Barcode Technology Flaws Put Some Patients at Risk

Flaws in the design and implementation of barcode systems designed to match hospital patients with the right dose of the right medication can increase the risk of certain medication errors, according to a study that looked at the use of the system in five U.S. hospitals.

The first-of-its-kind study looked at almost half a million instances where nurses and other staff scanned patients and medications. In a remarkably high percentage of instances, nurses overrode the technology in order to compensate for awkward or inconvenient aspects of the barcode systems. Nurses scanning the barcode on the medication or the patient's ID bracelet overrode the system for 4.2 percent of patients charted and 10.3 percent of medications charted.

The researchers identified 31 causes of system problems that prompted "workarounds" by nurses. These included: unreadable medication barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning ...