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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