Recent 2026 guidance from the Institute for Safe Medication Practices (ISMP) addresses barcode use across several medication-safety practices. The ISMP recommends barcode verification before every medication and vaccine administration, including settings where it is often underused. These areas include emergency departments, perioperative areas, infusion clinics, dialysis centers, radiology, labor and delivery, cardiac catheterization laboratories, and other outpatient locations. ISMP supports this recommendation with reports of wrong-drug, wrong-dose, and wrong-patient errors, particularly involving products with similar names, doses, packaging, label graphics, or cap colors. Because barcode medication administration can detect these errors at the point of administration, limiting its use to inpatient units leaves important safety gaps. Organizations should regularly evaluate scanning compliance, bypassed alerts, and acknowledged alerts to determine whether the technology is being used consistently and effectively. [1]
The document also provides more specific recommendations for pharmacy operations. Pharmacy should test the barcodes of all newly received products before they reach clinical users so unreadable, absent, duplicate, or incorrectly configured barcodes can be identified before they interrupt patient care. Pharmacy should also review the number, type, and placement of barcodes on product labels and overwraps because multiple possible scan points can cause confusion, scanning of the wrong barcode, or inadvertent bypass of alerts. For commercially available premixed products, ISMP recommends omitting pharmacy-generated barcodes from pharmacy-applied labels so clinicians are required to scan the barcode on the actual product. [1]
For compounded sterile preparations, the document introduces an important exception to the preference for scanning the manufacturer’s barcode. When a pharmacy compounds a patient-specific sterile preparation using a commercially manufactured diluent bag, the manufacturer’s barcode may identify only the original diluent rather than the medication that was added. When possible, the pharmacy label should therefore cover the manufacturer’s barcode and direct the clinician to scan the barcode on the patient-specific compounded-product label. This helps prevent the diluent bag from being incorrectly verified as the finished preparation. Similarly, 503B outsourcing facilities should position barcodes so end users are clearly directed to scan the barcode representing the actual compounded preparation. Thus, the guiding principle is to scan the barcode that accurately identifies the finished product being administered, which may be either the manufacturer’s barcode or a pharmacy-generated patient-specific barcode, depending on the product. [1]
The guidance also expands the recommendations concerning proxy scanning and patient identification. Like the earlier article, the document calls for a formal escalation process when a barcode cannot be scanned and emphasizes eliminating proxy scans. However, it extends this concept to patient identification by recommending that organizations limit and monitor reprinting of patient identification bands, prevent the use of reprinted bands as proxy scan sources, and determine whether the system can restrict scanning to the patient’s actual wristband rather than barcodes on labels, paperwork, or other patient-specific materials. Medication barcodes should likewise never be scanned from saved packaging or empty infusion bags. Organizations should examine and correct the workflows that encourage these practices rather than treating them solely as individual noncompliance. [1]
Finally, the document provides additional recommendations regarding technology reliability and performance monitoring. Information technology teams should proactively identify and resolve connectivity problems, slow system responses, and other failures that prevent barcode medication administration software from functioning as intended. Technology vendors should optimize the language and sounds associated with barcode alerts, and organizations should educate users about what each alert means to reduce incorrect overrides and alert fatigue. Automated dispensing cabinet vendors should also provide an option to require scanning of each individual dose during stocking or restocking. Organizations should routinely analyze scanning adherence, bypass frequency, alerts generated and acknowledged, and other performance measures. These data can identify technical failures and unsafe workarounds, guide targeted interventions, reinforce accountability, and determine whether barcode-safety strategies remain effective over time. [1]
Earlier ISMP guidance similarly emphasizes that barcode medication administration (BCMA) systems can reduce medication-administration errors, but their effectiveness depends on correct use and a clearly defined escalation process when scanning fails. Unsafe workarounds include administering a medication despite an unsuccessful scan, scanning after administration, or proxy scanning a barcode from a different source, such as an empty hanging bag, a separately supplied label, or another product. These practices may reflect poorly configured technology, workflow barriers, inadequate staff education, or insufficient understanding of the risks. Additional guidance from the ISMP recommends that medication-safety committees investigate the practices and system conditions that promote workarounds and modify workflows, technology configurations, and training accordingly. [2]
Pharmacy should test new product barcodes before distribution, and practitioners should preferentially scan the manufacturer’s barcode printed directly on the medication container because this verifies the actual product in hand. If a barcode fails, the practitioner should stop and compare the product with the medication administration record to confirm the correct patient, medication, and administration time and determine whether the order has been changed or discontinued. A pharmacist should then visually inspect the medication and verify that it matches the order; sending a replacement label alone is not considered safe, and pharmacy labels should be applied only by pharmacy personnel to pharmacy-prepared products. Organizations should establish a formal escalation procedure that specifies when and how barcode problems are reported, who evaluates and monitors them, and why proxy scanning is prohibited. [2]
Although published in 2004, guidance from the Veterans Health Administration continues to provide relevant and practical recommendations. The guidance describes BCMA as an interdisciplinary safety system that requires continuous evaluation and improvement, rather than simply the installation of scanning technology. Hospitals should establish a standing committee involving nursing, pharmacy, information technology, and biomedical personnel; obtain regular feedback from frontline staff; train all medication-administration personnel; cross-train pharmacists on nursing BCMA functions; and maintain accessible resources that communicate known problems and direct staff to the appropriate troubleshooting contact. [3]
Paper and electronic medication-administration records should not be maintained in parallel beyond a brief transition because duplicate systems can cause missed doses, duplicate doses, and documentation gaps. Planned downtimes should occur during low-volume periods using defined contingency procedures. Hospitals should also maintain readily available replacement scanners, computers, batteries, and related equipment and establish monitored procedures for routinely cleaning BCMA equipment. [3]
At administration, the nurse should scan the patient’s wristband and the medication immediately before giving the dose to help verify the patient, drug, dose, route, and time. Discrepancies should be resolved before administration, with pharmacy notified of missing or incorrect medication barcodes. The person administering the medication should personally document it at the time of administration. Allergy information displayed in BCMA should be confirmed via another source, as electronic allergy information may be inaccurate or overlooked. [3]
Printed medication-overview worksheets may support shift planning but should not be used to administer or document medications because they can quickly become outdated; the electronic record should therefore be refreshed regularly. Nurses should review missed-medication reports once per shift through a nonpunitive process, and organizations should actively notify nurses of new urgent orders rather than relying on repeated manual record checks. Worn, missing, or inaccurate wristbands should be replaced promptly, with periodic replacement considered in long-term care and wristband printers made readily available on patient-care units. [3]
These recommendations were informed by Veterans Health Administration observations, simulations, surveys, and stakeholder interviews. However, the recommendations were not directly evaluated for their effects on patient outcomes and may require adaptation to different hospitals and newer BCMA systems. [3]