Barcode scanning technology continues to improve patient safety.

Am J Health Syst Pharm (2009;66 1110-1115): “A total of 1465 medication administrations were observed (775 preimplementation and 690 postimplementation) for 92 patients (45 preimplementation and 47 postimplementation). The medication error rate was reduced by 56% after the implementation of BCMA (19.7% versus 8.7% , p < 0.001). This benefit was related to a reduction associated with errors of wrong administration time. Wrong administration time errors decreased from 18.8% during preimplementation to 7.5% postimplementation (p < 0.001). There were no significant differences in other error types. Conclusion. The implementation of BCMA significantly reduced the number of wrong administration time errors in an adult medical ICU.” – I’ve touched on this before. In a pre-barcode era mistakes at the bedside weren’t caught and patients suffered the consequences. Barcoded medication administration has tremendous potential. I am hopeful that hospitals will continue to develop its potential in this age of technology, and in doing so drive medication administration errors to zero.

Cool Technology for Pharmacy

NEPS Healthcare: “Managing the distribution of pharmaceuticals throughout the healthcare delivery process in hospitals and other healthcare institutions can provide opportunity for errors in both administration of medications and cost accounting. In addition to ensuring the five pharmaceutical “rights”— the right patient, the right drug, the right dose, at the right time, with the right route of administration—Health e-Connect can ensure a closed loop process for pharmaceutical cost accounting within the healthcare institution.” - NEPS provides an integrated software solution (called Health e-Connect) for the creation of pharmaceutical labels on a variety of direct thermal printers.  The software compliments the functionality of the pharmacy information system (in our case Siemens  Pharmacy) by  providing  a  label  printing  solution with virtually  unlimited  formatting  capabilities. The features that caught my attention include tall man lettering support and real time label formatting changes. I liked the product so much that I put it in the pharmacy IT budget for the upcoming fiscal year.

Problems with barcodes.

ISMP Medication Safety Alert! May 21, 2009 Vol. 14, Issue 10: “Please let us know if you identify problems bar_barcodewith  a company’s unit dose package barcode. An example of an ARICEPT (donepezil) unit-dose package with a barcode  problem appears in Figure 1 (shown in the PDF version of the newsletter). Note that the labeling material has been applied to the unit-dose package in such a way that tearing the doses apart destroys the barcode! Problems like this are due to inadequate quality control and are by no means isolated to one company. When issues like this occur, staff are forced to take extra steps to maintain the quality of the barcode, or they have to relabel products so they can be scanned at the bedside. This, of course, takes time and also increases the risk of a labeling error. If you send barcode problems to us along with a publishable photo, it will help us remind companies about the need for adequate quality control.”  Fortunately for us we haven’t seen anything like this, yet.


Barcode symbologies….what’s in your pharmacy.

I had a brief exchange with a colleague a few days back and the subject of where manufacturers were headed with barcoding came up. It’s an interesting discussion. As mentioned in a previous post the number of available barcode ready, unit-dosed medications has been slowly shrinking. As manufacturers work with government agencies and pharmacy organizations to come up with a standardized barcode format, it appears that they have put their unit-dosed, barcode ready medications on the back burner.

Manufacturers have a lot of barcode options to choose from, which may be contributing to the difficulty in developing a standard. However, it is important for the pharmaceutical industry to realize that the need for a barcode standard is ultimately driven by a goal for patient safety.
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Cool Pharmacy Technology

dellthinclient

Thin clients are computers that depend on a centralized server for processing power. They are simple devices that typically contain only the most basic hardware, and frequently do not contain a hard drive. Thin clients essentially serve as the interface to the server.

Thin clients are mostly inexpensive compared to traditional desktop PCs, and offer easier management and security secondary to their connection based on a singular source.

Our facility has plans to utilize the Dell thin client as a major component of our bedside barcode scanning system. Thin clients will be attached to monitor, keyboard, mouse and scanner creating a complete scanning solution in each patient room. The result is a simple, low maintenance platform.

I wouldn’t want to use a thin client computer as my primary work machine. I like to customize my work environment and they lack the flexibility. They are, however perfect when a secure, inexpensive solution is needed for use in high trafic areas like hospital wards.

Fewer unit-dosed, barcode ready drugs from the manufacturer?

I’ve noticed a trend over the past few months. Several medications that we typically purchase are no longer available in unit-dosed, barcode ready packaging. The result has been the purchase of more and more medications in bulk, which require repackaging and barcoding prior to dispensing. The reason for the trend is unclear, but appears to be a difference in opinion on what information should be contained in the barcode and what barcode standard to use. Even with organizations like ASHP encouraging manufacturers to develop standards and the FDA requiring barcodes on prescription medications, there appears to be a gap.
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Adverse Drug Event Occurences

I’ve been working with a group here on a Failure Mode and Effects Analysis (FMEA)  for our bar coding medication administration project (called MAK –Medication Administration checKing by our vendor, Siemens Medical ). The benefit to implementing such as system is to significantly reduce the number of errors that occur during medication administration in hospitals each year.

While researching the project I have come across several interesting facts. I would like to share them with you here.
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