Barcoding: the way to patient safety
Dr. Nabil Younis
Senior Advisor
The Egyptian Society for Quality in Health Care
ESQua
Medical Errors
Approximately 98,000 Americans die each
year from medical errors….7.000 of which
are medication errors
Where Do Medication Errors
Occur?
Transcribing
Ordering
Preparing
12%
Administering
39%
11%
38%
Barcode Technology
• Series of vertical lines and
spaces that scanner
converts to electrical signal
understood by computer
• Used in grocery stores
since 1970s
• Can store alpha and
numeric and information
• Provides accurate, fast,
real-time data collection
and entry
• Offers exceptional security
• Minimizes errors
associated with manual
data entry
Barcode Medication
Administration Technology
• Nurse barcode scans
name tag
• Nurse barcode scans
patient identification
bracelet
• Patient MR appears on
bedside laptop or handheld device
• Warnings/alerts are
issued when indicated
• Automatic documentation
of administration activities
Barcoding at the Point-ofCare
• Medication
Administration
• Transfusion Error
Checking
• Specimen Collection
• Supply and
Procedure Charge
Capture
Barcoding at Point of Care
Information Flow
Admission
BPOC System
Med. Erros
Bedside Barcode Unit
Pharmacy
Reporting & Error Analysis
Billing
Other Clinical Systems
Levels of PCPOC
Level 4
Laboratory specimen labeling; blood
product safety
Level 3
Alerts: look-alike/sound-alike; high risk
meds, clinical actions, order reconciliation,
maximum daily dose
Level 2
Drug reference; formulary
comments
Level 1
5 rights checking; eMR;
work lists
Departments Affected
• Departments affected by changes in the
medication process
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Pharmacy
Nursing
Medical Staff
Information Technology
Business Office
Clinical Engineering
Housekeeping
Human Resources
Telecommunications
Technology Solution
• Barcode enabled,
wireless, touch screen
computer
• Software checks to
assure 5 rights are met
• Warning screens
prompt the nurse
• Online order verification
• Work sheet
• Real time, electronic
documentation
Barcoding at the Point-of-Care
(BPOC)
• Staff scan barcode on
name badge, enter
secure password
• Scan Barcode on
patient ID to access
patient’s MR
• Scan Barcode on unitdose medication
• Verifies “5 Rights” &
provides alerts
Warning Message Definitions
Dose Omitted: A prior
dose has not been given.
Maximum Daily Dose
Exceeded:
The 24-hour maximum safe
dose will be exceeded.
Route Not Ordered:
The order does not specify the
route of administration.
Dose Early: A medication
is about to be given
greater than one hour before
it is due.
No Active Orders:
The selected medication has
not been ordered for the
patient.
Wrong Dose Range: The
medication entered does
NOT match the
prescribed dose.
Dose Late: A medication
is being given greater than
one hour after it was due.
Orders Discontinued:
The selected
medication has been stopped
by the physician.
Alert:
Look a like / sound alike.
Medication may have similar
name
Duplicate Medication:
This medication has already
been selected to be given.
Order Expired: The order
for this medication is no
longer valid.
Future Order:
The selected medication
is not currently scheduled.
Warning Message Algorithm
Nurse Response
Warning
Message
Continue
Cancel
Cancel
Administer
Potential
Error
Clinical Example
• A patient had an order for Glyburide (Diabeta)
5 mg by mouth every day
• The nurse scanned the barcode on what she
thought was Glyburide
• The following warning appeared:
Clinical Example
• Upon closer inspection what
she had scanned was
Glipizide (Glucotrol)
• Pharmacy had dispensed
Glipizide instead of
Glyburide
• Besides being from the
same classification, these
two generic drugs have
similar sounding names and
nearly identical packaging.
Pre and Post Implementation
Comparison
Pre-Implementation
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Incomplete MR verification
Manual MR entries
Inaccurate documentation
Incomplete charting
Limited allergy information
Physician access to
information complicated
• Voluntary reporting
Post-Implementation
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Automated MR
Electronic documentation
Real time documentation
Reduced reliance on memory
Legible documentation
Documentation available in
one place
• Automated recording of near
misses/errors
Nursing Workflow Benefits
• Automates
worksheets,
documentation
• Clarifies orders
• On-line
reference
Nurse Satisfaction
• Recruitment &
retention tool
• Positive nursing
surveys
• “Protecting my patients
and my license.”
Bar-coding keeps Sponges Out Of Patients &
Hospitals Out Of Court
How ?
Bar-coding keeps Sponges Out Of Patients &
Hospitals Out Of Court…cont
Safety-Sponge System prevents false correct
counts by computerizing all sponge counts in
an OR. As each individual sponge has a
unique bar code, no one sponge can be
counted twice and inadvertently create a false
correct count. This essentially eliminates the
root cause of retained sponges.
Address Barcode Needs
in Your Organization
• Identify medications already bar-coded by
the manufacturer
• Determine which medications pharmacy
produces that are patient specific
• Evaluate the ability of existing pharmacy
system printers to add barcode to labels
• Establish process to verify medications
against your formulary
• Create Patient ID bracelets with barcodes
• Develop Employee ID badges with barcodes
Success Elements
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Strong management support
Physicians & Nurses Committment
Timely response to concerns, questions
Constant, daily communication
Identify measurements of success before
implementation begins
• Dedicated IT support
Goals and Expectations
(Hospital Wide)
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Automatic recording of errors/near misses
Eliminate duplicate charting
Simplified/accurate billing process
Easier physician access to information
Quick quality check for trends
Knowledge enhancement with immediate
feedback
Identify Barcode Needs
• Look at internal systems first
• Identify which medications get to the
patient
• Can the systems providing those labels support
bar-coding?
• Can the systems support a patient-specific
barcode, patient account number and order
number?
• Can the systems support the bar code?
Address Barcode Needs
in Your Organization
• Identify medications already bar-coded by
the manufacturer
• Determine which medications pharmacy
produces that are patient specific
• Evaluate the ability of existing pharmacy
system printers to add barcode to labels
• Establish process to verify medications
against your formulary
• Create Patient ID bracelets with barcodes
• Develop Employee ID badges with barcodes
Questions?
The Egyptian Society for Quality in Health Care
Telephone :227-34-641 227-34-646 www.esqua.org
Address :45/a Ibn Al Nafeis, Al Manteqah as Sadesah, Nasr City, Cairo