Small symbol, wide impact
Octogenarian Gilbert Garber bears a bar-coded wristband during a recent Dana-Farber visit.
The bar code on Garber's wristband is the first step in a much larger, Institute-wide project that will soon involve every patient-care area. One day, his code will be matched against the chemotherapy he receives, the blood products or immunizations he may be given, and the laboratory slip used when his blood is drawn.
Using handheld scanners linked to portable computers, nurses will scan the code on the wristband, calling up an electronic medication administration record on a laptop computer. Then they will scan the label on the medication container. The computer will beep if a mismatch has occurred and alert nurses about unsafe drug doses or combinations.
Bar codes were inspired by prehistoric, memorial stones in Ireland, engraved with Ogham script (lines that correspond to letters in the Latin alphabet, depending on their position and slant). First appearing in supermarkets and warehouses during the 1980s, these symbols are now used for everything from library cataloging to patient identification.
According to the Institute of Medicine's landmark 1999 report To Err Is Human, hospitals that use bar codes have seen medication errors fall dramatically. Despite the benefits, however, only a few U.S. hospitals (including Brigham and Women's) currently employ barcoded medication administration systems, and they are geared for inpatients, notes Sarah Cohen of Information Services, who is leading the wristband project.
Dana-Farber is paving the way with an effort focused on outpatient care. The first phase involves coding wristbands and is being tested in one adult clinical area before it is applied to all patients here.
Adding a bar code to medications in pill form is challenging, even though many standard drugs have one on the label, explains Sylvia Bartel, RPh, MHP, director of Pharmacy. "We have to know whether the manufacturer's code pertains to individual doses or entire packages," she says. "Also, we have to supply bar codes for investigational drugs." Because a chemotherapy bag contains a mix of liquid drugs tailored to a particular patient, with amounts adjusted according to how the patient responds and other drugs given, these medications are difficult to code. Dana-Farber pharmacists have developed a system for such labeling and will begin using barcoded bags in the spring.
"Bar coding will help us prevent mix-ups regarding look-alike, sound-alike drugs," says Bartel. "The technician selecting the medication and the pharmacist checking the preparation will use the code to verify that the drug entered into the system is the same one being dispensed for the patient."
According to Weingart, bar coding provides an extra safety check at the end of a four-step medication process. "First, a physician prescribes a medication. Second, a pharmacist dispenses it. Third, a nurse administers it. And finally, a clinician monitors the patient and follows up on the medication's effects. While there are safeguards in place for the first two steps, until now there were few for the third step; a caregiver could still accidentally reach for the wrong drug."
In addition to reducing errors, the codes will provide valuable data about the medication-administration process and reveal ways to further improve patient safety. By building a database of "near misses," clinicians and hospital administrators will see the chain of events that leads to an error, and make appropriate changes.
