MORE THAN 7,000 of them–a higher number than those lost to workplace injuries–are killed because of mistakes in their medication. But what’s been done to fix the system since the Institute of Medicine reported these numbers three years ago?
The Veterans Administration Medical Center of North Chicago may have found a smart answer–and it involves just simple technology. This military vets’ hospital has been part of the national VA effort to implement a program called Bar Code Medication Administration (BCMA). The program works as follows: each patient is given a wrist band with a bar code, the same type used on magazine covers, food packages and other goods so that cashiers can scan them for the correct price.
The same thing happens in this bar-coded medication system. First, all patients who enter the hospital are given a specialized bar-coded wrist band that can transmit their relevant identifying information to a hospital computer. Then, a doctor enters the patient’s prescription into the computer, and that information is sent to the pharmacy. The pharmacist picks up and verifies the order to make sure that there are no glaring discrepancies like doses that are too high or multiple medications that could interact adversely. Once everything checks out, the information is sent to a large automated machine that spits out the medications in a special bar-coded package that’s earmarked for individual patients.
To complete the circle of technology, the patient’s medication is delivered to the hospital ward and is stocked on the medication cart the nurse uses to make her rounds. Each cart is especially equipped with a laptop computer and a scanner. The nurse scans the patient’s wrist band, and then scans the bar-coded medication package. When the computer confirms that both match, it displays a signal giving the go-ahead to administer the drug. If it’s the wrong medication or the wrong patient, an error message appears instructing the nurse to hold off. According to Kay Willis, chief of pharmacy for the North Chicago VA center, this system has reduced their medication errors by as much as 87 percent. “There’s been an improvement in medications administered on time,” she says. “We have eliminated wrong-patient errors, we have eliminated wrong-drug errors and wrong-dose errors.”
So why hasn’t this program been implemented at hospitals around the country? As always, solving one part of a problem can raise a new one. Assigning bar codes to patients may remove the potential for errors caused by names that are similar or misspelled. But it doesn’t solve the issues raised by how the medications themselves are bar-coded. Right now, hospitals like the VA are receiving drugs from the manufacturer–most of which don’t come bar coded–separating them into unit doses and affixing their own bar codes. This, of course, takes more time and money, and more importantly, increases the chance of mistakes by the pharmacist who is sorting and labeling the medications.
That’s why healthcare experts like Gary Mecklenburg, CEO of Northwestern Memorial Healthcare System and former chairman of trustees for the American Hospital Association, thinks bar-coding is a great idea and important for patient safety but needs to be worked out more comprehensively. He believes it’s going to take collaboration on the part of hospitals and manufacturers to make the system effective and efficient, something he considers critical before rolling the program out nationally. “I think we need a uniform bar-coding system that everyone adopts and is implemented at the manufacturing level for every dose of medication that’s going to be administered at the hospital,” he says. “Without that we will not have uniform standards and we will have multiple systems that probably will add to both cost and errors rather than solving the problem.”
For now, drug manufacturers seem to agree that patient safety and preventing these medication errors is also their priority. They’ve been looking closely at ways to incorporate these changes and applying bar codes right as medications roll off the assembly line. A universal system like that eliminates the potential of an error by an individual pharmacist. Getting all manufacturers to bar-code their medications, however, is not something that will be done overnight. The Pharmaceutical Research and Manufacturers of America (PhRMA) estimates that it will take a few years to implement all of the necessary changes. The FDA has already held hearings on the need for bar-coding, and now the real work begins as hospitals and manufacturers hammer out the details. If the VA system is an example of the potentials of national bar-coding system, this technology could help hospitals reclaim thousands of lives that otherwise might have been lost to error.
