Bar coding drugs and med-surg supplies can enhance patient safety

Healthcare Purchasing News, Sept, 2003 by Agatha L. Nolen

In the hospital setting, almost all patients receive a medication during their inpatient or outpatient stay. With medications, a mistake can be deadly. Nurses are taught to administer the "Right Drug to the Right Patient at the Right Dose and Right Route at the Right Time." This is known as the 5 Rights of the medication use process.

While administering a medication to the wrong patient is almost always significant, administering the right drug to the right patient at the wrong time could result in a patient being overdosed or under treated.

Because of the risk of medication administration and the critical nature of timing, the software infrastructure that supports bedside scanning with bar coded medications is unique.

Challenges in bar coding medications in hospitals

1. Size of the product--The unit level must be bar coded, not the box. Consequently medications that need to be bar coded may be smaller than 1/2" x 1."

2. Regulatory requirements--Most state boards of pharmacy require that a pharmacist verify the accuracy of a product that has been repackaged or relabeled. In some states, only nationally certified pharmacy technicians can unit-dose medications.

3. The need for sophisticated software--Applying bar coding to medications is primarily a patient safety issue and not simply a matter of revenue capture/asset accountability. Therefore, very sophisticated software is needed that matches a particular drug bar code mad ensures that is it ordered for that particular patient. The software does not just charge or capture that the patient received the item. Instead, the software must first double check that the medication was actually ordered by a physician for that patient.

4. Lack of availability of manufacturer-labeled unit-dose medications with bar codes--Only a dozen or so drug companies have committed to a full unit-dose bar coded product line.

5. Lack of standardized barcodes on manufacturer labeled drugs--There is a wide array of formats utilized by manufacturers in bar coding existing products. Scanners must be programmed to accommodate all these differences.

6. Limited number of vendors that offer equipment and service contracts--Few companies offer equipment and labor to bar code medications for hospital pharmacies.

7. Reliable bar codes on repeat scans--Some items need to have reliable bat- codes that will repeatedly scan on multi-dose products, such as a vial of insulin which may contain 100 doses.

8. Lack of NDC numbers on some products--Not all over-the-counter medications have an assigned "National Drug Code" (NDC number).

9. Zero-defect database maintenance--If a link in the database is inaccurate, a patient may receive an incorrect drug.

Current initiatives and issues

1. Large hospital groups (e.g. VA, HCA) have incorporated bar coding of inpatient medications into patient safety programs with wide multi-facility participation.

2. Most facilities are investing in equipment mad bar coding medications on site.

3. Considerable expense is added to drug costs to maintain bar coding including supplies, technician labor and pharmacist labor.

4. New technology presents new challenges. Scanners may lose their programming and need to be frequently reprogrammed. Detailed downtime plans for information systems must be developed since medication administration data must always be available for patient safety. Medication administration information must be real-time, making a wireless network necessary.

The future

1. Research presented to the FDA showed a 71%-93.5% decline in medication administration errors when bat coding is utilized.

2. The FDA will require manufacturers to label products with standardized bar codes in the coming years. (2)

3. Incorporation of medication bar coding into national patient safety initiatives:

a. ASHP Goals and Objectives for Pharmacy Practice in Health Systems to be achieved by 2015, Draft, May 2, 2003.

b. National Patient Safety Partnership. (3)

Agatha L. Nolen, M.S., D.Ph., FASHP, is director of pharmacy at Centennial Medical Center in Nashville. She can be reached at agatha.nolen@hcahealthcare.com

(1) Federal Register: March 14, 2003, pg.12399-125341 Ibid.

(2) www.ashp.org

(3) National Patient Safety Partnership, Press Release, May 12, 1999.