Archives for December 12, 2003

Bar codes matching drug to patient coming soon – Bar codes matching drug to patient coming soon

…Inside hospital pharmacies, tiny bar codes just an eighth of an inch tall adorn the blister packs that hold single-pill doses of certain drugs, like Dilantin for seizures and Lipitor for cholesterol.

With a handheld scanner, health care workers guard against medication mixups by matching each pill’s bar code to a hospitalized patient’s wristband and medical chart. It is to ensure the right person swallows the right dose of the right drug at the right time. If anything’s off, an alarm beeps.

By February, the Food and Drug Administration will issue orders requiring that every medication sold to hospitals soon bear supermarket-style bar codes.

It’s a major move that, once fully phased in, is expected to protect many of the estimated 7,000 hospitalized patients who die every year because of drug errors.

And, not just drugs:

The impact promises to go beyond routine drug mistakes. For example, printing a matching bar code for the vial of Mr. Jones’ blood before the nurse leaves his bedside guards against mixed up samples is crucial in ensuring patients receive the right blood type and other test results.

Patients get the wrong blood in one of every 14,000 transfusions, causing at least 20 deaths a year.

“Those are totally preventable tragedies,” says Dr. Gerald Sandler, Georgetown University Hospital’s transfusion chief. He began pushing for electronic solutions five years ago when his hospital had a near-miss — two children awaiting transfusions switched seats after the nurses double-checked who was supposed to get which bag of blood. But he says hospitals can’t afford the systems unless drug and blood safety are paired.

I am, with minor reservations, all for this. Medication errors large and small are all over the medical literature, and this has some promise to stop the majority of them.

My reservations revolve around human factors in several ways, and some silly old practicality. First, this will make sure the right patient gets the prescribed medication. However, it won’t help if the wrong medication or the wrong dose was prescribed, but there are efforts underway to address those issues separately.

Second, people will get the wrong bar code applied to them, or scanned into the system. It’s a GIGO world.

This leads to the third concern: now, again, we have people working for machines, and not machines helping people out. I’ll give you the example you’ve seen but maybe not realized: take something to the checkout line that has a bad code that isn’t in the system, and the entire transaction grinds to a halt. There’s a full length rant about this topic I’ve decided to skip, but you know what I mean.

Lastly, we (medical professionals in all fields and disciplines) have to make sure that common sense stays in the loop as these scanners are implemented. There will be hospitals that put into their rules that no patient can get a medication before all the barcoding has been done, which is fine for stable inpatients but would be a disastrous delay in the ED. Also, fallbacks for mass casualties, power and equipment failures need to be in place.

I’m generally glad this will be implemented, and hope it ends medication errors. It won’t, but it should stop the majority of them.