Hospitals Adopt Bar Coding

The Institute of Medicine (IOM) estimates as many as 7,000 American lives are claimed by adverse drug events each year, while the U.S. Food and Drug Administration (FDA) reports roughly 1.25 million medication errors occur annually. By now, the research into patient safety and medication errors is familiar to most. And the benefit of technologies like bar coding is well documented. Seven years after the IOM's landmark report To Err Is Human: Building a Safer medication errors is familiar to most. And the benefit of technologies like bar coding is well-documented. Seven years after the IOM's landmark report, To Err Is Human: Building a Safer Health System, a Google search on the title returns 140,000 hits. It's a big issue, but the astronomical numbers and abstract percentages can be difficult to grasp.

Beyond the statistics, current events illustrate how these matters affect quality of care, competitive standing and organizational readiness:

• Patients, staff and even organizations are at risk. After a fatal medical error in July - when a patient received an epidural instead of penicillin - a nurse is facing felony charges. State regulators also considered revoking the hospital's license and Medicare contract.

• Medical directors and administrators are finding creative ways to move forward - and compete. As reported in October, a public hospital in San Jose, Calif., will use a multimillion-dollar grant to acquire bar-coding technology and reduce medication errors.

• Hospitals that don't start planning now may be forced into action sooner than later. In September, a tragic overdosing incident in Indianapolis claimed three infants. U.S. Senators Evan Bayh and Richard Lugar responded by announcing their intention to quickly introduce patient safety legislation.

Patient safety - and medication safety - is a perfect storm because failures immediately impact cost, competitiveness and healthcare providers' missions. Yet, available technologies can identify and verify medications, patients and clinicians, and dramatically reduce errors for a modest investment.

Industry experts estimate only 10 to 20 percent of U.S. hospitals and health systems use bar-code technology at the bedside. But as additional research drives the public policy debate, a few key organizations are pushing the issue to a critical mass. Through research, regulation and recommendations, a variety of organizations are attempting to promote medication safety measures, including the adoption and use of bar code technology.

FDA and Medication Labeling
In the case of the FDA, the idea is to harness market forces by ending a Catch-22. Its "Bar Code Label Requirements for Human Drug Products and Biological Products" rule was issued in 2004 and took effect in April 2006. It requires manufacturers and repackagers to apply machine-readable bar codes to most drug and biological product packages intended for humans.

The FDA's objective was to remove a barrier to adoption. On the one hand, manufacturers argued that few provider organizations used bar codes and there was little justification for the added cost. On the other hand, hospitals were reluctant to implement systems designed to read bar codes because unit doses were not pre-labeled.

Prior to 2004, only 30 to 40 percent of medications in unit-dose packaging were available with bar codes. Now, the figure has increased significantly but still falls short of what's needed for effective patient safety programs. This rule excludes bulk pharmaceuticals and a few medications that are not easily labeled, like syringes, vials and ampuls. It also exempts compounds, such as patient-specific IVs, specialty mixes and injectibles.

For maximum benefit, hospital pharmacies will require some repackaging equipment, including on-demand thermal printers and supplies, to ensure that they can produce patient- or drug-specific labels for each medication administered in the hospital. The collective benefit, according the FDA's 2004 estimates, will be tremendous: Over 20 years, 478,000 adverse drug events will be prevented and $93 billion in medical costs saved.

Joint Commission Standards As part of its mission to improve care quality and safety, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issues National Patient Safety Goals. No. 3 on its list of 14 goals for 2006 was "improve the safety of using medications," which includes a new requirement for hospitals: "Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings."

JCAHO does not specifically mandate bar coding, but bar-code systems are designed to manage precisely this data, including drug name, strength, dose, expiration date or expiration time. The technology adds a layer of accuracy - and, therefore, safety - to the process of labeling and retrieving the data necessary to guarantee the "five rights" of medication administration at the bedside: the right patient, right medication, right dose, right route of administration and right time.

ASHP's Vision for the Future
The American Society of Health-System Pharmacists (ASHP) offers another endorsement of medication safety measures as a part of its Health-System Pharmacy 2015 Initiative. The initiative represents a blueprint for best practices in the pharmacy.

Two key ASHP objectives call for 75 percent of hospitals to "use machine-readable coding to verify medications before dispensing" and "before administration to a patient." The 2005 baselines for these measures stood at 11.5 and 9.4 percent, respectively. Though a minority of provider organizations currently takes advantage of mature technologies such as bar coding, there is no shortage of examples to learn from.

Better Bedside Manner at Beloit
When Beloit Memorial Hospital, a 175-bed community hospital in Beloit, Wis., decided to bolster patient safety, it evaluated initiatives for their impact on quality, disruption of clinical workflow and overall value.

Computerized physician order-entry systems, it determined, were cumbersome and complex. Beloit determined that a "second check" of medication at the bedside held greater promise. Bar-coding systems were more cost-effective, less disruptive and better at preventing medical errors.

Within a year of deployment, one department reported a 74 percent decrease in medication errors. The next department to implement decreased its errors by 89 percent in just six months. Today, Beloit uses bar coding in all inpatient units.

BWH Ahead of the Curve
For some organizations, the patient safety case alone is more compelling than any pending rules or regulations. Boston-based Brigham & Women's Hospital (BWH) didn't wait for the FDA guidelines to take effect. It set up one of the first comprehensive hospital-based drug repackaging operations.

BWH installed a medication administration system that uses bar-code scanning to track pharmaceuticals from preparation in the pharmacy to the point of care. At one point, BWH produced and applied more than two million two-dimensional bar-code labels a year. BWH reports a reduction in medication administration errors in line with the 60 to 80 percent decreases commonly reported in the research literature.

Safety First at Sutter
Sutter Health - a California network of hospitals, community-based cardiac and cancer care centers, rehabilitation clinics and behavioral health centers - takes a big-picture approach to medication and patient safety. It is in the midst of a $25 million patient safety effort that calls for a bar code scanner at every bedside in all 26 hospitals. The idea is to leverage technology investments in a comprehensive way.

At registration, patients receive bar-coded wristbands. When the wristband, the medication label and the nurse's ID badge are all scanned at the bedside, the medication administration system verifies the combination for a "five rights" check that catches dangerous mismatches. The system can alert caregivers about allergies, interactions, look-alike/sound-alike drugs and high-risk drugs. In addition to unit-of-use medications, Sutter Health is increasingly using bar code labels to help track and manage specimens, blood products, IV mixtures, asset tags and file labels.

The initiative will eventually cover all of the approximately 30 million medications Sutter nurses administer annually. And initial results are encouraging: Sutter Health estimates that the system caught 28,000 medication errors - over the course of 2.6 million drug administrations - in the first year alone.

Of course, medicine is a human endeavor; it will never be perfect. But the cases for renewed attention to patient and medication safety are compelling. As the thinking behind recent activities of the FDA, JCAHO and ASHP becomes more commonplace, so will the successes on the scale of Beloit Memorial, Brigham & Women's and Sutter Health.  HCW

Deborah H. Murphy is a member of the Healthcare Information Management and Systems Society's Auto ID Task Force, and the global practice leader for life sciences at Zebra Technologies. She can be reached via e-mail at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it