Question: Overcoming Resistance to a Needed Change

You are the charge nurse of a medical/surgical unit. Recently, your hospital spent millions of dollars to implement bar-coded medication administration (BCMA) to reduce medication errors and to promote a culture of patient safety. In this system, the nurse, using a handheld device, scans the drug he or she is planning to give against the patient's medication record to make sure that the right drug, at the right dose, is being given at the right time to the right patient. The nurse then scans the patient's name band/arm band to assure the right patient is receiving the drug and finally scans his or her own name badge to document who is administering the drug to the patient. If any of the codes do not match, a signal goes off, alerting the nurse of the discrepancy. It has come to your attention, however, that some nurses are overriding the safety features built into the bar-coding system. For example, some nurses are reluctant to wake sleeping patients to scan their bar code before they administer an IV push medication, and instead simply scan the chart label. Some nurses have overridden the bar-code warning, assuming it was some kind of technological glitch. Some nurses have administered drugs to patients despite having name bands that have become smudged or torn and no longer scan well. Still other nurses are carrying multiple prescanned pills on one tray or charting that drugs have been given, even though they were left at the bedside. Finally, you learned that one nurse even affixed extra copies of her patient's bar codes to her clipboard, so that they could be scanned more quickly.

ASSIGNMENT: Despite thorough orientation and training regarding bar coding, it is clear that some staff have developed "work arounds" to the bar-coding system, increasing the risk of medication errors and patient harm. Your staff suggest that while they understand BCMA reduces risks to patients, that the equipment does not always work and that performing the additional safety checks inherent in BCMA often takes them more time than how they did it in the past, ultimately delaying medications to patients who need them. The staff states they will try to be more careful in implementing the BCMA procedures, but you continue to sense resistance on their part. What strategies could you employ now to foster refreezing of the new BCMA system? Would rational-empirical, power-coercive, or normative-reeducative strategies be more effective? Provide a rationale for your choice.