Pediatric Informatics: Computer Applications in Child Health (Health ...

28 Medication Administration and Information Technology 365
a dose, it is automatically documented as administered when the dose bar code
number matches the order number for the drug/dose/form/time, as displayed on
the primary BCMA screen. If there is a mismatch on any parameter, an alert box is
presented. The BCMA also automatically updates the electronic medication administration
record (eMAR) with the time of administration and operator identification
when the medications are scanned as “administered” (Fig. 28.2).
Logistic problems encountered during widespread deployment of the BCMA
throughout the VA system included equipment procurement, bar code print quality,
pharmacy coverage and lack of standardization of medication administration policies
and practices (across VA hospitals). Ethnographic observation and analysis of
medication administration practices pre- and post-BCMA deployment provided
insight into unanticipated negative effects:
Unexpected automated functions (such as removal of missed doses from the
BCMA display)
Degraded coordination between nurses and physicians
Bypassing scanning (manual data entry) to increase efficiency
Increased anxiety regarding and prioritization of audited activities
Decreased capacity for complex sequences (such as steroid tapers)
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Variable flexibility in handling system failures
Fig. 28.2 Bar code medication administration (BCMA) user interface