# Impact of barcode medication administration on patient safety in UK hospital settings: protocol for a mixed-methods realist evaluation

## TL;DR

This study examines how barcode medication administration systems affect patient safety and nursing time in UK hospitals.

## Contribution

The study introduces a mixed-methods realist evaluation to explore BCMA's impact in UK settings, where prior evidence is limited.

## Key findings

- The study will identify mechanisms by which BCMA systems influence patient safety and nursing workflows.
- Findings will be tailored to different healthcare professionals and settings, offering context-specific insights.
- Recommendations for practice will be developed based on triangulated data from multiple methods.

## Abstract

Barcode medication administration (BCMA) systems are increasingly being implemented in hospital settings, with the aim of decreasing medication administration errors. However, the majority of the literature demonstrating the value of BCMA in supporting patient safety is from the USA. Furthermore, little is known about the underlying mechanisms that support its use. This study aims to explore the impact of BCMA on patient safety including medication admisntration errors and nursing time spent providing direct patient care, in terms of what works, for whom, under what circumstances, and how.

We will use a mixed-methods realist evaluation. The study will be conducted in four phases, at two London NHS teaching trusts and one South West Region NHS Trust using different electronic health record systems. Phase 1 will involve documentary analysis and a narrative review to develop an initial programme theory for how BCMA is expected to work. Phase 2 will use interviews with key informants to refine this programme theory. The programme theory will then be tested in phase 3 using mixed methods: (1) observation of nurses’ medication administration; (2) analysis of alert data from the BCMA systems to understand the alerts’ clinical significance and utility and (3) interviews with nurses and hospital inpatients to explore their views. These data will be triangulated to refine and finalise the programme theory in phase 4, together with recommendations for practice.

The Study Coordination Centre has obtained approval (24/SC/0326) from the Oxford B NHS Research Ethics Committee and the Health Research Authority. The study’s findings will be presented at scientific meetings and published in peer-reviewed journals. Additionally, summaries of the findings will be produced, targeted at relevant groups such as healthcare professionals, policy-makers and study participants.