Jerry Fahrni

This is a great questions and one that I previously would have said is a no-brainer. I believe a bar coding system for medication dispensing from the pharmacy is an improvement in patient safety, but I would be hard pressed to prove it. A colleague of mine (John Poikonen at RxInformatics.com) is fond of saying that there is no evidence to support the use of bar coding. Here’s a quote from John: “The pharmacy profession is drunk with the notion that BCMA works for patient safety, in the face of little to no evidence.“ He has a point.

I can demonstrate that our bar code system in the pharmacy has improved work flow, improved inventory management and saved us a little money along the way. What I can’t show you is clear cut evidence that it has made the dispensing process safer. Anecdotally, it works. I can testify from working in the main pharmacy (I still staff about four days a month) that I find fewer errors during our Pyxis replenishment then I did prior to bar coded storage. The errors I do find are typically related to technician workarounds. We are all familiar with the human factor and possible workarounds for bar coding.1 However, I still can’t prove that bar coding is safer.

I was determined to make a solid case for bar coding, so I combed through our drug error/adverse drug events data for several months before and after implementation. To my surprise, I found virtually no difference. I’m sure the reason for the discrepancy in my thought process and reality involves many factors, such as the lack of self-reporting associated with medication errors. There is no question that medication errors are under-reported.(2,3)  Regardless of the reason, I simply do not have the evidence at my disposal to make a valid case for bar coded medication dispensing improving patient safety.

One of the only studies I’m aware of that directly addresses the impact of bar code technology on pharmacy is a 2006 article in the Annals of Internal Medicine .(4) Like most articles associated with bar code scanning, the data is difficult to interpret. This is, in part, due to the problem I mentioned above. Documenting medication errors prior to bar code implementation requires direct observation over long periods of time without observer bias. Needless to say the process is difficult and labor intensive.

To make matters worse a recent article by Sakowski published in the American Journal of Health-System Pharmacy found that the majority of errors detected by bar code medication administration (BCMA) were benign and posed minimal safety risk.(5) C’mon guys, you’re killing me here.

A recent survey at Pharmacy OneSource demonstrates that a majority of healthcare practitioners believe that bar coding is a good strategy to prevent medication errors in the pharmacy. Less than 3% of the people participating in the poll felt that bar coding would not prevent medication errors.

While I still feel that a bar coding strategy in the pharmacy is a solid way to decrease the risk of medication errors, I must concede that I cannot find evidence enough to back up my beliefs. The process must clearly be studied further to create evidence to support our current practice. It’s too late for my facility as we have fully implemented bar coded storage and dispensing in our pharmacy, and I will do it all again in any hospital that I decide to work for. For now we need someone to analyze the process and come up with a strategy to further develop the practice. Someone once told me that healthcare practitioners shouldn’t design systems; engineers should design systems. I think that’s fair. What we need now is to find an engineer willing to ride this crazy merry-go-round we have spinning out of control in healthcare. Any volunteers?

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1. Koppel R, Wetterneck T, Telles JL, et al. Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety J. Am. Med. Inform. Assoc. 15: 408-423. First published online as doi:10.1197/jamia.M2616
2. Cullen DJ, Bates DW, Small SD, et al. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv. 1995;21(10):541-8.
3. Jha AK, Kuperman GJ, Teich JM, et al. Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report. J Am Med Inform Assoc. 5(3):305-14.
4. 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. Ann Intern Med 2006; 426-434.
5. Sakowski J, Newman JM, Dozier K Severity of medication administration errors detected by a bar-code medication administration system Am J Health Syst Pharm 2008 65: 1661-1666