Barcode technology moves to ICU bedside

Goals are to decrease workflow problems

Although hospital pharmacists and other staff have had some time to become accustomed to barcode technologies at many health care organizations, there continues to be a need to study how the process can be expanded and improved.

St. Luke's Episcopal Hospital in Houston, TX, was an early adopter of barcode technology in the acute care setting, says Craig P. Frost, RPh, MBA, pharmacy manager.

But placing the technology in the hospital's intensive care unit (ICU) would not be a simple process.

Implementing barcode technology in the ICU has resulted in minor difficulties, partly because physicians were not receiving the patient information they needed on time, says Sujit Sansgiry, PhD, an associate professor and director at graduate studies of the University of Houston in Houston, TX.

Frost and Sansgiry are co-investigators of a study they've begun that will identify workflow factors in implementing safe and effective bedside barcode technology in the ICU.

"We know the ins and outs of it," Frost says. "But we were hesitant placing the technology in the ICU because of three main challenges."

Frost describes the challenges, as follows:

1. The documentation is complex. "The electronic medication administration documentation that we're trying to achieve is coupled in our software with all of the other non-medication-related documentation that the nurse has to do," Frost says.

For example, the nurse has to measure vital signs, fluid balance, and provide head-to-toe nursing assessments, he says.

"In our technology, the nurses have to document those data points along with medication administration," Frost says. "But the ICU requires more intensive documentation of those types of data points."

So the ICU staff nurses and other professionals were reluctant to use the technology, Frost adds.

2. It alters the staff's workflow. The order entry process drives the nurse's workflow and can determine what the nurse's workflow is, Frost says.

The process highlights when the first dose is ordered and the time medication therapy is discontinued, he explains.

"These can all drive the nurse's workflow goals," he says.

For example, if there's an order for a new antibiotic to be given twice a day, and it is supposed to be started immediately, there's a problem if the bedside processes make it difficult or impossible to meet that goal, Frost explains.

"That can cause a problem in the nurse's workflow because the nurse will be late with the task, even though it's not the nurse's work efficiency that is the problem, but a technology issue that is making the nurse late in medication administration," Frost says.

"So the pharmacist has to be sensitive to those sorts of workflow issues and think about order entry and the downstream impact of scheduling that order entry," he adds.

This workflow barrier has been a challenge since the beginning of the bedside administration, Frost notes.

For pharmacists, there isn't that much information about how it will impact their workflow in the ICU, Frost says.

"In the ICU environment, there are more emergent clinical situations where nurses need to administer more medications more quickly, and that can be held back by technology," Frost explains. "If barcode technology adds time to an already urgent situation, then it can be a barrier."

Also, if the electronic documentation isn't done in a timely manner then physicians who rely on the data to assess patient status will be concerned that they cannot make a decision about their patients' therapeutic needs, he adds.

3. Documenting titrated medicated infusions is a challenge. "The rate of administration of medicated infusions changes based on physiological parameters of the patient," Frost says. "Frequently, the software package we have does not have a robust way of dealing with that."

This is an obstacle that is primarily limited to the ICU environment, he adds.

The primary barrier to a smooth implementation of barcode technology and the theme that is present in all three challenges is timing, Frost says.

"How long does it take to do a particular administration-related task? How long does it take to document oral medication versus infused versus dialysis medication?" Frost says. "We need to look at details around the timing of those nursing tasks."