Table 1 Thematic Framework incorporating facilitators and barriers to barcode medication administration (BCMA) use as identified in qualitative interviews with nursing staff
THEME | WORKING DEFINITION | SUBTHEMES | |
|---|---|---|---|
FACILITATORS | BARRIERS | ||
BOTH FACILITATORS AND BARRIERS WITHIN THEMES | |||
TIME EFFICIENCY | Impact of BCMA on workflow, process and perceived impact on duration of drug round | - Streamlined Process - Perception of having time to use BCMA - Ability to stock appropriate drugs on trolley | - Viewed as time consuming - Difficulty scanning medications |
CULTURE AND ACCOUNTABILITY | Presence of culture of using BCMA on ward, responsibility and potential repercussions | - Perception of BCMA as mandatory - Strong ward culture of BCMA - Enforced use - Encouraged use - View of BCMA as “standard practice” | - Lack of perceived repercussions - Not enforced |
EQUIPMENT | Availability and usability of equipment required to perform BCMA | - Wireless scanners - Adequate numbers of scanners / trolleys | - Broken equipment - Software Issues |
TRAINING | Provision of adequate training on BCMA system and ongoing support | - Thorough initial training - Ongoing support and troubleshooting - Informal support | - Delays between training and implementation - Lack of training for temporary staff |
EFFECT ON PATIENT INTERACTIONS | Changes to interaction between nurse and patient when using BCMA for medication administration | - More time spent with patient at bedside - Patient aware of BCMA process - Patient has improved perception of safety | - Nursing focus on computer screen - Patient not receptive to wristband being scanned |
ONLY FACILITATORS WITHIN THEME | |||
PATIENT SAFETY | Perceived safety benefits when using BCMA for medication administration | - Viewed by nurses as beneficial for patient safety - Improved nursing confidence that mistakes prevented | |
ONLY BARRIERS WITHIN THEMES | |||
STAFFING AND WORKLOAD | Potential impact of staffing levels and workload on individuals perceived ability to use BCMA system | - High workload - Short-staffing - Role and Responsibilities | |
ERGONOMICS – BCMA TROLLEY | Impact of BCMA trolley design on ease of use and willingness to use | - Physical challenges of BCMA trolley - Unable to sit or write at trolley - Risk of injury | |
ERGONOMICS – WARD LAYOUT | Impact of ward layout on ease of using BCMA technology | - Obstacles on ward - Inconsistent wireless signal | |
INFECTION CONTROL | Implications of infection control measures on ability to use BCMA technology | - Uncertainty regarding policy and use of BCMA - Increased workload | |
DRUG RELATED | Limitations on use of BCMA technology resulting from prescriptions or drugs themselves | - Volume of medications to be scanned - Ability to scan medications | |