Most hospital personnel would probably agree that
the proliferation of technology in their facility has made their jobs easier
and more efficient. Many will say that technology, specifically the use of bar
coding, is making patients' hospital stays safer, particularly in the area of
medication dispensing errors. A study published in the Sept. 19 issue of the
Annals of Internal Medicine (2006;145:426-434) found a positive
relationship between bar coding and reduced drug dispensing errors, according
to data gathered by Dr. Eric G. Poon, MD, MPH, and his research team at
Brigham and Women's Hospital in Boston.
During their review of general hospital
conditions, the researchers found that medication errors were fairly common,
with pharmacy dispensing errors contributing significantly to these errors.
From a statistical viewpoint, the overall number of dispensing errors was
relatively low; however, this rate can be misleading due to the high volume of
prescriptions dispensed on a daily basis. Based on some estimates, more than
100 undetected dispensing errors occur every day in a busy hospital, with only
about one third caught by nurses before administration of the medication to
the patient.
In April, the FDA mandated that all
medicines used in hospitals carry a bar code. While it has been widely assumed
that the FDA dictum would lower the number of dispensing errors, few studies
have been conducted to study the impact of this technology. Dr. Poon and his
team performed a before-and-after evaluation of dispensing errors and adverse
drug events (ADEs) over a 20-month period in a 735-bed tertiary care academic
medical center, where approximately 5.9 million doses of medications were
dispensed per year from the central inpatient pharmacy. During the bar code
conversion process, the pharmacy built a repackaging center that affixed a bar
code onto every dose of medication if the manufacturer had not already applied
a bar code.
A trained research pharmacist inspected the
medications that had already been dispensed to look for errors, while two
board-certified internists independently reviewed and rated the severity of
each dispensing error by using an explicit set of criteria.
Physician–reviewers determined whether the patient could have been injured if
the error had reached the patient, classified these errors as potential ADEs,
and further categorized the level of potential harm as significant, serious,
or life-threatening. The researchers then matched each post–bar code process
according to the types of medications dispensed with its equivalent pre–bar
code process and compared the rates of dispensing errors.
The authors found that, "The rates of target
dispensing errors and potential ADEs substantially decreased after the
implementation of bar code technology: The target dispensing error rate
decreased by 85%, and the rate of all dispensing-related potential ADEs
decreased by more than 60%."
However, the researchers added that these
data should be considered only within the specific parameters of the study.
For example, the study examined the effects of bar coding on patient safety in
only one urban academic medical center that cares largely for adult patients.
Another factor that needs to be considered is the individualized dispensing
processes of other hospitals. Their study was significant only given the
target hospital's processes. Additionally, the investigators point out,
"Neither participants nor assessors were blinded to the purpose of our
before-and-after study." Yet, even with all the caveats, the researchers say
their study suggests that bar code technology in hospital pharmacies is moving
in the right direction.
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October 2006
Pharmacy and Technology