Bar Codes Reduce Pharmacy-Related Potential Adverse Drug Events by 63 Percent at BWH
BWH researchers found the hospital’s bar coding technology has reduced the rate of targeted dispensing errors by 85 percent and the rate of potential adverse drug events by 63 percent.
“Overall, the use of bar code scanning technology appears to have a significant impact on the rate of dispensing errors that were serious enough to potentially harm patients,” said Eric Poon, MD, MPH, lead author of the study and associate physician in the Department of General Medicine. “We saw bar code scanning dramatically reduced the likelihood that the wrong medications or wrong doses of medications would be dispensed from the Pharmacy to the nursing units.”
This study, published in the Sept. 19 Annals of Internal Medicine, began before BWH installed bar code technology. Researchers observed the dispensing of 115,000 medication doses from the Pharmacy to measure the rate of dispensing errors. Pharmacists and pharmacy technicians at that time manually retrieved medication doses from several storage areas and relied on visual inspection alone to verify the retrieved doses before dispensing the medications to patient care units.
When bar coding was installed at BWH in 2003, every dose of medication was affixed with a bar code, and pharmacists and pharmacy technicians scanned each bar code to ensure that they dispensed the right medications. Following barcode technology conversion, researchers observed the dispensing of nearly 254,000 doses to re-measure the rate of dispensing errors.
By comparing the error rates before and after the implementation of bar code technology, researchers found dispensing errors targeted for reduction by bar code technology fell by 85 percent and potential adverse drug events due to dispensing errors fell by 63 percent.
“For a hospital like the Brigham and Women’s Hospital, which dispenses about 6 million doses of medications a year, we project that this technology is preventing about 13,000 dispensing errors every year, of which about 6,000 would have had the potential to harm patients,” Poon said. “However, like other forms of information technology in healthcare, the effectiveness of bar code scanning technology depends on the way it is used. Our findings suggest that in order to reap the maximal benefit from this technology, every medication dose should be scanned before it reaches the patient.”
The study also found that the way the bar code technology is set up may affect its ability to reduce errors. The research team examined three configurations of bar code technology implemented in the hospital pharmacy. In two of these configurations, all medication doses were verified by bar code scanning during the dispensing process. In the third configuration, only one dose was scanned if several doses of the same medication were being dispensed. In the two configurations that required pharmacy staff to verify all doses of medications by scanning, dispensing errors were reduced between 93 and 96 percent and risk of potential adverse drug events was reduced by 86 to 97 percent. The configuration that did not require scanning of every dose achieved only a 60 percent reduction in dispensing errors and saw nearly a 2.5-fold increase in risk of potential adverse drug events.
The study was supported by a grant from the Agency for Healthcare Research and Quality. Jennifer Cina, PharmD, William Churchill, MS, Nirali Patel, PharmD, Erica Featherstone, BS, Jeffrey Rothschild, MD, MPH, Carol Keohane, BSN, RN, Anthony Whittemore, MD, David Bates, MD, MSc, and Tejal Gandhi, MD, also are authors of this study.