Published on January 15, 2010

Bar Coding for Patient Safety

New technology at Genesis helps prevent medication errors

Bar codes, for years a staple of the grocery and retail industries, now are being used at Genesis Health System's four hospitals to keep patients from receiving the wrong medications.

With a hand-held scanner connected to a wireless laptop computer, a nurse or respiratory therapist scans a bar code on the patient's identification wristband and then a bar code on individually packaged medications. If a discrepancy is identified, a system alert is immediately visible on the computer.

After successful pilot programs on several hospital units, bar coding is now used in most acute patient care areas on the Davenport and Illini campuses. It also is used on the Genesis, DeWitt campus.

Improving Safety
"Research has shown that bar coding can improve the quality, safety and efficiency of the medication delivery process," says Charlene Loding, Director of Patient Care Services at the Genesis, Illini Campus. "Our No. 1 priority is to provide a safe environment for our patients. Errors associated with medications are the most frequent cause of adverse medical events."

Representatives from Nursing, Respiratory Therapy, Pharmacy, Information Technology and Quality worked on the project for more than two years.

To accommodate bar code identification, the electronic medication administration functions within the Cerner system currently used by Genesis had to be expanded. Hand-held bar code readers, which plug into laptop computers, and portable carts had to be purchased. The carts give clinicians a place to set their laptops and also contain a locked drawer where medications can be securely stored for transportation to the patient bedside.

At the bedside, the clinician uses the handheld device to scan a bar code on the patient's personalized wristband and a bar code on each dose of medication. The bar codes ensure medications correctly match what the doctor orders.

When the bar codes are scanned, the computer "reads" them into the Cerner software application that checks the database of orders for that patient. If a drug-patient-dosetime- route mismatch exists, the system generates a warning. Immediately - through a message box on the computer screen - the clinician is alerted to any potential errors and is given other critical information that could prevent potential adverse drug events.

"Nurses and respiratory therapists have been charting medications on the Electronic Medication Administration Record, or EMAR, for quite some time," says Shirley Gusta, Manager, Information Technology, Genesis Health System. "What we're changing now is that the six ‘rights' - the right patient, medication, dose, route and time and checking for allergies - are actually verified during the administration process, which adds another level of safety and validation. Additionally, the EMAR is then automatically updated by the bar code charting actions."

Positive Reviews
In the busy patient care environment, where patients suffer from more acute illnesses, medications are more potent and care is more complicated than in the past, nurses initially were lukewarm to the new process.

"Like with anything new, people were concerned, especially about the extra time they envisioned the process would take," says Gina Allen, Nurse Manager of the Medical/Telemetry Unit on the Genesis, Illini Campus. "But the training was excellent, and staff realized it wasn't going to be as hard as they had originally thought. The system has worked really well."

Traci Cox, RN, a nurse on the Rehabilitation Unit at Genesis, West Central Park, says bar coding has been a positive experience: "I feel safe. I feel like I have somebody on my shoulder for my fourth check, making sure the patients are getting the proper medications. And the patients feel safe. We explain what we're doing and why - that it's a safety check for them. That makes them feel better."

"It gives me more confidence," adds Tracy Zeimet, RN, a nurse at Genesis, DeWitt. "And the patients are really impressed that we're using this kind of technology in a small hospital."

Pharmacy Preps
Packaging medications in single or unit doses for nurses, instead of asking them to prepare the correct dose from a larger quantity, is among the best ways to reduce medication administration errors.

So, before bar code medication administration could begin, the Pharmacy worked with Information Technology to assign a Cerner bar code number to each of the roughly 6,000 different drugs used in the hospital. Because only about half of those drugs come from the manufacturer with a usable bar code already attached, the Pharmacy had to purchase machines for each campus to repackage the products into unit doses and label with bar codes.

One machine repackages tablets and capsules, which often come in bottles of 100, into singledose packets with a bar code. A second machine dispenses oral liquids into unit-dose cups, then places a bar-coded seal on them. A third machine prints bar code labels that attach to syringes, ampules, or vials. A fourth machine overwraps them. Typically, pharmacy technicians oversee the repackaging machines, and each run is double-checked by a pharmacist. It's a big job, especially when you consider that the four hospital campus inpatient pharmacies together dispense some 2.6 million doses of medication every year.

It's a critical step in the bar code medication administration process.

"Pharmacy is now repackaging more medications to apply medication-specific bar codes," says Kevin Cahill, Director of Pharmacy at Genesis Medical Center, Davenport. "Therefore, it's critical for our Pharmacy staff to assure the correct bar code is applied to the correct medication and dosage form to provide a safe medication administration system."

Getting Results
Without question, Bar Code Medication Administration has improved patient safety and reduced medication errors. In just the first 10 days of the pilot, six potential medication errors were caught and others have been avoided since then. But the technology does not guarantee that mistakes won't be made.

The bar coding process does not replace proper patient identification using patient name and birth date. Safe medication administration includes verifying patient ID with name and birth date and scanning the patient's wristband.

"We have this technology and by applying best practices, we will enhance the safe medication administration process here at Genesis," Cahill says.