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Facilitators and barriers in using barcode technology to ensure safe medication dispensing, preparation, and administration in a children's hospital: a focus group study for clinical pharmacists.

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Τίτλος: Facilitators and barriers in using barcode technology to ensure safe medication dispensing, preparation, and administration in a children's hospital: a focus group study for clinical pharmacists.
Συγγραφείς: Laakkonen L; Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland., Kvarnström K; Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.; HUS Pharmacy, Helsinki University Hospital (HUS), Helsinki, Finland., Janhunen K; Corporate Group Administration, Western Uusimaa Wellbeing Services County, Finland., Linden-Lahti C; Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.; HUS Pharmacy, Helsinki University Hospital (HUS), Helsinki, Finland., Kuitunen S; Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland. sini.kuitunen@helsinki.fi.; HUS Pharmacy, Helsinki University Hospital (HUS), Helsinki, Finland. sini.kuitunen@helsinki.fi.
Πηγή: International journal of clinical pharmacy [Int J Clin Pharm] 2026 Aug; Vol. 48 (4), pp. 1519-1532. Date of Electronic Publication: 2026 Apr 02.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer Country of Publication: Netherlands NLM ID: 101554912 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2210-7711 (Electronic) NLM ISO Abbreviation: Int J Clin Pharm Subsets: MEDLINE
Imprint Name(s): Original Publication: Dordrecht : Springer
Ιατρικοί όροι (MeSH): Pharmacists*/standards , Pharmacists*/psychology , Hospitals, Pediatric*/standards , Pharmacy Service, Hospital*/standards , Pharmacy Service, Hospital*/methods , Pharmacy Service, Hospital*/organization & administration , Medication Errors*/prevention & control , Electronic Data Processing*/methods , Electronic Data Processing*/standards , Medication Systems, Hospital*/standards , Attitude of Health Personnel*, Focus Groups/methods ; Humans ; Qualitative Research ; Professional Role ; Electronic Health Records ; Female ; Workflow ; Male
Περίληψη: Introduction: Barcode technology is widely used in hospitals to improve medication safety. Although this technology is considered effective for making system-wide improvements, its implementation faces several challenges. Hospital pharmacists play a key role in supporting this process.
Aim: To explore clinical pharmacists' perceptions of the facilitators and barriers to using barcode technology in a pediatric hospital setting.
Method: A qualitative focus group study. Fourteen clinical pharmacists working in the pediatric department of a university hospital were chosen for the focus groups (n = 3) using purposive sampling to identify the individuals who regularly use barcode technology in clinical practice. The focus group discussions, guided by a semi-structured interview guide with six questions, were recorded and transcribed verbatim. Two researchers independently conducted inductive content analysis, which was later thoroughly reviewed by the entire research group.
Results: The data revealed four main themes: factors encouraging the adoption of barcode technology, factors complicating barcode workflow, ideas to improve workflow efficiency, and at-risk behaviors. Factors encouraging the adoption of barcode technology were associated with the benefits and usability of barcode technology, increased expertise and teamwork, positive user experience, and supportive functions of the electronic health record (EHR) system. Factors complicating barcode workflow included deficiencies related to barcodes in labels and drug packages, negative attitudes of users, organizational factors, the use of the EHR system, and deficiencies in workstations and equipment. These factors were found to contribute to at-risk behaviors, while ideas to improve workflow efficiency focused on removing factors complicating barcode workflow and reducing at-risk behaviors.
Conclusion: Various factors can influence the implementation of barcode technology in clinical practice, underscoring the importance of an organizational process to identify system deficiencies and continuously improve usability. Building on previous studies, our research emphasized the issues related to dispensing and preparation workflows, as well as the need for pediatric-specific EHR system customization as key development areas. Our findings can guide risk management efforts in implementing and maintaining barcode technology in hospitals.
(© 2026. The Author(s).)
Competing Interests: Declarations. Competing Interests: The authors declare no competing interests. Ethics approval: An approval for the study was obtained from HUS. According to the Finnish National Board on Research Integrity TENK, ethical approval is not required for the present qualitative focus group study involving healthcare professionals [33]. This study was not a medical study that interfered with a patient’s physical or mental integrity, as defined by the Finnish Act on Medical Study (1999/488). The participants received a written statement about the study and provided written informed consent to participate before the focus group discussions. The research material was anonymized during data transcription and handled confidentially, so that only members of the research group who had signed the confidentiality and data protection agreement had access to it. Consent to participate: Written informed consent was obtained from all individual participants included in the study. Consent to publish: Not applicable.
References: Mueller BU, Neuspiel DR, Stucky Fisher ER, et al. Principles of pediatric patient safety: reducing harm due to medical care. Pediatrics. 2019;143:e20183649. https://doi.org/10.1542/peds.2018-3649 . (PMID: 10.1542/peds.2018-364930670581)
Conn RL, Kearney O, Tully MP, et al. What causes prescribing errors in children? Scoping review. BMJ Open. 2019;9:1–16. https://doi.org/10.1136/bmjopen-2018-028680 . (PMID: 10.1136/bmjopen-2018-028680)
The Joint Commission Sentinel Event Alert. Preventing pediatric medication errors. A complimentary publication of The Joint Commission. 2021;39:1–5. https://www.jointcommission.org/en/knowledge-library/newsletters/sentinel-event-alert/issue-39 . Accessed 9 Sept 2025.
World Health Organization. Medication Without Harm-Global Patient Safety Challenge on Medication Safety. Geneva: World Health Organization; 2017. https://www.who.int/publications/i/item/WHO-HIS-SDS-2017.6 . Accessed 9 Sept 2025.
Institute for Safe Medication Practices. Implement strategies to prevent persistent medication errors and hazards. ISMP featured articles. 2023;28:1–4. https://www.ismp.org/sites/default/files/newsletter-issues/20230323.pdf . Accessed 9 Sept 2025.
Hutton K, Ding Q, Wellman G. The effects of bar-coding technology on medication errors: a systematic literature review. J Patient Saf. 2021;17:e192-206. https://doi.org/10.1097/PTS.0000000000000366 . (PMID: 10.1097/PTS.000000000000036628234729)
Institute for Safe Medication Practices (ISMP). ISMP Targeted Medication Safety Best Practices for Hospitals 2024–2025. ISMP; 2024. https://www.ismp.org/guidelines/best-practices-hospitals . Accessed 9 Sept 2025.
Institute for Safe Medication Practices. ISMP Guidelines for Sterile Compounding and the Safe Use of Sterile Compounding Technology. ISMP; 2022. https://www.ismp.org/system/files/resources/2022-04/ISMP195-Compouding%20Guidelines%20v1-042722-2.pdf . Accessed 9 Sept 2025.
Kuitunen S, Airaksinen M, Holmström A-R. Evolution of intravenous medication errors and preventive systemic defenses in hospital settings—a narrative review of recent evidence. J Patient Saf [Internet]. 2024;20:e29-39. https://doi.org/10.1097/PTS.0000000000001222 . (PMID: 10.1097/PTS.000000000000122238536101)
Kuitunen SK, Niittynen I, Airaksinen M, et al. Systemic defenses to prevent intravenous medication errors in hospitals. J Patient Saf. 2021;17:e1669–80. https://doi.org/10.1097/pts.0000000000000688 . (PMID: 10.1097/pts.0000000000000688321759628612901)
Billstein-Leber M, Carrillo CJD, Cassano AT, et al. ASHP guidelines on preventing medication errors in hospitals. Am J Health Syst Pharm. 2018;75:1493–517. https://doi.org/10.2146/ajhp170811 . (PMID: 10.2146/ajhp17081130257844)
European Association of Hospital Pharmacists (EAHP). EAHP Position Paper on Patient Safety. 2025 Jun. https://eahp.eu/policy-hub/patient-safety/ . Accessed 10 Feb 2026.
Khammarnia M, Kassani A, Eslahi M. The efficacy of patients’ wristband bar-code on prevention of medical errors: a meta-analysis study. Appl Clin Inform. 2015;6:716–27. https://doi.org/10.4338/ACI-2015-06-R-0077 . (PMID: 10.4338/ACI-2015-06-R-0077267670664704040)
Zheng WY, Lichtner V, Van Dort BA, et al. The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: a systematic review. Res Social Adm Pharm. 2021;17:832–41. https://doi.org/10.1016/j.sapharm.2020.08.001 . (PMID: 10.1016/j.sapharm.2020.08.00132891535)
Shah K, Lo C, Babich M, et al. Bar code medication administration technology: a systematic review of impact on patient safety when used with computerized prescriber order entry and automated dispensing devices. Can J Hosp Pharm. 2016;69:394–402. https://doi.org/10.4212/cjhp.v69i5.1594 . (PMID: 10.4212/cjhp.v69i5.1594278261575085324)
Pruitt ZM, Kazi S, Weir C, et al. A systematic review of quantitative methods for evaluating electronic medication administration record and bar-coded medication administration usability. Appl Clin Inform. 2023;14:185–98. https://doi.org/10.1055/s-0043-1761435 . (PMID: 10.1055/s-0043-1761435368893399995218)
Kuitunen S, Laakkonen L, Janhunen K, et al. Facilitators and barriers associated with the use of barcode technologies in drug preparation and administration in hospital settings—a narrative review of qualitative studies. J Patient Saf. 2025;21:511–20. https://doi.org/10.1097/PTS.0000000000001381 . (PMID: 10.1097/PTS.00000000000013814060550212610909)
Morriss FH, Abramowitz PW, Nelson SP, et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. J Pediatr. 2009;154:363–8. https://doi.org/10.1016/j.jpeds.2008.08.025 . (PMID: 10.1016/j.jpeds.2008.08.02518823912)
Morriss FH, Abramowitz PW, Nelson SP. Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code-assisted medication administration system. Am J Health Syst Pharm. 2011;68:57–62. https://doi.org/10.2146/ajhp090561 . (PMID: 10.2146/ajhp09056121164067)
Eiland LS, Benner K, Gumpper KF, et al. ASHP–PPAG guidelines for providing pediatric pharmacy services in hospitals and health systems. Am J Health Syst Pharm. 2018;75:1151–65. https://doi.org/10.2146/ajhp170827 . (PMID: 10.2146/ajhp17082729555640)
Sutherland AB, Phipps DL, Grant S, et al. Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units. Ergonomics. 2025;68:444–58. https://doi.org/10.1080/00140139.2024.2333396 . (PMID: 10.1080/00140139.2024.233339638557363)
Grailey K, Hussain R, Wylleman E, et al. Understanding the facilitators and barriers to barcode medication administration by nursing staff using behavioural science frameworks. A mixed methods study. BMC Nurs. 2023;22:378. https://doi.org/10.1186/s12912-023-01382-x . (PMID: 10.1186/s12912-023-01382-x3782852010571469)
Williams R, Kantilal K, Man KKC, et al. Barcode medication administration system use and safety implications: a data-driven longitudinal study supported by clinical observation. BMJ Health Care Inform. 2025;32:e101214. https://doi.org/10.1136/bmjhci-2024-101214 . (PMID: 10.1136/bmjhci-2024-1012143983282511784319)
Giraldo L, Schachner B, Luna D, et al. Exploring nurses’ perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform. 2018. https://doi.org/10.3233/978-1-61499-872-3-134 . (PMID: 10.3233/978-1-61499-872-3-13429857405)
Berdot S, Boussadi A, Vilfaillot A, et al. Integration of a commercial barcode-assisted medication dispensing system in a teaching hospital. Appl Clin Inform. 2019;10:615–24. https://doi.org/10.1055/s-0039-1694749 . (PMID: 10.1055/s-0039-1694749314341616703993)
Williams R, Aldakhil R, Blandford A, et al. Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology? BMJ Open. 2021;11:e044419. https://doi.org/10.1136/bmjopen-2020-044419 . (PMID: 10.1136/bmjopen-2020-044419342107218252881)
Spetz J, Burgess JF, Phibbs CS. What determines successful implementation of inpatient information technology systems? Am J Manag Care. 2012;18:157–62. (PMID: 22435909)
Samaranayake NR, Cheung STD, Cheng K, et al. Implementing a bar-code assisted medication administration system: effects on the dispensing process and user perceptions. Int J Med Inform. 2014;83:450–8. https://doi.org/10.1016/j.ijmedinf.2014.03.001 . (PMID: 10.1016/j.ijmedinf.2014.03.00124717725)
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. https://doi.org/10.1093/intqhc/mzm042 . (PMID: 10.1093/intqhc/mzm04217872937)
Huston SA, Hobson EH. Using focus groups to inform pharmacy research. Res Social Adm Pharm. 2008;4:186–205. https://doi.org/10.1016/j.sapharm.2007.09.001 . (PMID: 10.1016/j.sapharm.2007.09.00118794031)
Amin MEK, Nørgaard LS, Cavaco AM, et al. Establishing trustworthiness and authenticity in qualitative pharmacy research. Res Social Adm Pharm. 2020;16:1472–82. https://doi.org/10.1016/j.sapharm.2020.02.005 . (PMID: 10.1016/j.sapharm.2020.02.00532067887)
Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62:107–15. https://doi.org/10.1111/j.1365-2648.2007.04569.x . (PMID: 10.1111/j.1365-2648.2007.04569.x18352969)
Finnish National Board of Research Integrity (TENK). The Ethical Principles of Research with Human Participants and Ethical Review in the Human Sciences in Finland Finnish National Board on Research Integrity TENK Guidelines 2019. TENK; 2019. https://tenk.fi/sites/default/files/2021-01/Ethical_review_in_human_sciences_2020.pdf . Accessed 9 Sept 2025.
Carayon P, Wetterneck TB, Hundt A, et al. Evaluation of nurse interaction with bar code medication administration technology in the work environment. J Patient Saf. 2007;3:34–42. (PMID: 10.1097/PTS.0b013e3180319de7)
Hurley AC, Bane A, Fotakis S, et al. Nurses’ satisfaction with medication administration point-of-care technology. J Nurs Adm. 2007;37:343–9. (PMID: 10.1097/01.NNA.0000285114.60689.0217939465)
Hong JY, Ivory CH, Vanhouten CB, et al. Disappearing expertise in clinical automation: barcode medication administration and nurse autonomy. J Am Med Inform Assoc. 2021;28:232–8. https://doi.org/10.1093/jamia/ocaa135 . (PMID: 10.1093/jamia/ocaa135329096107883990)
Boonen M, Vosman F, Niemeijer A. Tinker, tailor, deliberate. an ethnographic inquiry into the institutionalized practice of bar-coded medication administration technology by nurses. Appl Nurs Res. 2017;33:30–5. https://doi.org/10.1016/j.apnr.2016.10.007 . (PMID: 10.1016/j.apnr.2016.10.00728096019)
Boonen M, Rankin J, Vosman F, et al. Nurses’ knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: discovering nurses’ agency inside ruling. Health (London). 2020;24:279–98. https://doi.org/10.1177/1363459318800155 . (PMID: 10.1177/136345931880015530230356)
Koppel R, Wetterneck T, Telles JL, et al. Workarounds to Barcode Medication Administration Systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc. 2008;15:408–23. https://doi.org/10.1197/jamia.M2616 . (PMID: 10.1197/jamia.M2616184369032442264)
Hänninen K, Ahtiainen HK, Suvikas-Peltonen EM, et al. Automated unit dose dispensing systems producing individually packaged and labelled drugs for inpatients: a systematic review. Eur J Hosp Pharm. 2023;30(3):127–35. https://doi.org/10.1136/ejhpharm-2021-003002 . (PMID: 10.1136/ejhpharm-2021-00300234795001)
National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP). Recommendations for Bar Code Labels on Pharmaceutical (Drug) Products to Reduce Medication Errors NCCMERP; 2007. www.nccmerp.org/recommendations-bar-code-labels-pharmaceutical-drug-products-reduce-medication-errors . Accessed 9 Sept 2025.
ECRI. Top 10 Patient Safety Concerns 2024. ECRI; 2024. https://home.ecri.org/blogs/ecri-thought-leadership-resources/top-10-patient-safety-concerns-2024 . Accessed 9 Sept 2025.
Kuitunen S, Saksa M, Holmström AR. Medication errors and error chains involving high-alert medications in a paediatric hospital setting: a qualitative analysis of self-reported medication safety incidents. Drugs Real World Outcomes. 2025;12(1):45–61. https://doi.org/10.1007/s40801-024-00469-4 . (PMID: 10.1007/s40801-024-00469-439661246)
Kuitunen S, Niittynen I, Airaksinen M, et al. Systemic causes of in-hospital intravenous medication errors. J Patient Saf. 2021;17:e1160-1168. https://doi.org/10.1097/pts.0000000000000632 . (PMID: 10.1097/pts.0000000000000632)
Stavroudis TA, Shore AD, Morlock L, et al. NICU medication errors: Identifying a risk profile for medication errors in the neonatal intensive care unit. J Perinatol. 2010;30:459–68. https://doi.org/10.1038/jp.2009.186 . (PMID: 10.1038/jp.2009.18620043010)
Grissinger M. Medication errors affecting pediatric patients: unique challenges for this special population. Pa Patient Saf Advis. 2015;12:96–102.
Rough S, Shane R, Armitstead JA, et al. The high-value pharmacy enterprise framework: advancing pharmacy practice in health systems through a consensus-based, strategic approach. Am J Health Syst Pharm. 2021;78:498–510. https://doi.org/10.1093/ajhp/zxaa431 . (PMID: 10.1093/ajhp/zxaa43133539506)
Ruutiainen H, Holmström AR, Kunnola E, et al. Use of computerized physician order entry with clinical decision support to prevent dose errors in pediatric medication orders: a systematic review. Pediatr Drugs. 2024;26:127–43. https://doi.org/10.1007/s40272-023-00614-6 . (PMID: 10.1007/s40272-023-00614-6)
Kuitunen S, Kärkkäinen K, Linden-Lahti C, et al. Dose error reduction software in medication safety risk management—optimising the smart infusion pump dosing limits in neonatal intensive care unit prior to implementation. BMC Pediatr. 2022;22:118. https://doi.org/10.1186/s12887-022-03183-8 . (PMID: 10.1186/s12887-022-03183-8352558468902762)
Häkkinen A, Viitanen J, Savolainen K, et al. Closing the loop for controlled substances surveillance: a field study of the usability and user experience of an integrated electronic narcotic consumption. In: Digital health and wireless solutions. NCDHWS 2024. Communications in computer and information science. Vol 2083. Springer, Cham; 2024:93–109. https://doi.org/10.1007/978-3-031-59080-1_7.
Cozzoli N, Salvatore FP, Faccilongo N et al. How can big data analytics be used for healthcare organization management? Literary framework and future research from a systematic review. BMC Health Serv Res. 2022;22:809. https://doi.org/10.1186/s12913-022-08167-z . (PMID: 10.1186/s12913-022-08167-z357331929213639)
Contributed Indexing: Keywords: Barcode medication administration; Barcode technology; Focus group study; Medication safety; Pediatrics; Qualitative content analysis
Entry Date(s): Date Created: 20260402 Date Completed: 20260714 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13369583
DOI: 10.1007/s11096-026-02132-0
PMID: 41925998
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:2210-7711
DOI:10.1007/s11096-026-02132-0