Barcode scanning was more accurate than drop-down menus, and is faster for recording vaccine data compared to typing vaccine lot numbers. By thoroughly testing barcode scanning in live settings, we gained a better understanding of the complexities of its integration into existing workflows. Adopting new technologies in healthcare settings has often introduced risks such as increased user workload, communication breakdowns, and fragmentation of information  and . Tyrosine Kinase Inhibitor Library In both case studies, our readability data indicate that users may expect immediate success with
scanning. Some nurses switched from barcode scanning to the manual method when vial barcodes were not read promptly (i.e., within 2 s). Therefore, more work is needed to ensure optimal barcode readability. It is important to choose a scanner that is both affordable for public health agencies and sufficiently sensitive to read the small barcodes. GS1 Canada has developed a scanning guide to aid new adopters in this decision . Adequate training must be provided to ensure comfort with scanning and the optimal technique, and users must have sufficient technical support. Our interviews indicated
that users were very satisfied with the training sessions, and that the combination of one-on-one instruction, practice time with dummy vials, and an on-site barcode scanning expert check details is an ideal training model. Finally, vaccine manufacturers must ensure that their production lines are printing barcodes at an adequate darkness for scanning. Study participants reported that the smaller unit dose vials were most problematic; although the barcodes are the same size as those on multi-dose influenza vials, the smaller size of the actual vial leads to greater curvature of the barcode, which may explain the scanning difficulties. These types of challenges have been previously identified in studies evaluating the use of barcode scanning technology for medication administration
in hospitals and healthcare institutions in North America. While scanning has been found to effectively reduce the isothipendyl rate of human errors associated with dispensing, transcribing and administering medications ,  and , it has also been problematic to users for reasons including troublesome scanners, barcode not being readable (smudged, torn, etc.), and inadequate training . Our interviews with immunization staff also demonstrated that users anticipate that this technology will improve record quality and efficiency. The workflow used in this evaluation (scanning after vaccine administration) was chosen because of the nursing practice of recording vaccine information into immunization records following vaccination rather than before, in case the vaccine does not end up being administered.