The purpose of this research was to identify current practices, policies, and processes impacting nurse faculty who supervise nursing students administering medications in the clinical setting using bar coded medication administration systems (BCMA). BCMAs are one of the proposed solutions to medication administration errors. They have been reported to reduce medication errors by as much as 86% (Rivish & Modeda, 2010). Up to 50% of United States (U.S.) hospitals had implemented BCMA technology in 2011, with the goal of improving compliance with the Five Rights of medication administration (Hassink, Jansen, & Helmons, 2012). BCMAs were intended to eliminate “workarounds” which contribute to mediation errors. However, this has not been fully realized. Kelly, Harrington and Matos (2016) state that workarounds are most commonly developed as solutions to barriers in patient care delivery and are developed to account for a technology shortcoming.
Very little has been written about nurse faculty’s role related to nursing student supervision while administering medications using BCMAs. One of the competencies of the Quality and Safety Education for Nurses (QSEN) project for safety is that student nurses obtain knowledge of safety-enhancing technologies, such as barcode medication administration systems (QSEN, 2014). Research on the impact of the changes related to supervision of nursing student medication administration by faculty in the clinical setting is limited. In some settings students are not provided with a unique log-in code for electronic health records or BCMA records. When faculty supervise student nurses' administration of medications in these situations, the faculty code is used and faculty name is reflected as the person administering the medication in the record. Reid-Searl (2013) suggested that legal requirements surrounding nursing student medication administration are not being met. Nurse practice acts across the U.S. stipulate documentation of interventions to be within scope of practice as a registered nurse. The act of improperly documenting the person who gives medication potentially violates the standard of care and in essence falsifies the record (York, Cynthia. “Documentation of Medication Administration by Student Nurses During Clinical Experience.” Received by Ann Carruth, September 4, 2106 letter).
A descriptive cross sectional survey method was used to better understand the current use and policies used by nursing faculty supervising nursing students. Two hundred thirteen (N= 213) surveys were returned from an online invitation to a national sample of Dean’s of Schools of Nursing. Nurse faculty from 17 states returned surveys. These states represented all regions of the U.S.
The findings revealed that most agencies do not give BCMA codes to student nurses to retrieve assigned patient medications, but (60%) were given codes to chart in the electronic health care record (EHR). However, nurse faculty (54%) said they or a nurse scanned their badge at the time of medication administration. The majority (74%) felt technology had increased patient safety, but 25% indicated it was inadequate for use with student nurses. Faculty (50%) indicated over-rides are frequently required due to technological issues, and 32% indicated a student had a medication error using a bar code system. The majority of agencies either had no policy about student administration of medication, or the faculty were unsure about an agency policy (55%). Additionally, the majority of the faculty 54% were over the age of 50 likely indicating they were not originally trained to give medications using this technology.
It is important that faculty and nurse preceptors who supervise nursing students in the skills of medication administration know and are able to recognize what constitutes workarounds. Faculty should receive clear policies and training in the use of all electronic health records and BCMA systems they use while supervising nursing students. This training should include hands on experience to the extent that the faculty feels comfortable enough with the system to avoid workarounds, which maybe longer if faculty are older and have used the technology for a shorter length of time. Kelly et al., (2016) indicated ongoing evaluation and adjustments within a safety culture environment that is user–centric with input from front line users is a pro-active approach that can be used by organizations to address workarounds. Frontline users include nursing faculty and the nursing students they train and as such need to have input into these policies and processes.
These findings are relevant as technology usage continues to increase seemingly without consideration for the training of future nurses. Most hospitals do not have a separate policy for nursing student medication administration, which could help to address issues with student nurse use of BCMA. The use of the BCMAs and EHR systems has legal implications for supervision of nursing students by faculty. Future research into the impact of BCMA systems and EHRs on the safe and legal training of our future nursing workforce is needed to ensure protection for patients, students and faculty who teach them.