The September 2014 issue of Pharmacy Purchasing & Products contains an article on the use of bar code scanning during the preparation of compounded sterile products (CSPs). The article touches on some of the topics that Mark and I cover in our report, In the Clean Room; errors in the IV room, bar code scanning during medication preparation, image capture, remote verification, and so on.
The article discusses the implementation of a bar-coded medication preparation (BCMP) system for chemotherapy at Indiana University Health Bloomington Hospital (IUHBH), a not-for-profit community hospital with 355 licensed beds and an average daily census of 180.
IUHBH implemented the BCMP system in hopes of improving safety as well as reducing waste.
According to the article “The pharmacy installed a BCMP system in November 2010 to improve the accuracy of [their] sterile compounding process and help eliminate IV mixing errors in the pharmacy…….[with a] primary focus to ensure the accuracy of chemotherapy doses.”
During the first full year of use, IUHBH credits the system with intercepting 28 chemotherapy errors. The second and third years were slightly less with 20 and 17 errors intercepted, respectively. That’s a significant safety improvement.
The most disturbing statistic presented in the article is the breakdown of intercepted errors: 23% involved the wrong drug, 12% involved the wrong amount of drug, and 6% were prepared incorrectly. It’s important to note that not all these intercepted errors would have been missed, or would have caused patient harm without the system, but the numbers remain eye opening nonetheless.
In addition to fewer errors during CSP preparation, IUHBH found:
- Reduction in medication preparation time from an average of 47 minutes prior to system implementation to 39 minutes by the end of the first year. Further tweaks in workflow resulted in an average preparation time of 30 minutes by the end of the third year. Preparing CSPs “fast” should never be a #1 priority, but it’s still a metric worth tracking.
- Reduced waste via intercepted errors prior to mixing. IUHBH estimates an avoided waste of $24,000 annually, averaged over three years.
The article concludes that “trusting human vigilance and manual methods of verification to detect medication errors is unreliable”. Saying that using humans as a method for verification is unreliable is an understatement. Checking bias, fatigue, constant interruptions in the pharmacy, etc all play a role to make humans a poor choice as a safety check. Bar code verification isn’t perfect, but it’s a tool that can definitely help reduce errors when used properly. Combined with other technologies in the IV room along with well-conceived workflows make it even more useful.
Woods S. Bar-Coded Medication Preparation for Chemotherapy. Pharm Purch Prod. 2014; 11(9):8-10. Available at: http://www.pppmag.com/article/1568/September_2014/BarCoded_Medication_Preparation_for_Chemotherapy/ Accessed October 16, 2014.