HEALTH-SYSTEM EDITION
TECHNOLOGY

White paper says bar-coding effective but faces barriers

There's no question bar codes can significantly reduce medication errors, but the technology still has barriers to overcome, according to a new white paper.

Study results have shown that bar-code-enabled point-of-care (BPOC) systems of varying sophistication produced a 65% to 74% reduction in medication errors, according to the white paper issued by Bridge Medical Inc., Solana Beach, Calif. The white paper's literature review also found that the Veterans Health Administration's BPOC system has prevented up to 86% of all medication errors from reaching the patient.

Even though BPOC is an effective tool, getting the technology into the hands of the nurses at the bedside has been more difficult than putting bar-coded toothpaste and toilet paper on supermarket shelves. Perhaps the biggest hurdle has been the reluctance of drug manufacturers to apply bar codes to unit-dose packaging. That leaves the job of affixing the zebra stripes to providers.

The drug industry's resistance will soon disappear once the Food & Drug Administration implements a proposed rule mandating the use of unit-dose bar codes on all human drug and biologic products. Bar-coding got another boost recently when two powerhouse group purchasing organizations, Novation and Premier Inc., announced that future Rx contracts will require bar-coding on all unit-of-use packaging.

Getting manufacturers to bar-code products in unit-dose is an external matter, but getting health-system executives to accept the technology can set off an internal struggle. Competition for scarce resources can be fierce, and BPOC systems can cost hundreds of thousands of dollars. If BPOC is ever going to be adopted, administrators must buy into medication error reduction and be willing to include a budget item for the technology, according to the white paper.

Even when the top brass comes on board with BPOC, staffers down the chain may resist at the point where the technology meets the practice—the patient bedside. For example, instead of scanning each patient's wristband, the nurse may pick the patient from the computer screen and, thus, bypass the "right patient" safety feature. Some nurses may fear enhanced error tracking will lead to punitive action against them, and some nurses chart medications post administration, which short-circuits all of the checks associated with the medication itself.

"When a practice or technology exists that is proven to reduce error, it is our shared responsibility to communicate its efficacy," wrote Michael Cohen, R.Ph., president, Institute for Safe Medication Practices, in the white paper foreword. "BPOC systems provide a safeguard against error at the most vulnerable stage in the medication use process—during administration. As stakeholders in the quality improvement of this nation's health care, we must recognize the vulnerability of the patient in all of us."

All bar-code systems are not created equal; their functionality, sophistication, and effectiveness in preventing medication errors span the spectrum, according to the white paper. On the lowest rung are systems that just check for the five rights: patient, drug, dose, time, and administration route. At the bedside, the bar codes on the patient's wristband and medication are scanned to verify the pharmacy order. The scan provides a complete and accurate electronic or on-line medication administration record. However, errors in the order will not be intercepted.

Level two BPOC systems go beyond the five rights to include integrated on-line reference systems with enhanced pharmacy communication. The most sophisticated systems integrate dose calculation tables. Such systems provide tools to proactively research a medication order but will not alert the nurse to a potential error in that order.

Higher up the sophistication ladder are BPOC systems with embedded computer logic and alert engines that test the pharmacy order and the nurse's actions against preprogrammed standards. Level three systems also alert nurses to look-alike/sound-alike drugs and the intended use of the medication they're about to administer. There may also be warnings about high-risk meds, near-miss error reports, and order reconciliation.

To request a copy of the white paper, send an e-mail to info@bridgemedical.com. It can also be viewed on the Web at http://www.bridgemedical.com/pdf/whitepaper_barcode.pdf.

Carol Ukens

Carol Ukens. White paper says bar-coding effective but faces barriers.

Drug Topics

2002;22:HSE48.