In an attempt to tackle the issue of medication errors, hospitals are making greater use of innovative technologies such as bar-coded medication administration (BCMA) systems. While BCMA systems can be effective at mitigating the risk of medication error, their effectiveness in chemotherapy settings has not yet been reported. Therefore, the Chemotherapy Daycare Centre (CDC) at the Princess Margaret Hospital (PMH) approached the HumanEra team to determine whether they should pursue purchasing a BCMA system to improve medication safety. HumanEra therefore conducted a study to understand the benefits and risks of BCMA systems for chemotherapy.
First, ethnographic field research was conducted to understand the work environment and workflows. Workflow diagrams were created to demonstrate differences in the current workflow versus the workflow required with the introduction of a BCMA system. This information was used to inform the usability testing of two BCMA systems in a simulated chemotherapy unit in the usability laboratory. Nine nurses completed a series of tasks without a BCMA system as well as with each of the two BCMA systems. Their ability to detect four types of errors was measured (wrong time, wrong dose, missing drug, and wrong patient) as well as time to complete medication administration tasks, task completion rates and user preferences. Usability issues were also noted.
BCMA systems were shown to improve error detection rates. However, more than twice the amount of time was required to administer an IV medication when a BCMA system was used. Additional implementation challenges were discovered that could also have negative patient safety implications. Based on the results of this study, PMH chose not proceed with acquiring a BCMA system until system integration with their oncology patient information system could be achieved. This study illustrates the value in using usability testing to proactively highlight the safety, usability and functional issues with new technology prior to acquisition.
Canadian Cancer Society Research Institute
Dr. Vishal Kukreti
White, R., & Kukreti, V. (2010, Oct). Safer chemotherapy administration? High fidelity usability testing of bar-coding technology. Presentation at Princess Margaret Hospital Innovation Rounds, Toronto, ON.