Immediate steps toward patient safety: one health system explains how bar-code point-of-care technology offered a means to reduce medication errors that can be implemented relatively easily while pursuing more complex, long-term solutions

Healthcare Financial Management, Feb, 2004 by Van R. Johnson, John Hummel, Terance Kinninger, Russell F. Lewis

Implementation

Sutter Health found that the technical and time commitments of BPOC system implementation are minor compared with the challenges and risk associated with other system installations. The medication administration process may be slowed slightly as nurses respond to the system's warnings and alerts issued by the system, but this time loss is balanced by automated documentation of medication administrations. In most instances, nurses have mastered the system in as little as two hours of training. Sutter accomplished a hospitalwide BPOC system implementation in six to eight months.

The greatest challenge to BPOC implementation is the need to bar-code unit-dose medications. However, the task is not as difficult as commonly perceived. Although the U.S. Food and Drug Administration (FDA) and others report that only 35 percent of medications are bar-coded by manufacturers, Sutter Health found that manufacturer bar-coded line items account for nearly 60 percent of all oral and injectable medications administered in hospitals.

Sutter continues to bar code the remaining doses at a cost of about five cents per dose. Because Sutter delivers 32 million doses annually, these remaining doses cost the organization about $1.6 million each year. However, when the FDA issues its final rule later this year requiring manufacturers to place bar-code labels on medications bound for hospitals, that per-dose cost is expected to fall to one cent.

Why BPOC?

Meeting organizational, regulatory, and community patient-safety needs depends on an approach that considers the perspectives of all individuals involved in the patient-care process. From the physicians' perspective, a CPOE system is a key to promoting patient safety. On the other hand, a BPOC system offers a cost-efficient and easy-to-implement bedside approach to ensure patient safety that more directly addresses the concerns of nurses and patients. The best approach to acquiring a BPOC system can be identified by considering the medication use process, the availability of current technology, its cost, and the length of time and effort needed to successfully implement the technology.

AT A GLANCE

Patient safety should be a fundamental element in any hospital's philosophy, mission, and vision, Use of barcode point-of-care technology (BPOC) to reduce medication errors is a patient-safety approach that hospitals can implement within a short time frame and obtain immediate benefits. Advantages of BPOC are that it is intuitive, cost-effective, and conducive to improved patient satisfaction.

ABOUT SUTTER HEALTH

Surfer Health is a not-for-profit healthcare network of 26 acute care hospitals. Headquartered in Sacramento, Calif., the health system provides services to more titan 100 northern California communities, with one affiliate in Hawaii. The system also includes physician organizations; medical research facilities; regionwide home health, hospice, and occupational health networks; and long-term care centers.

LEVELS OF BAR-CODE POINT-OF-CARE (BPOC) SOPHISTICATION

Level 4

Blood Transfusion, Lab Specimen Identification,
Legal Medication Administration Record,
Advanced Error Data Capture

Level 3

Sound-Alike/Look-Alike Alerts, Maximum
Daily Dose Warnings, Allergy Alerts,
Weight-Based Dose Checking

Level 2

Drug References, Formulary
Comments, Nursing
Documentation Tools

Level 1

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