Bar codes help reduce some medication errors

A study at the University of Wisconsin (UW) Hospital and Clinics in Madison shows the hospital has reduced medication administration errors by 87% with the use of a hand-held wireless bar code scanner.

By employing a hand-held bar code scanner at the bedside, the hospital strives to ensure that the five key aspects of medication administration are correct, thereby reducing medication errors. The results of a recent study show dramatic improvements in medication administration and documentation accuracy, based on a direct observational study of caregivers by trained observers, says Steve Rough, PharmD, UW Hospital’s director of pharmacy service organization. Of the errors observed in the pre-bar code phase of the study, 44% involved medications given at the wrong time; 21% involved the wrong dose of a medication; 15% resulted from omission of a medication; 15% used the wrong dosage form (for example, injection vs. medication taken by mouth); and 5% involved use of an incorrect drug.

Although the vast majority of these errors don’t result in negative consequences, hospital proponents say the value of hand-held bar code scanners is in eliminating the small number of errors that can cause serious patient harm. Following implementation of the new technology, the prevalence of wrong dose, wrong dosage form, and omission errors were observed to decrease by more than 90%, while medications given at the wrong time dropped by more than 75%. UW chose a hand-held bar code scanner called Admin-Rx, manufactured by McKesson Automation Inc.

"Nurses have come to appreciate Admin-Rx’s ability to avert errors," Rough says. "We know that approximately 3.2% of doses scanned generate some sort of warning message to help nurses avert potential errors."

The device is currently used on 11 of the hospital’s 22 inpatient units. Based on the immediate benefits observed in the study, Rough says implementation is being accelerated with the goal of having it operational hospitalwide by April 2003. Tom Thielke, PharmD, UW Hospital director of pharmacy, says the initial results suggest that the hand-held scanners are a good way to reduce common types of medication errors.

"These results are very enlightening, and not just for our hospital," Thielke says. "The system virtually eliminates human errors in administering and documenting medications. When you see how many medication errors are averted by the system, you realize how crucial point-of-care bar code technology is for enhancing the medication administration process."

The Admin-Rx product is a hand-held computer that displays, receives, and charts real-time patient and medication information. Before giving a patient medication, nurses scan a bar code on their identification badge, a second bar code on the medication and a third on the patient’s wristband. If there are any discrepancies regarding patient, dose, method, or time, the device alerts the nurse. If everything is verified, the nurse gives the patient the medication and documents it via the unit, which logs a historical record of all medications given to the patient.

The McKesson product is part of a larger system of hospital pharmacy automation products. Sue Lehnherr, RN, UW Hospital’s nursing director, says the reduction in errors isn’t the only benefit from the bar code system. The hand-held units produce dramatic improvements in medication administration record documentation accuracy, with post-implementation accuracy exceeding 99%. Additionally, pre- and post-use satisfaction surveys have demonstrated a 42% overall improvement in nurse satisfaction with the medication administration and documentation process, and a 64% improvement in nurse perception of system efficiency and safety.

"These results can be attributed to the nurses having clear, real-time patient information at their fingertips, a reliable system that alerts the caregiver to late doses or medication omissions, and consolidation of medication verification, administration and documentation into a single step at the point of care," Rough says.

Nurses welcome the technology after some initial trepidation, she says, and patients also can feel more secure about receiving the right medication when they see the nurse check all the bar codes with the scanner.