NHS Purchasing and Supply Agency
Barcodes are the linear markings we see on our newspapers and shopping items from the supermarkets, which are “scanned” by machine at the checkout. The use of global GS1 standard barcodes in the day-to-day supply of medicines to patients could radically improve patient outcomes.
Barcodes themselves are nothing more than a key to open a database of information about the product. The barcode is a representation of the GS1 standard, an open global standard of identification which provides information about the products. It is known as the auto-identification and data carrier (AIDC) system of coding. This open global standard is in use in 103 countries around the globe including the USA, Japan and EU countries.
The use of international standards for product identification, barcoding and electronic communications has the potential to improve significantly the accuracy and speed of response of healthcare services. A more efficient and accurate healthcare supply chain will reduce errors at every point, reduce cost and enable healthcare professionals to provide even higher quality of care for patients. This important point is the key deliverable for adopting this technology, to facilitate a reduction in errors associated with patient care, thus improving patient safety.
All babies born in the UK since 2003 have been issued with a unique NHS number. The NHS Numbers For Babies (NN4B) service was launched at midnight on 29 October 2002 (see Resources). Implementation of NN4B means that babies now have an NHS number from birth, and for life. This makes the process of building a true lifelong electronic health record possible. This number can be displayed as a barcode on the wristband. As these babies grow up and make use of the NHS, they will be identified by this NHS number.
This number is at the heart of the NHS Care Records Service (NHS CRS). It enables disparate information to be collated around a single, unique identifier to build a comprehensive record of a person’s health as set out in Information for Health (see Resources).
Through the use of these two machine-readable codes – the NHS number within the NHS Care Record Service, together with the barcode shown on the medicine – a closed-loop system could be demonstrated. It checks the patient’s NHS number on their wristband, identifies the patient and opens their electronic care record. The medical history of the patient can then be interrogated to check whether the patient has the condition for which the product is licensed treatment. This is mediated using the NHS Dictionary of Medicines and Devices, which is a critical tool underpinning the electronic care record. If this is all in order then authorisation is given for the medicine to be administered; if not, then an alert is generated by the system which highlights that other information is required before the medicine is authorised. These alerts are shown in many different ways determined by the system supplier. This could be applied in both the primary and secondary care setting.
Barcode technology is not expensive, is economical to purchase and cost is not a barrier to use. However, there are limitations to its use, as there needs to be “line-of-sight” of the barcode for the barcode scanner to be able to read the code presented as a linear barcode. The resolution of the printing, together with erased, damaged or warped printing of the barcode, can all present problems in reading barcodes.
Barcodes facilitate machine-readable data input. Compared with manual data entry methods, which possess an error rate of one in every 300 characters entered, barcoding is virtually error-free, with less than one error per one million characters entered. Errors in medication administration are linked to the following statistics:
- 10.8% of patients on medical wards experience an adverse effect.
- One-third of the adverse effects lead to greater morbidity or death.
- Medication errors alone cost the NHS about £500 million a year in additional days spent in hospital.
- Adverse events cost the service an estimated £2 billion a year in additional hospital stays alone.
- 12% of adverse events were related to medicine use.(1)
In the pharmaceutical sector, it has been suggested that around 90% of products entering a wholesaler warehouse contain GS1 barcodes.
Where are these barcodes used?
- Pharmaceutical manufacturers and distributors use the barcodes internally within their warehouses for logistics, “track and trace” and for eTrading including advanced shipping notices for customers.
- Pharmaceutical wholesalers use barcodes for booking in goods received, if they cannot use advanced shipping notes, and to identify and pick stock for orders. Some wholesalers check each and every item against the order, prior to dispatch.
- Primary care pharmacies use the barcode in the Electronic Prescription Service to identify the prescription assigned to the patient. The Electronic Prescription Service is part of NHS Connecting for Health’s Electronic Transmission of Prescriptions (ETP) programme, which will also include, in the longer term, the integration of the Electronic Prescription Service with the NHS Care Records Service (see Resources). Primary care pharmacies also use the barcode at the point-of-sale to ensure the correct pricing of product.
- In hospital pharmacies, barcodes are used for eTrading, for robotic dispensing from automated picking machines and to facilitate contract changes for medicine procurement.
NHS contracts for medicines are managed centrally and are made available to the NHS via a web-based catalogue. This information is downloadable and so can be transferred electronically into hospital pharmacy stock control purchasing records to create a seamless flow of procurement information. The new purchasing records would be invoked when the need for replenishment of an item is flagged.
Automation and robotic dispensing of medicines has also made use of the barcode displayed on the medicine packaging. These large store cupboards make efficient use of the available space, by storing the products randomly, but in the most space-efficient manner. Therefore many more products can be stored in the available space than was previously managed by using conventional shelving. The automated devices read the barcode on the product, store it in the most appropriate space in the cabinet and can retrieve the item promptly on request when it is required for dispensing to a patient.
Other code types
Barcodes are just one representation of the GS1 code. This code can be displayed in other representations, with additional benefit. Datamatrix codes are smaller and could be used to identify unit dose products, for example single dose injections or vaccines. Datamatrix has the added ability to carry more information than a standard linear barcode, such as batch and expiry information. This type of information, carried in a machine-readable, error-free way, will demonstrate even more benefit to patient as it is introduced.
Radiofrequency identification (RFID) shows additional benefit, as the “line-of-sight” requirement for scanning of information is no longer required. Although this technology is currently too expensive for use in pharmaceuticals, current carriers of the GS1 code such as barcodes could be migrated to these more efficient codes over time.
By harnessing the use of technology, using machine-readable codes to identify unambiguously a number of parameters, such as products, patients, location of treatment and others, healthcare can be formalised into a pathway of decision-making. This pathway can then be broken down to simple steps which can be audited and so raise the level of confidence in the systems employed.
1. A spoonful of sugar – Medicines management in NHS Hospitals. London: Audit Commission; 2001.
NHS Number for Babies
What is an NHS Care Record?