcode scanners in medication administration offers several advantages, including a reduction in medication errors, enhanced patient safety, and a more streamlined medication administration process. By scanning barcodes on medication packaging and patient wristbands, healthcare providers can confirm that the correct medication is given to the right patient, in the right dose, and at the right time. This technology helps prevent medication mix-ups and improves accuracy in healthcare settings. However, the successful integration of barcode scanning in medication administration depends on several factors, including the availability of well-designed systems, thorough staff training, and adherence to best practices. While barcode scanners are effective in reducing errors, they are not infallible and should be complemented by other safety measures. In conclusion, barcode scanners are a valuable asset in medication administration, but their effectiveness is contingent upon the healthcare facility’s dedication to proper implementation and ongoing quality control. When used correctly, they contribute to safer and more efficient patient care.

Author Notes

Mark Garette Tiu, RN                          https://orcid.org/0009-0008-9620-4847

Thierryfritz Isulat, RN                         https://orcid.org/0009-0003-5671-9284

Pearl Jean Ballarta, RN                       https://orcid.org/0009-0005-3351-0765

May Salas, RN                                     https://orcid.org/0009-0000-8964-8118

KimberlyAnn  De Leon, RN                 https://orcid.org/0009-0004-5099-5138

Roison Andro Narvaez, MSN RN         https://orcid.org/0000-0001-7555-5420

St. Paul University Philippines

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