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Bar codes make sure it's what the doctor ordered

It's tedious and time consuming, but the technology is reducing medication errors at places like Northside and Edward White hospitals.

By NICK BIRDSONG
Published August 3, 2005

ST. PETERSBURG - Margaret Taylor doesn't use her computer at home. Her husband "set her up" to send e-mail. So when the registered nurse of 14 years found out she would have to operate an automated computer system, she said she had to "pray, a lot."

"Of course, I was intimidated," she said. "I was like, "Oh, boy, how is this going to work?' It was another new thing to learn and you know, I'm not that young."

Taylor works at Northside Hospital and Heart Institute at 6000 49th St. N. Northside ditched its paper-run operation last year and opted for Meditech's bar code based Electronic Medication Administration Record, known as eMAR, in January.

Hospital Corporation of America, which owns 191 facilities nationwide, including Northside and Edward White Hospital on Ninth Avenue N, found that by using bar coding technology, the risk of harmful medication errors could be reduced greatly.

A patient admitted to an HCA hospital receives a wristband with a bar code that stores the person's medical record, lab results and allergies. The bar code is used for tracking and identification throughout the stay.

The system lowers the margin for error when it comes to dispensing medications to patients, HCA says.

In December 2004, HCA examined 7.4-million medication doses. Using eMAR, the bar coding system produced 233,540 warnings. This averted 183,215 medications from being wrongly given to patients.

"These would have just been inadvertent errors that may or may not have caused major damage," said Heather Wood, nursing director of the medical and surgical units at Northside. "But nobody knows. Now, with this kind of system, we can track that kind of data."

HCA's goal was to implement the program in all of its hospitals by the midpoint of this year. The new technology is in 119 of the hospitals now.

But the process is tedious and time consuming. Each pill must be bar coded and individually packaged, then programmed to coincide with the patient's armband. Everything is recorded. Once a medication is given, the system is automatically updated and schedules the next administration. It took four months to get the system up and running at Northside.

Before medication is given, the bar codes on it and the armband are scanned to verify that it is the correct medication and the correct patient.

"Not only that. It makes sure that along with the patient's medical history and allergies that it's okay for them to take this medication and the lab values are appropriate," Wood said.

If anything is wrong, a prompt will flash on the blue screen of the Dell laptops, warning nurses of a potential problem.

Northside may be at the forefront in the health care industry toward automatic identification. Bar coding is just one aspect of it, said Paul Schyve, senior vice president of the Joint Commission on Accreditation of Healthcare Organizations. The commission doesn't require eMar for approval, but it encourages health care organizations to learn more about bar coding and radio frequency identification.

"When you can identify people and medications automatically, you reduce the risk of human error that could give the wrong medication to the wrong patient," Schyve said. "The bottom line is, we do see auto identification methods as being methods that can improve patient safety."

All Children's Hospital may be lagging behind. It is still a couple of years and a pending contract away from switching to the bar coding system. But the hospital is positioning itself to make the move, said director of pharmacy Dennis Gates. All Children's inked a deal with a company years ago and will be using that medication administration record system, MAR, in the future.

The eMAR system hasn't completely befuddled less tech-savvy nurses. The system can usually be learned in one eight-hour training day, Wood said. One nurse whom she recently hired said he turned down job offers from two other local hospitals because they didn't use bar coding technology. Taylor said she feels more competent than ever.

"I just love it because it so safe," Taylor said. "I just have more of a sense of completion, that everything is done right."

Bar coding can't be used in the emergency room or in neonatal intensive care.

Otherwise, though, "now we can wave a red flag and say, "Wait a minute, wait a minute. That's the wrong medication,' " Schyve said.

[Last modified August 3, 2005, 00:36:17]