A recent trifecta for bar-coding

Bar-code medication administration has been around for a while, but hasn’t gained the same notoriety as other forms of healthcare technology like computerized provider order entry (CPOE) and clinical decision support (CDS). However, it looks like the tide is starting to change as we’re currently in a unique position to see bar-coding from several different angles.

Part 1 – the beginning, i.e. the pharmacy:
Earlier this week I briefly touched on the ASHP Statement on Bar-code Verification During Inventory, Preparation, and Dispensing of Medications. As clearly stated in the title of the paper, ASHP’s position is aimed squarely at what happens from the time a medication arrives in the pharmacy until it is dispensed, i.e. sent to the patient or placed in an automated dispensing cabinet. The document concludes that “Prudent use of bar-code scanning in inventory management, dose preparation and packaging, and dispensing of medications can enhance patient safety and the quality of care.” I can agree with that, especial the part that states “prudent use of bar-code scanning”. Technology won’t do much for you if it is implemented poorly or used recklessly.

Part 2 – the end, i.e. the patient:
By now everyone in healthcare has read, or at least heard of, the study by Poon, et al “Effect of Bar-Code Technology on the Safety of Medication Administration” in the May 6 edition of the New England Journal of Medicine. You really need to read the article if you haven’t. Error reduction in the article breaks down like this:

• Drug treatment errors, including incorrect medicine dosage, fell by 41%; 11.5% before and 6.8% afterward. This is probably the crown jewel of the information presented.
• Transcription errors occurred with 6.1% of orders before bar-code use. They were completely eliminated bar-coding was adopted. This makes sense as the documentation becomes electronic.
• Medicine errors deemed to have potential for serious harm fell from 3.1% to 1.6%. That’s a relative reduction of about half.
• Timing-related errors, when a drug is given at least an hour earlier or later than intended, fell by 27%. I’m not sure what impact this has on patient care. One thing to take away from this particular dataset is that bar-coding may have uncovered a nursing practice issue. It doesn’t mean the nurses are doing something wrong. It means the process needs to be dissected.

There are some important takeaways from the NEJM article. First, don’t get caught up in the numbers. The article provides valuable insight into the potential for using bar-code technology at the point-of-care. The reader gets to see the overall process, which is important. Second, remember to look at the data critically and apply it to your situation. Every facility is different. Take what you can from the article and leave the rest. Remember, the data was collected in 2005.

Part 3 – tying it all together:
TMIT is offering a a free webinar on Barcoding End-to-End Solutions: From Pharmacy to Bedside to help bring together everything I mentioned above. The webinar features an incredible list of speakers including David Bates, MD, Eric Poon, MD, AHSP’s very own Karl Gumpper, RPh and a host of others. Do a PubMed search for some of those names and see what you come up with. Needless to say the webinar has some serious firepower in its list of speakers.

From the webinar website:

As many as 10% of hospital inpatients experience an adverse drug event. Serious medication errors are common in hospitals and often occur during order transcription or the administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system.

This webinar will address the bedside barcoding aspect of the following Safe Practices:

Safe Practice 16: Safe Adoption of Computerized Prescriber Order Entry

Safe Practice 18: Pharmacist Leadership Structures and Systems.

The webinar site also contains links to some useful bar-code references.

So there you have it. A triplet of things offering readers the chance to see bar-code technology in healthcare from every angle. I’m really looking forward to the webinar; I’m already registered. I recommend taking advantage of the opportunity to hear such a distinguished panel of speakers present.