Bar coding helps improve patient safety

Key Points

In 2004, FDA finalized a rule requiring bar codes on most human drugs and biologics by mid-2006 in an effort to improve patient safety by reducing medication errors. Patient safety continues to be a primary focus of today's healthcare industry, and bar code medication administration (BCMA) has helped healthcare professionals achieve patient safety goals.

"Bar-coding implementation is not a stand-alone initiative, it's a cultural change. The entire medication-based committee structure has been somewhat transformed and focused on medication safety," according to Richard Paoletti, MBA, RPh, director of pharmacy services at Lancaster General Hospital, Pennsylvania.

An observational study conducted in 2006 at Brigham and Women's Hospital, Boston, Massachusetts, which dispenses approximately 6,000,000 doses of medication each year, evaluated the implementation of BCMA technology. The study included a cost-benefit analysis.

Three different bar code processes were employed; 2 included scanning all doses during dispensing and the third involved scanning only 1 dose, even if several doses were dispensed. All unit doses contained a bar code.

The researchers identified target dispensing errors (ie, wrong medication, wrong dose or strength, wrong formulation, expired drugs) that bar coding was designed to address. Target potential adverse drug events (ADEs) were also identified, including dispensing errors that could harm the patient if the errors were not corrected before drug administration. The researchers compared pre- and post-bar code implementation data on ADEs and dispensing errors.

During the study's 5-month pre-BCMA implementation phase, 115,164 doses of medication were dispensed compared with 253,984 doses of medication dispensed during the 7-month BCMA implementation phase. Overall, bar coding was associated with a 74% decrease in the rate of target potential ADEs and a 63% decrease in the rate of all potential ADEs, which included ADEs not related to dispensing. The BCMA processes that required all doses of medication to be scanned were associated with a 93% to 96% relative reduction in target dispensing errors (P<.001) and an 86% to 97% relative reduction in target potential ADEs (P<.001). The single-dose scanning process was associated with a 60% relative reduction in target dispensing errors (P<.001) and a 2.4-fold increase in target potential ADEs (P=.014). The authors stated that the system that was configured to scan every dose during dispensing yielded the best possible outcomes.

The cost-analysis of BCMA implementation demonstrated a simulated annual cost savings of $2.20 million. The total simulated implementation costs were $2.24 million ($1.31 million in 1-time costs during the initial 3.5 years and $342,000 for each recurring year starting in Year 3) in 2005 dollars. The net benefit after 5 years was demonstrated to be $3.49 million. The break-even point for the investment was within 1 year after the system became fully operational.

The Aurora Health Care system in Milwaukee, Wisconsin, implemented BCMA in 2004 to help improve patient safety. At that time, 75% of the facility's medications were labeled, and the objective was to have 100% of unit-dosed medications bar coded. The Aurora Health Care system employs a point-of-care BCMA model that uses bar-coded wristbands to help identify patients and medication bar coding to help "close the loop" with the facility's computerized physician order entry system. The medication bar code, wristband, and electronic record are all scanned to ensure that they match.

According to Gary L. Cochran, PharmD, assistant professor of pharmacy practice at the Nebraska Medical Center, Omaha, "Use of BCMA will undoubtedly prevent errors; however, it is not perfect and can actually cause new, unique errors. This can be minimized by including staff in the planning and implementation process, monitoring system performance, and making changes as system vulnerabilities are identified."

SOURCES

Traynor K. FDA to require bar coding of most pharmaceuticals by mid-2006. American Society of Health-System Pharmacists website. http://www.ashp.org/s_ashp/article_news.asp?cid=167&did=2024&id=4736. Published April 1, 2004. Accessed December 19, 2007.

Maviglia SM, Yoo JY, Franz C, et al. Cost-benefit analysis of a hospital pharmacy bar code solution. Arch Intern Med. 2007;167:788–794.

Poon EG, Cina JL, Churchill W, et al. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Arch Intern Med. 2006;145:426–434.

Raschke R. A stepping stone to safety: Bar coding becomes a key piece of a health system's patient safety strategy. Most Wired OnLine website. http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=hhnmostwired/pubsnewsarticlemostwired/data/07winter/070425mw_online_raschke&domain=hhnmostwired. Published March 28, 2007. Accessed December 19, 2007.

Examining medication errors prevented by and associated with bar-code medication administration (BCMA) technology. US Pharmacopeia website. http://www.usp.org/pdf/en/patientsafety/capslink2007-05-01.pdf. Published May 2007. Accessed December 19, 2007.

Dr Kaufman is president of PRN Communications, Inc, a consulting/medical writing and editing firm.