Effect of Bar-Code Technology on the Safety of Medication Administration

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This is a review of Eric G. Poon et al. study of barcode medication administration[1].

Research questions

Does the use of barcode verification technology in transcription and medication administration reduce the rate of error, and therefore improve patient safety?

Abstract

The authors did a comparison of rates of errors in medication administration and order transcription in a hospital before and after the implementation of a barcode Electronic Medication Administration Record(eMAR). These errors categorized as timing errors and nontiming errors, and were reviewed by clinicians to be determined as potential adverse drug events. The study found that units that used barcode eMARs had a lower rate of error in medication for both timing and nontiming categories than units that did not use barcode eMARs, and that errors in order transcription were completely eliminated in units that used barcode eMARs.

Methods

35 adult medical, intensive care, and surgical units at a large 735-bed tertiary academic medical. Rates of error in order transcription and medical administration were recorded over a 9 month period in 2005. A little while into the study, the hospital began to roll out a barcode eMAR system in April 2005, with full implementation of the system in all 35 units of the study in July 2005. Specially trained nurses were used to shadow the staff and record any errors they saw. These errors were then reviewed by a panel of clinicians to assess the danger level to the patient. This was done twice in each unit observed, once before the implementation of the system and once after the implementation of the system.


Results

Units without the barcode eMAR had a 11.5% nontiming medication administration error rate, and units with the barcode eMAR had a 6.8% nontiming medication administration error rate. The system reduced error by 41.4%, and also reduced potential adverse drug events from 3.1% to 1.6%. Timing errors in medication administration were reduced by 27.3% with the implementation of the system. Order transcription errors were completely eliminated by the system.

Conclusion

The study clearly showed that implementation of the barcode system at the bedside does reduce errors in medication administration and order transcriptions, and therefore improve patient safety.

Comments

The study did mention that it studied an early version of the system, and that further studies needed to be done on later versions. Also, the hospital studied had a full computerized physician order entry(CPOE) system and a barcode verification system for the pharmacy staff in place. Hospitals that do not have one or either of those systems in place will experience different results that may not improve patient safety. Paper did mention that barcode verification in the pharmacy and CPOE systems do reduce error rates in medication dispensing and ordering, so the results seen in the study may be the result of all three systems working together rather than just one system working independently of the others.

References

  1. Poon, Eric G., Carol A. Keohane, Catherine S. Yoon, Matthew Ditmore, Anne Bane, Osnat Levtzion-Korach, Thomas Moniz, Jeffrey M. Rothschild, Allen B. Kachalia, Judy Hayes, William W. Churchill, Stuart Lipsitz, Anthony D. Whittemore, David W. Bates, and Tejal K. Gandhi. "Effect of Bar-Code Technology on the Safety of Medication Administration." New England Journal of Medicine N Engl J Med 362.18 (2010): 1698-707. Web. 30 Sept. 2015. http://www.nejm.org/doi/full/10.1056/NEJMsa0907115?viewType=Print&viewClass=Print.