Information Technology Reference
In-Depth Information
6.3
Issues Relating to BCMA
Nurses in a ward carry out most of the orders for patients during a hospitalization.
Blood transfusions are primarily reported by the nurses at a ward, implying that
many invasive and high-risk medical treatments are conducted at the ward; depend-
able authentication should be performed beforehand. Below is a typical workflow
process from ordering the blood transfusion to the actual transfusion to give a
general idea of the workflow at a healthcare setting:
A physician inputs the blood transfusion order via CPOE (Computer-based
Provider Order Entry). The blood type of the patient is registered on an electronic
medical record, previously inspected by a blood transfusion department system.
The blood transfusion department accepts the order from the physician and
performs the radiation on the blood bag and dispenses it. At the staff station, nurses
verify the dispensed blood with the form issued by CPOE; then, they carry the blood
to the patient's bedside. The nurse scans the barcode on the staff identification plate
and inputs it as the performer's identity. Then she scans the barcode on the hospital
card of the patient. Finally, she scans the barcode on the blood bag to perform three
points authentication (Dzik
2007
).
Because the authentication process requires the authenticating person and
materials at the ward, mobile terminals such as a PDA (Personal Digital Assistant)
and PHS (Personal Handy-phone System), attached to a barcode reader, are widely
used. In Japan, BCMA has been implemented on mobile terminals since the 2000s
and has spread rapidly (Akiyama
2007
a). The number of negative incidents has
been remarkably reduced in hospitals using BCMA (Watanabe et al.
2006
; Matsuda
et al.
2006
; Makoto
2004
); however, such incidents have not been completely
eliminated.
The patients wear a wristband with a barcode in many hospitals, but the
responses from patients in this regard have not been positive (Yano et al.
2008
).
Therefore, some hospitals use a hospital card instead of the wristband, using the
wristband only in a limited number of situations, such as during operations.
However, these sorts of measures may be the cause of certain problems. Too
many barcodes required for authentication (Tomohiro
2005
), and the complicated
operation of the mobile terminal, can lead to nurses bypassing authentication
(Watanabe et al.
2006
) or refraining from using BCMA; there are many reports
that nurses have been hesitant in using BCMA (Yano et al.
2008
; Tateishi et al.
2008
). For example, the light of a scanner is very bright, which can disturb sleeping
patients. Another example sets out how a nurse gave up using the terminals because
the terminals were not charged and spare terminals could not be found immediately.
A system that reduces the burden on practitioners is, obviously, desirable (Lisby
et al.
2005
; Kaplan
2005
). Koppel analyzed the 'workarounds' of BCMA and their
causes in detail (Koppel et al.
2008
): (1) The user administers medication without
scanning the medication barcode to confirm whether it is the correct medication,
leading to wrong medication administered, (2) the user administers medication
without scanning patient ID barcode to confirm it is the correct patient, leading to
