MJ Brownlee
PharmD
Senior Pharmacy Practice Management Resident
Kansas University Medical Centre
A Dhingra
PharmD
Director of Pharmacy
Central Washington Hospital, Wenatchee, Washington, USA
HN Godwin
MS FASHP
Director of Pharmacy and Professor
Kansas University Medical Centre
Kansas City
Kansas, USA
The increasing focus on medication errors in professional literature and public media has fuelled advances towards automated medication ordering, dispensing, delivery and administration systems. This article provides the hospital pharmacy practitioner with a general background to barcode scanning technology, which can aid in the reduction of medication administration errors in the hospital setting.
Medication errors: costs and causes
The 1999 Institute of Medicine (IOM) Report, a US Government-sponsored report on medical errors, significantly changed the way the US healthcare systems view and focus on medical errors. In this report, medical errors were estimated to cause the deaths of 44,000– 98,000 patients per year. Of those deaths, 7,000 have been tied specifically to medication errors.(1) In a recent study of 36 US hospitals, medication administration errors were shown to occur in 14.5% of doses given.(2) The impact of medication errors is evident; in some cases they are estimated to increase patient care costs by upwards of US$3,000 per error.(3)
Medication administration errors can occur for a number of reasons, including excessive workload, noncurrent or inaccurate patient information, documentation errors and miscommunication.(4)
Automated administration systems
Automated patient safety systems have been shown to decrease medication administration error rates by impacting on the processes linked to inaccuracy and high variability. Currently, fewer than 6% of US hospitals utilise technology such as barcoding or prescriber order entry (POE).(5) Barcode scanning technology can be linked to a reduction in medication administration errors by ensuring the “five rights” of medication administration: right patient, right dose, right route, right drug and right time. It is essential that each of the “rights” be verified before medication administration to ensure that the patient receives their medications safely.
The technology involved with automated medication administration can be overwhelming and complex to the common end-user. In simple terms, the main components are the pharmacy computer system, scanning devices (handheld or laptop), a secure radio-frequency (RF) network (like the radio in your car), barcode writing software, printers and other supportive technologies. RF communications between the handheld and pharmacy computer system allow for real-time medication information transmission. Once an order is received in the pharmacy and entered into the pharmacy computer system, it is immediately available on the handheld for the nurse to view patient information and administer medications. This provides the nurse with an order that has been verified and appropriately scheduled by a pharmacist.
The medication administration process begins when the nurse scans his or her personalised barcode to log on to the system. The nurse can then select which patient to administer medications to by scanning the barcode on the patient’s wristband or by selecting the patient from the handheld device touchscreen.
The patient profile provides the nurse with detailed medication information about the patient, including dosing time, route, dose, frequency and special instructions from the pharmacist. The nurse can utilise this information to administer medications to the patient and/or print reports, including the medication administration record (MAR) once the medication is administered.
The handheld device serves as an electronic MAR that informs the nurse which medications are due, pending, as needed or discontinued. When ready to administer a medication, the nurse simply scans their identification badge (barcode), the barcodes of medications to be administered, and then the patient’s wristband barcode. After scanning the patient’s wristband, the nurse administers the medications to the patient and then records on the handheld that the doses have been given. The handheld device also alerts the nurse to any problems that may arise in the medication administration process, such as wrong patient, wrong drug, wrong time, wrong route or wrong dose. The process of barcode scanning in this order allows the system to prevent errors by ensuring the “five rights” of medication administration mentioned above.
When and how to implement the technology
Successful implementation of barcode scanning technology can be quite laborious and multifaceted. It is best to perform implementation on patient care pilot units before going hospitalwide with barcode scanning technology.
The beginning step to the process should be identification of a medication administration error issue and how it can be solved through the use of an automation tool. An example of this would be to ensure the “five rights” of medication administration, increase medication administration documentation and decrease the number of medication errors. It may be decided that the implementation of barcode scanning technology can aid in the resolution of the problem. Once a solution to the problem is established, a good plan must be devised that gives consideration to vendor selection, contract negotiations, funding/cost, training, troubleshooting and staffing.
In addition to proper planning, the actual barcoding of the medications presents a definite hurdle to implementation, as most manufacturers do not currently barcode medications with a standard barcode. Technologies are available to aid in the barcoding of medications, but they come at a high cost and consume labour resources. Quite possibly the most critical component to the implementation of barcode scanning technology is staff buy-in. If your nurses and physicians are not convinced that it is going to work, implementation will not be worth trying, as there will always be complexities that arise. However, a strong foundation of planning will alleviate many problems with the implementation of barcode scanning technology.
It is easy to see how a technology such as barcode scanning can improve patient safety by decreasing medication administration errors. However, before implementation of barcode scanning technology a hospital must take a critical look at what their goals and expectations are from such a project. With proper planning and hospital staff support, it is our belief that barcode scanning technology should be pursued by hospitals, health systems and hospital pharmacies internationally to ensure accuracy of medication administration and to reduce the prevalence of medication administration errors.
References
- Kohn L, Corrigan J, Donaldson M. To err is human – building a safer health system. Washington, IOM: National Academy Press; 1999.
- Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med 2002;162:1897-903.
- Bates DW, Spell N, Cullen DJ, et al. The cost of adverse drug events in hospitalized patients. JAMA 1997;277:307-11.
- Leape LL. Error in medicine. JAMA 1994;272:23:1851-7.
- Computerized physician order entry, lessons from pioneering institutions. Washington DC: The Advisory Board Company; 2001.
Resources
Institute of Medicine
W:www4.national
academies.org/iom/iomhome.nsf
Institute for Safe Medication Practices
W:www.ismp.org
American Society of Health-System Pharmacists
W:www.ashp.org
The Advisory Board
US company that publishes studies and more than 3,000 customised research briefs each year on progressive management and clinical practices in healthcare
W:www.advisoryboardcompany.com
McKesson Automated Health
W:www.mckesson.com
Pyxis
A Cardinal Health company
W:www.pyxis.com
Bridge Medical
A patient safety company
W:www.bridgemedical.com
