CHANGES IN WORK FLOW FOR FACULTY SUPERVISING STUDENTS IN A CLINICAL SETTING AS A RESULT OF BAR CODE MEDICATION ADMINISTRATION Ann Carruth, Dean College of Nursing and Health Sciences Eileen Creel, Department Head, School of Nursing

BACKGROUND  IOM (1999), reported nearly a million patients each year are injured in hospitals in the U.S. due to medication error. Bar coded medication administration systems (BCMA) are one of the proposed solutions to medication administration errors and may reduce reported medication errors by as much as 86%.  Bar coded medication administration has significantly changed nurses workflow processes.  BCMAs were intended to eliminate “work arounds” which contribute to mediation errors. However, this has not been fully realized and new work around have been developed.  With the integration of new electronic technologies in the clinical setting, policies to guide nursing instructors who supervise students in medication administration may not be meeting current needs.  No studies have addressed workarounds used by nursing faculty in the supervision of student nurses medication administration fusing BCMAs.

 Various policies impact faculty instruction: Medication administration policy, automatic dispensing machine (ie: PIXIS) policy; electronic health records policy, bar code medication administration process policy. These are unique to each agency.  Many agencies do not have a policy specific to student medication administration.  Research on the impact of the changes related to supervision of nursing student medication administration by faculty in the clinical setting is limited. A survey by Reid-Searl (2013) suggests that legal requirements surrounding nursing student medication administration are not being met.

METHODS  A descriptive cross sectional survey method was used to better understand the current use, processes, and policies in practice today by nursing faculty supervising nursing students in clinical settings. An invitation was sent to participate in an online survey using SurveyMonkey.  All Dean’s or Directors listed on the LACANE roster were ed to participated in the survey. was used to send 531 s to B. S. and A.D. programs in 45 states.  CCNE and ACEN site visitor lists were used to randomly select B.S. and A.D. programs nationally.  267 B.S programs in 42 states and 264 A.D. programs in 45 states were invited to participate.

ARE STUDENTS GIVEN A UNIQUE BADGE/BARCODE OR ACCESS CODE TO DOCUMENT MEDICATION ADMINISTRATION IN THE EHR?

ARE STUDENTS GIVEN A BAR CODE/BADGE OR ACCESS CODE TO RETRIEVE MEDICATION FROM THE MEDICATION DISPENSING MACHINE?

WHICH STATEMENT BEST REFLECTS THE SITUATION OF RETRIEVING MEDICATIONS FROM MEDICATION DISPENSING MACHINES?

WHICH STATEMENT BEST REFLECTS THE PROCESS OF MEDICATION ADMINISTRATION?

DOES YOUR AGENCY HAVE A POLICY FOR MEDICATION ADMINISTRATION BY STUDENTS SEPARATE FROM A GENERAL POLICY ON MEDICATION ADMINISTRATION?

WHICH OF THE FOLLOWING REFLECTS YOUR SITUATION WITH MEDICATION ADMINISTRATION?

HAVE ANY OF YOUR STUDENTS HAD A DRUG ERROR OR NEAR-MISS DRUG ERROR USING BARCODE MEDICATION ADMINISTRATION (BCMA) SYSTEMS?

IF YES TO PREVIOUS QUESTION, WHICH OF THE FOLLOWING WERE CONTRIBUTING FACTORS?

YOUR AGE FALLS IN WHICH RANGE?

IMPLICATIONS & RECOMMENDATIONS  Age and technology  Senior students are more likely to be given bar code access badges, however all level of students are administering medications. Clinical facilities should broaden access to BCMA codes for all persons engaged in mediation administration.  Development of medication administration policies by hospitals to include student nurse in the BCMA process with input from clinical faculty involved in processes.  Additional research into the extent that faculty are engaged in work-arounds – and if they are aware these are work-arounds.  Schools of Nursing should review/consider the legal implications for supervision of nursing students engaged in medication administration with new technologies. (i.e.: when the chart does not reflect the student nurse’s name as the person administering the medication – is this falsification of medication record?  LSBN considers this falsification of the medical record.