Barcode medication administration work-arounds: a systematic review and implications for nurse executives
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Updated: May 7, 2026

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Published on: June 11, 2012
Barbara Voshall1, Ronald Piscotty, Jeanette Lawrence
1Author Affiliations: Professor of Nursing (Dr Voshall), Graceland University, Independence, Missouri; Assistant Professor (Dr Piscotty), College of Nursing, Wayne State University, Detroit, Michigan; Certified Registered Nurse Anesthetist, (Dr Lawrence), Presbyterian Orthopedic Hospital, Charlotte, North Carolina; Pediatric Nurse Practitioner (Dr Targosz), Troy, Michigan.
Abstract:
Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety.
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