Six Months After Go-Live: Evaluating Bar-Code Scanning of Expressed Breast Milk on a Mother-Baby Unit With the DeLone and McLean Success Model
[Student Name]
University of Phoenix
HSN/376: Health Information Technology for Nursing
Week 4 Assignment
[Instructor Name]
[Date]
The mother-baby unit, its system and its data are a composite written for a model paper.
Hospitals spend heavily on choosing and installing information systems and much less on finding out whether they work. Six months ago, the mother-baby unit at my hospital began scanning bar codes on containers of expressed breast milk before each feeding, matching the milk to the infant's wristband and checking the expiration time. This paper evaluates that system using a published model of information system success, so that the conclusions rest on defined measures rather than on how the staff feel about it.
Why the System Was Installed
Breast milk given to the wrong infant is a real risk on units where many mothers store milk in the same refrigerator, and it is treated as an exposure to another person's body fluid, with testing and disclosure to both families. Expired milk carries a risk of bacterial growth. Steele and Bixby (2014) reported that after a children's hospital centralized milk handling and introduced bar-code scanning, reported milk administration errors fell to zero, and in the first six months scanning prevented 55 attempts to feed the wrong milk to an infant and 127 attempts to feed expired milk. Before scanning, those near misses would not have been visible at all.
The Evaluation Model
DeLone and McLean (2003) proposed six related dimensions for judging whether an information system succeeds: how well the system itself works, the quality of the information it produces, the quality of the support behind it, the extent of its use, the satisfaction of the people who work with it, and what it finally gains for patients and staff. This framework is useful because it separates whether a system works technically from whether people use it and whether it improves anything, and a system can succeed on one dimension and fail on another.
Applying the Model
System quality. Measure: scanner uptime and scan success rate. Result: the system was available 99.6% of the time, but 8% of scans failed on the first attempt, almost all because labels printed on the unit's older printer smudged when containers were cold and damp.
Information quality. Measure: accuracy and completeness of the milk record, checked by auditing 50 containers against the record. Result: 47 of 50 were accurate. The three errors were expiration times entered from the time of labeling instead of the time of expression.
Service quality. Measure: time to resolve scanner and printer problems reported to the help desk. Result: median resolution time was 26 hours, during which nurses used a manual double check.
Use. Measure: percentage of breast milk feedings with a documented scan, taken from system reports. Result: 91% overall, with a clear drop on night shift, 84%, when staffing is lowest.
User satisfaction. Measure: a short survey of 38 nurses. Result: 79% agreed that scanning makes milk feeding safer, but 61% said the failed scans slowed them down during feeds, and several described scanning the label after the feed was given.
Net benefits. Measure: prevented errors recorded by the system and reported milk errors. Result: the system blocked 14 wrong-milk attempts and 31 expired-milk attempts in six months, and no wrong-milk feedings were reported, compared with three in the year before go-live.
What the Evaluation Uncovered
The net benefits are clear, and they match the published results. The evaluation's most important finding, however, was a workaround: some nurses scanned after the feed rather than before it, which records a scan while removing the protection the scan exists to provide. The model helps explain why. Poor system quality, smudged labels and failed scans, and slow service quality created delays at the bedside, and on night shift, with fewer staff, nurses protected their time by moving the scan to after the feed. The use measure, a documented scan, could not show the difference, because the record showed a scan in both cases. This is a known weakness of measuring use by counting system events. Koppel et al. (2008) studied bar-code medication administration at five hospitals and identified 15 types of workarounds, such as scanning copies of patient wristbands attached to carts or doorframes, and 31 types of causes, many of them technical, including smudged, torn or unreadable labels and malfunctioning scanners. The breast milk workaround on my unit fits their pattern exactly: a technical problem made the safe path slower than the unsafe one, and busy nurses chose the faster path while still producing a record that looked compliant.
Recommendations
1. Replace the unit's label printer with one that prints freezer-grade labels, the single change most likely to improve system quality, reduce failed scans and remove the reason for the workaround.
2. Correct the expiration time entry by having the system calculate expiration from a required time-of-expression field.
3. Ask the help desk to treat scanner and printer failures on this unit as urgent, with a four-hour target.
4. Measure use differently: compare the scan time with the feeding time documented in the flowsheet, so that scans after the feed can be counted.
5. Share the prevented-error numbers with staff monthly, since seeing blocked errors is a strong reason to keep scanning before the feed.
Limits of This Evaluation
This evaluation has limits that the unit should keep in mind. The before-and-after comparison of reported errors depends on voluntary reports, and wrong-milk feedings before go-live may have been underreported, which would make the improvement look smaller than it is, or overreported after a highly publicized event, which would make it look larger. The satisfaction survey reached 38 of about 55 nurses, and those who answered may not represent those who did not. The audit of 50 containers is small. None of these limits changes the main findings, but each argues for repeating the measures rather than treating one evaluation as final.
Next Evaluation
The unit will repeat the evaluation at twelve months, using the same measures, so that the effect of each recommendation can be seen.
Conclusion
Six months after go-live, bar-code scanning of breast milk has prevented errors and eliminated reported wrong-milk feedings. The DeLone and McLean model showed that its success is incomplete, because technical problems produced a workaround that the usual use measure could not see. Evaluation after implementation is how a unit finds problems like this before they cause harm. Week 5 will bring the course together around technology and patient safety.
References
DeLone, W. H., & McLean, E. R. (2003). The DeLone and McLean model of information systems success: A ten-year update. Journal of Management Information Systems, 19(4), 9-30. https://doi.org/10.1080/07421222.2003.11045748
Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616
Steele, C., & Bixby, C. (2014). Centralized breastmilk handling and bar code scanning improve safety and reduce breastmilk administration errors. Breastfeeding Medicine, 9(9), 426-429. https://doi.org/10.1089/bfm.2014.0077
How this HSN 376 Week 4 example is structured
The HSN/376 description names the evaluation of information systems as a core topic. This paper evaluates one real kind of system with a published evaluation model rather than with impressions. It sets the model out briefly, applies each dimension with a defined measure and a result, reports a problem the evaluation uncovered and closes with recommendations and the next evaluation date. Students search this week as HSN 376 Week 4, HSN376 Wk 4 or HSN/376 Wk 4; all three are the same assignment.
HSN/376 Week 4 questions, answered
What does HSN/376 Week 4 usually ask for?
The course description lists the evaluation of information systems. Many sections ask students to evaluate a system used in their setting after implementation, with criteria, measures and recommendations.
What is the DeLone and McLean model?
A widely used model of information system success with six dimensions: system quality, information quality, service quality, use and intention to use, user satisfaction and net benefits.
Why scan expressed breast milk?
Feeding one infant another mother's milk can expose the infant to infections and medications, and it is a serious error. Scanning matches the milk to the infant and catches expired milk before it is fed.
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