Barcode Medication Administration Technology and Minimisation of Workarounds and Deviations from Designed Processes: A Systematic Review and Extended Typology of Clinicians′ Workarounds

The use of information technology in healthcare improves the services provided and their safety for patients. Although the Barcode Medication Administration (BCMA) technology has been widely adopted in health facilities over the last almost 30 years as a tool with the potential to reduce medication administration errors, a number of studies describe high rates of workarounds and deviations from designed processes where BCMA is used. The purpose of this review is to identify, based on a literature review, the types of workarounds and deviations from processes using BCMA, their causes and consequences, including suggestions for potential solutions to reduce them. This review was prepared using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. Scientific studies were searched in the international citation databases Web of Science and Scopus. The search covered papers published in English, between 1995 and 2023. The initial search yielded 1386 studies, of which 39 were included in the review. A qualitative content analysis was carried out. Nineteen studies addressed the topic of workarounds, their causes and their impact in the form of medication errors. Seventeen studies focus on proposing solutions to reduce workarounds and their causes. Three studies cover both topics. This article extends the older typology of workarounds and their causes. Newly identified were 7 types of BCMA workarounds (22 in total), 104 causes of workarounds (135 in total) and a list of secondary factors influencing the occurrence of workarounds, and 8 potential medication errors (15 in total). The occurrence of workarounds and deviations from the BCMA process is influenced by the implemented technologies and organisational or sociotechnical aspects related to the nature of work in each department. The most frequently cited reasons are organisational (e.g., missing drug barcodes, lack of nurse training, and high workload) and technological (e.g., connectivity and software issues). Suggestions for limiting workarounds focus mainly on limiting workarounds in which drug barcode scanning is omitted. In addition, proposals focus on ensuring that all doses picked by the hospital pharmacy are barcoded in the form of unit‐dose packaging, or on quality improvement projects in conjunction with the use of the BCMA technology by nurses. Future research should focus on designing a methodology for phased implementation of the BCMA technology to help healthcare organisations make decisions about the planning and details of implementation and the appropriateness of combining various identification technologies.