I came across an interesting article in the July issue of Pharmacy Practice News. The article describes some of the posters presented at the 2013 ASHP Summer Meeting in Minneapolis. The technology covered is relatively old, and a little antiquated when you look at much of the technology floating around the world these days. Nonetheless, this technology still represents opportunity in healthcare.
The article presents information from posters covering barcode scanning for non-sterile compounding, Automated Dispensing Cabinets (ADCs) tied to Computerized Provider Order Entry (CPOE) in the emergency department (ED), using clinical surveillance software to save money, and the use of clinical decision support systems (CDSS) to check medication orders against patient indications to reduce medication errors.
As I said, none of these technologies are new per se, but the use of barcode scanning and CDSS to root out potential medication errors is creative.
Indiana University Health (IUH), a 355-bed hospital in Bloomington took the barcode scanning technology that they were using in the cleanroom environment and adapted it for use in preparing nonsterile compounds, i.e. liquid syringes and other bulk preparations. According to Stephen L. Speth, RPh, MS, the hospital’s inpatient pharmacy manager “The technician scans the ingredients and takes pictures of the amounts. That information is electronically captured and used by the pharmacist for verification.” The system has been successful in capturing potential errors before leaving the pharmacy. According to the article the system captured 21 oral liquid syringe errors in the first five months, representing 0.9% of all doses processed. That’s exactly what barcode technology is supposed to do. If used properly it can capture mistakes before they become errors. Throw in the fact that the system helped IU reduce waste from intercepted compounding errors and cut preparation time, and you have a winner.
The other thing that caught my attention was the use of a clinical decision support system (CDSS) to root out potential errors caused by Sound-Alike-Look-Alike Drugs (SALAD). Researchers at the Center for Education and Research on Therapeutics (CERT) at the University Of Illinois Chicago College Of Pharmacy CDSS) to compare orders entered via the hospital’s CPOE system to the patients list of indications. If the indication for the medication is not documented on the patient’s problem list, an alert prompts the prescriber to cancel the order, ignore the alert or add an indication to the problem list. According to Michelle L. Brayson, PharmD, a co-investigator, “A lot of mistakes were discovered. Often, it was very clear that the mistakes were pick-list errors where the prescriber made the wrong choice from several similar options, or the drug names were next to each other in certain order sets, as with nimodipine and famotidine.” It happens all the time. I recall one specific error caused by propranolol 40mg being sent to a patient in place of Prilosec 40mg; SALAD.
Sound-Alike-Look-Alike Drugs have been a problem within healthcare for many years. Both the Joint Commission and ISMP have attempted to decrease this type of error through guidelines and regulatory requirements. Most of these guidelines and regulatory requirements are complete crap. All they do is create more unnecessary manual processes in the medication distribution system. At least the use of CDSS at the point of order is proactive.
And there it is. Simple, yet innovative application of aging technologies to improve the medication use process. Sometimes the simple approach is the best.