Prescription errors cause an estimated 7,000 deaths in the US every year. It’s easy to see how it happens. A doctor scrawls a prescription for 1.0mg of a medicine on a piece of paper, and a pharmacist misreads it as 10.0mg. Or a doctor confuses one drug brand name with the very similar brand name for another, completely different, drug.
In a busy working environment, where health professionals may have competing demands on their time, mistakes are inevitable. But a system of bedside scanning can minimise those mistakes by introducing automated checks that prevent the wrong medication or dosage being administered to patients.
There are three key components to bedside scanning:
- Computerised physician order entry (CPOE). This enables doctors to enter medication orders into a computer system, rather than write them onto a piece of paper. CPOE immediately removes the problem of poor, easily misread handwriting. It can also alert the doctor to potential risks in the medication, such as allergic reactions or incompatibility with other medicines.
- Patient wristbands. The patient has a wristband with patient’s name and a barcode that contains a unique patient identifier. When a health professional at the bedside scans the wristband with a scanner linked to a computer, the computer calls up the electronic patient record, which displays the medication and dosage the patient requires.
- Barcodes on medication. Each item of medication, whether it’s a solid or a liquid form, has its own standardised unique identifier. When the health professional scans the item, computer software compares the barcode information to the information in the patient record, to check that this is the right medication at the right dosage. If it’s not, then the system immediately alerts the health professional so that they don’t administer the medication.
Barcodes are now a regulatory requirement
Last year, the European Union (EU) introduced regulations that mean all prescription medicines will need to carry a barcode on their secondary (outer) packaging. The barcode must include a unique product identifier containing the product code, a serial number, the batch number and the expiry date of the drug.
This is an important step, but we can make the system even safer by insisting that all medication should have a barcode both on the secondary packaging (the box containing the blister pack, for example) and the primary packaging (each blister hole containing the pill, or each vial). This enables an extra check, making sure that the product matches the prescription. Regulation will extend this further by making barcodes mandatory on medical devices such as catheters or implants so that, when a patient enters the operating theatre, the surgeon can be certain that the right implant is used.
The type of barcode is also important. Traditional linear barcodes can hold only a small amount of information. Datamatrix barcodes, adopted by the international standards organisation GS1, can hold far more information in a small space. The more information contained in a barcode, the easier it is to track a medicine or device to its source, reducing the likelihood of fake medications entering the supply chain.
Although regulatory bodies are now taking the need for barcodes on medicine seriously, they can only be truly effective if implemented alongside a CPOE system. CPOE acts as the ‘glue’ between the patient wristband, which is linked to the electronic patient record, and the units of medication. It is the CPOE that confirms that the right medication is being given to the right patient.
Not just patient safety
Bedside scanning is important for improving patient safety. But there’s an added benefit. Every time a medicine is administered to a patient, the information is recorded, providing a wealth of data about what medication is being prescribed, for which diseases and at what dosage. Healthcare providers can analyse how much they’re spending on particular medicines and the impact of changing from one supplier to another.
Over the next five years we can expect to see regulatory bodies mandate the use of barcodes on primary packaging, while more hospitals implement CPOE systems. That combination of technologies will help drive down medication errors and save patient lives – and it can’t come too soon.
Author: Christian Hay, partner at Medinorma LLC, is a senior consultant at GS1, the international standards organisation.
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