Barcode Medication Administration (BCMA): How It Works, Common Workarounds and How Nurses Use It Safely

Barcode medication administration (BCMA) is one of the most effective technologies for preventing medication errors at the bedside. By scanning the patient’s wristband and each medicine before giving it, nurses can catch the wrong patient, wrong drug, wrong dose and wrong time before harm occurs. Yet studies across many hospitals have found frequent workarounds, such as scanning copies of wristbands or overriding alerts, that quietly remove that protection.

This guide explains how BCMA works, the errors it prevents, why workarounds happen, and practical ways nurses and organisations can make scanning safe and realistic.

How BCMA works

1. The prescriber orders the medicine electronically.
2. The pharmacist verifies it, and it appears on the electronic medication administration record (eMAR).
3. At the bedside, the nurse scans the patient’s wristband.
4. The nurse scans each medicine’s barcode.
5. The system checks the “rights”: right patient, drug, dose, route and time, and alerts if something does not match.
6. The nurse gives the medicine and documents it, often automatically.

Errors BCMA can catch

• Wrong patient (two patients with similar names).
• Wrong medicine (look-alike, sound-alike drugs).
• Wrong dose or strength.
• Medicine already given (duplicate doses).
• Medicine discontinued or not yet verified.
• Allergy conflicts.
• Wrong time (too early or late).

Common workarounds

Why nurses use workarounds

Workarounds are rarely laziness. They usually point to system problems:

• wristbands that are missing, damaged or unreadable;
• medicines without barcodes, or barcodes that do not scan;
• scanners with dead batteries or poor connectivity;
• too many irrelevant alerts;
• heavy workloads and time pressure during busy medicine rounds;
• emergencies where scanning genuinely is not possible.

Each workaround is a signal. Reporting it helps fix the cause.

Safe scanning: a nurse’s checklist

1. Scan at the bedside, every patient, every time.
2. Check the wristband is on the patient and readable; replace it if not.
3. Scan every medicine, not just one from a group.
4. Read every alert. If you override, document why.
5. Still do your own checks: allergies, indications, observations (for example, BP before antihypertensives, glucose before insulin).
6. Ask the patient to confirm their name and date of birth when possible.
7. Give the medicine right after scanning, then confirm administration.
8. Report hardware, labelling and alert problems.

What organisations should do

• Provide enough working scanners and charged batteries.
• Ensure pharmacy repackages unlabelled medicines with barcodes.
• Print durable wristbands and replace damaged ones quickly.
• Review override data and reduce low-value alerts.
• Monitor scanning compliance in a just culture, not to blame individuals.
• Involve frontline nurses in solving the root causes of workarounds.

BCMA in settings without electronic systems

Many hospitals worldwide still use paper medication charts. The principles of BCMA still apply: positive patient identification, checking each medicine against the chart, double checks for high-alert medicines, and giving medicines immediately after preparation. Our guide to high-alert medications explains where extra checks matter most.

Frequently asked questions

What does BCMA stand for?

Barcode medication administration: scanning the patient and each medicine before giving it.

Does BCMA eliminate medication errors?

No, but it greatly reduces several types of error when used properly. Workarounds remove much of its protection.

What should I do if a wristband will not scan?

Replace the wristband, then scan. Do not use copies kept away from the patient.

Is overriding an alert ever acceptable?

Sometimes, when you have checked and the alert does not apply. Document your reason.

But what if scanning slows down the medicine round?

Then the round, the equipment or the alerts need fixing, not the safety check. Report what slows you down. Safe scanning is faster than investigating a serious medication error.

Related: Medication safety guide · High-alert medications · Medication round interruptions

Sources: Institute for Safe Medication Practices guidance on BCMA; published studies on BCMA workarounds; WHO Medication Without Harm global patient safety challenge. Follow your organisation’s medicines policy.