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Effect of Bar-Code Technology on the Safety of Medication Administration

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Bar Code Safety and Efficacy
Errors that occur earlier in the medication process are more readily detected (~50% are prevented during the ordering stage) while very few (< 2%) are caught at the administration stage (bates et al., 1995). further, it has been noted that more than one third of medication errors occur at the latter stage (leape et al., 1995). because of the relatively high proportion of errors and the lack of success preventing them, error reduction strategies targeted at the administration stage
High rates of preventable medication errors have been repeatedly reported in studies in the medical literature (Bates et al., 1995; Leape et al., 1995; Flynn et al., 2002; Kanjanarat et al., 2003). It is difficult, however, to cite a single number to define the extent of the medication error problem due to differences in institutions, study methodologies, error definitions, and other variables. On the high end of estimates, one study that compiled data from 36 institutions reported 19% (~1 in 5) of the medication doses studied over a 4-day period involved medication errors (Barker et al., 2002). These errors included wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). The number of these errors deemed potentially harmful adverse drug events (ADEs) was 7%. A comprehensive review of medication error studies cited in the Institute of Medicine (IOM) 2000 report on errors in the U.S. healthcare system suggests that preventable ADEs, i.e., harmful medication errors, occur in ~1% to 10% of hospital admissions. The IOM report further estimated that 770,000 patients are injured and ~7,000 die each year due to medication errors.
An estimated 28% to 95% of ADEs can be prevented (AHCPR, 2004)
The added costs associated with treating medication errors can be very high (Classen et al., 1997; Bates et al., 1997). For example, one study found that ~2% of admissions experienced a preventable ADE with an added cost per patient of ~$4,700 (JCAHO, 2004). Extrapolated, this suggests an added cost of ~$2.8 million per year for a 700-bed teaching hospital. This figure does not include the significant costs of defending against malpractice claims stemming from preventable inpatient ADEs (Rothschild et al., 2002).
UHC data suggest administration errors account for ~35% of all medication errors and 41% of errors causing harm.
44,000 and 98,000 patients die each year as a result of medical errors. In a more recent report, Preventing Medication Errors (2006), the IOM stated that at least 1.5 million preventable adverse drug events (ADEs) occur in hospitals nationally and that the additional costs of treating iatrogenic drug-related injuries conservatively amount to $3.5 billion per year.
2006, approximately 136 million doses of medications were administered via the eMAR & Bar Coding system, providing approximately 2 million alerts to potential problems and 300,000 alerts of clinical significance. Increased communication between disciplines has resulted in decreased medication and treatment omissions Case study : 67% decrease in medication administration errors within the first four months of operation A comparison of the medication administration error rates pre- and post-implementation shows that medication administration errors were reduced by an average of 82% for the five units studied After implementation, MUSC discovered that waste, which had ranged between 10% and 11% a month, declined to approximately 4%.
Calling that “a dramatic decline,” Dr. Maughan said that it “met the ROI [return on investment] we were hoping for.” Such a sharp decrease in waste, he said, created “a potential for a $10,000 gain over capital investment costs per month. The capital investment costs for the system we chose were actually quite low. That created a strong case for moving forward on the fiscal side.”
Strategies for Minimizing Errors in I.V. Sterile Compounding: ASHP
We must improve the quality of our CSP preparation processes to eliminate sources of error • We must be able to guarantee accuracy of pharmacy-prepared CSPs • We must improve efficiency and productivity • We must reduce waste • We must become more agile and responsive to the changing pharmacy practice environment
Bar code verification for product selection • Bar code verification for preparation • Bar code verification for checking • Bar code verification for delivery • Bar code verification for administration

Cost-Benefit Analysis of a Hospital Pharmacy Bar Code Solution: Saverio M. Maviglia,
In inflation- and time value–adjusted 2005 dollars, total costs during 5 years were $2.24 million ($1.31 million in 1-time costs during the initial 3.5 years and $342 000 per year in recurring costs starting in year 3). The primary benefit was a decrease in adverse drug events from dispensing errors (517 events annually), resulting in an annual savings of $2.20million. The net benefit after 5 years was $3.49 million. The break-even point for the hospital’s investment occurred within 1 year after becoming fully operational. A net benefit was achieved within 10 years under almost all sensitivity scenarios. In the Monte Carlo simulation, the net benefit during 5 years was $3.2 million (95% confidence interval, −$1.2 million to $12.1 million), and the break-even point for return on investment occurred after 51 months (95% confidence interval, 30 to 180 months).

Although few medication errors result in adverse drug events (ADEs),3 hospitals incur $2200 in additional costs per ADE4,5 and $4685 per preventable ADE.6 Nationally, the cost of ADEs is $2 billion per year.6 (CPOE) can prevent serious ordering errors by up to 55%.7 However, many medication errors occur in the dispensing, transcribing, and administering stages of the medication process.8 Although medications picked from inventory are routinely checked and double-checked, 3% to 6% contain an error,9,10 and only 34% of dispensing errors and 2% of administration errors are intercepted before patient exposure.11 Given the high volume of medications dispensed by a hospital pharmacy, even a modest reduction in the overall error rate might avert many preventable ADEs.12

Recently, we studied medication dispensing error rates at our institution before and after the implementation of a bar code–assisted dispensing system.13 Before bar coding, 0.19% of dispensed doses had errors with the potential to harm patients (potential ADEs, usually incorrect medication, strength, or dosage form). After implementing bar coding, the rate of potential ADEs from dispensing errors decreased to 0.07%. With approximately 6million doses dispensed annually, this represents approximately 7260 averted potential ADEs annually. Although not all potential ADEs lead to actual ADEs, the savings from this technology may be substantial.

The Effect of Barcode-Enabled Point-of-Care Technology on Patient Safety: Literature Review by Bridge Medical, Inc.
(JCAHO) called national attention to this basic source of serious error by establishing “correct patient identification” as one of six National Patient Safety Goals for 2002. BPOC systems are uniquely able to provide a fail-safe verification of patient identity satisfying this critical goal. In addition, barcode technology is effectively being used to identify nurses and other caregivers. Many organizations now include a barcode on staff identification badges that can be scanned to log in to computer applications. The use of barcodes in this manner facilitates log-in and helps to accurately capture user information for audit trails and reporting purposes.

Using barcode technology to monitor medication administration enables more data to be collected with a higher degree of accuracy, thus shortening the data collection period.28,29 Collection occurs simultaneously with regular nursing activity, so no additional staffing is required. Most importantly, BPOC systems warn nurses of errors to prevent patient injury. Observation and retrospective techniques simply catalog error.

Preventable ADEs lengthen the average patient stay by 2.2 days, and are estimated to cost approximately $4,600 per event.30 This can add up to millions of dollars per year for the average hospital, not including malpractice costs, readmissions and litigation costs, or the cost of injuries to patients. Litigation alone can be financially devastating to a hospital. On average, jury awards for medication errors reached $636,844 per award in 2000.31 BPOC systems can pay for themselves through avoided litigation alone. The literature shows that any given hospital is likely to experience an ADE rate of 6.5 percent of admissions.32 Approximately 30 percent of ADEs are due to errors— i.e., they are avoidable.33 Hence, hospital liability coupled with a litigious patient population often results in a lawsuit.

Effect of Bar-Code Technology on the Safety of Medication Administration: POON
For every 6.5 adverse events related to medication use per 100 inpatient admissions; more than one fourth of these events were due to errors and were therefore preventable. 2 Among serious medication errors, about one third occur at the ordering stage of the medication process, another third occur during medication administration, and the remaining third occur in about equal numbers during the transcription and dispensing stages.3

14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate) — a 41.4% relative reduction in errors (P…...

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