 Keep the Bar Coded Unit Doses Coming
When St. Luke's Hospital (Chesterfield, MO) began planning an electronic medication administration and reporting (eMAR) system in 2003, more than half of its medication inventory lacked bar codes.
The 493-bed hospital implemented a bar coding system to support the solution.
Since the recent rollout of the eMAR system, the hospital says it has achieved such benefits as increased patient safety, accurate reporting, and information integration and communication between departments. It has also found that its bar coding requirements have dropped considerably.
"When the process began, about 35 to 40% of drugs had bar codes coming from manufacturers. Today we are up to 75 to 80%," says director of pharmacy Richard Fook.
 For addressing bulk shipments, the pharmacy repackages and bar codes oral solids in unit-dose packs. For repackaged liquids in vials and ampoules, "we place a small 2-D Data Matrix bar coded label on the medication. The 2-D code contains enough information to allow us to include the lot and expiry data," Fook says.
"The eMAR system has not decreased medical errors, per se. But the technology has allowed us to catch more "near misses," and it allows us to analyze our processes to minimize future errors," he adds.
In St. Luke's system, caregivers scan their ID badges, patients' ID bracelets, and medication doses, initiating wireless information transfer to medication administration software on a laptop computer. Nurses view patient-specific data and monitor for warnings. Real-time data are stored in the patients' medication administration records.
Following in the footsteps of pioneers like St. Luke's, hospitals are gearing up to implement medication management systems with bar coding applications. Bar coded medication management and electronic medical record systems are the top priorities for hospital IT, according to The 2006 Leadership Survey by the
Health Care Information and Management Systems Society (HIMSS).
Reducing medication errors/improving patient safety and electronic medical records (EMR) implementation are cited first and second, respectively, as the top priorities in the next 12 months and for two years out. Sixty-nine percent said they plan to implement bar coding in the next two years.
"In the past six months, planning has turned into action. The technology is ready and proven. Upper management, nursing, and pharmacy now have to commit to internal process and practice change," says Ken Tighe, CEO, Care Fusion (McLean VA), a medication-management-solutions provider.
Predicts Tighe: "Most people feel 10% of the market have systems today, and 10 to 15% will adopt them in the near future. The vast majority of hospitals will have bar code based medication-management systems within the next five or six years."
Fook says he favors a further diminution of the hospital's repacking operations. "Going forward we would like to see lot and expiry data included in the manufacturers' bar codes. Very few have them today. And we would like to see more unit-dose packaging."
North Adams Regional Hospital (North Adams; MA) installed a point-of-care eMAR system in 2003, and today is repacking 30 to 35% of inventory. Director of pharmacy Mark Kessler at the 50-bed hospital says: "We are trying to get out of the repackaging all together. It is just another step that can introduce error."
 Yet Ken Kleinburg, senior director of global healthcare, Symbol Technologies, points out that that unit-of-use bar coded packaging is widely available. Repacking of bulk product will continue to be an economical option for many larger hospital systems.
"There is a prevalent misconception. Just because hospitals are buying 40 to 60% of their product in bulk form, that doesn't mean manufacturers are not in compliance with FDA's bar coding regulations. You can find just about everything you need in bar coded unit-dose packaging if you shop around," Kleinburg says.
"Most hospitals are buying 40 to 60% of product in unit-dose forms with bar codes. Some manufacturers have pulled back on their unit-dose packaging, either because they don't think there is a demand for it or that it would be an added expense they would have to pass on to their customers. Hospitals that already repack medications might continue to buy in bulk to realize lower prices and leverage the equipment they already have," he says.
Despite all the headway that has been made in the last few years with drug manufacturers increasingly providing bar coded product at the lowest-sized level of packaging, could hospital demand now be dropping? If FDA's vision of improving patient bedside safety is to be realized, hospitals need to over come their institutional resistance to new technology, and manufacturers need to continue to make bar coded unit-dose packages an affordable solution.
David Vaczek
Senior Editor |
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