In a hospital setting, physicians, pharmacists and nurses are responsible for making sure that the correct dose of the correct medication is administered at the correct time to the correct patient. Whether they occur at the order stage or during administration, errors are common. In an effort to reduce those errors, in 2005 Brigham & Women’s Hospital in Boston took the direction of many academic medical centers and implemented bar-code verification technology within an electronic medication-administration system (bar-code eMAR). An existing system imported medication orders electronically from either the physician’s order entry or the pharmacy staff. Adding bar-code medication verification at the bedside allowed nurses to automatically document the administration of drugs by means of bar-code scanning.
Poon et al. looked at rates of errors in order transcription and medication administration before and after implementing bar-code eMAR at this hospital. Observations were broken down into errors in timing (involving administrations that were early or late by more than 1 hour) and errors unrelated to timing. There was a 41% reduction in non-timing errors, and a 51% reduction in potential adverse drug events from those errors. There was a 27% reduction in timing errors, though the rate of potential adverse drug events associated with those errors did not change significantly. Prior to implementation of bar-code eMAR, there were 6.1 transcription errors and 2.9 potential adverse drug events per 100 medication orders transcribed. With the new system in place, transcription errors were completely eliminated.
“We know that medication errors are common and preventable, and this study shows that using bar-code eMAR is an effective way to reduce those errors,” says Mary Beth Hamel, a deputy editor at NEJM.
Health care information technology has been thought to be a promising strategy for reducing errors, and the new office of Health Information Technology in the U.S. Department of Health and Human Services has been established with that in mind. Bar-code eMAR is being considered as a criterion for achieving “meaningful use” of health information technology and for obtaining financial incentives under the American Recovery and Reinvestment Act of 2009.
The authors conclude, “Our findings show that the bar-code eMAR technology improves medication safety by reducing administration and transcription errors, providing support for the inclusion of this technology as a 2013 criterion for achieving meaningful use under the American Recovery and Reinvestment Act.”
Is your hospital or clinic using bar-code medication verification technology? What’s been your experience?