Technology that helps retailers is increasingly being used by hospitals to improve patient safety.
Scannable bar codes often are found on medications in Utah hospitals. And it's not uncommon to find them on the arms of patients, as well.
At St. Mark's Hospital, "everything sent to the unit has a bar code on it," according to pharmacy director Dennis Long. That's also true of other MountainStar Hospitals along the Wasatch Front.
Bar codes are used to a varying degree, as well, at Intermountain Healthcare's facilities, University Hospital, the Salt Lake veterans' hospital and elsewhere.
While it makes more work for nurses, who must take several steps to reconcile a drug order with the drug in hand with the patient who's getting it, it's a big step forward in making sure patients are given the correct medication in the correct dose, Long said.
That's an issue that received national attention recently when heparin at 1,000 times the recommended strength was used to flush the lines of actor Dennis Quaid's newborn twins. In Indiana last year, three infants died in a similar incident.
Hospitals administer tons of medication, and "there's a lot of room for error," Long said, so anything that will reduce it is welcome.
The process goes something like this: A physician orders a medication, which is then transmitted to the pharmacy by electronic order (Intermountain), facsimile (the U.) or high-resolution scanner (St. Mark's) over the Internet. Some pharmacies, like the one at LDS Hospital, use a robotic, bar code-based system to dispense the medications.
At St. Mark's, all medications are either already bar coded or have bar codes added as soon as they come in. When a pharmacy technician pulls the medication, it's scanned to be sure it's right, then is checked again by the pharmacist. On the floor, the nurse has to look at the electronic medication administration record (called eMAR) and review it before taking the medication to the patient's room. Both patient and medication bar codes are scanned to make sure it's a match, before anything is administered.
Several hospitals that don't yet use eMAR say they'll implement it early next year. That will further enhance use of bar codes for patient safety.
Intermountain's process is already similar, according to spokesman Jess Gomez. University Hospital will begin using electronic physician orders in March. Already, though, 99 percent of all medications have a bar code, which is scanned before a drug is administered, said Craig Herzog, director of pharmacy automation and informatics. And patient bar codes are coming.
The U. uses high-speed prepackaging machines, and prescriptions are dispensed to a carousel where they are scanned to see it's the correct product. Then a label is printed with the patient's name and other relevant information. It's double-checked by the pharmacist before it's sent to the floor. If something seems wrong with a physician's order, pharmacists are duty-bound to question it and resolve it, Herzog said.
Hospitals also make increasing and extensive use of programs that check interactions between different medications and compare dose ranges with what's ordered. If something's off, the pharmacist is notified automatically, immediately. Physicians who place orders electronically are notified nearly instantly if they make a dosing error.
The Food and Drug Administration, in response to medication errors and patient safety concerns, has mandated that all hospitals use electronic prescribing within the next couple of years. No more hard-to-read handwritten prescriptions. Bar codes are on their way to becoming standard, as well.The word "standard," however, points out one of the challenges. "One of the challenges is to make sure we have the scanners and technology that can read different types of bar codes," Herzog said. That's a big issue when selecting new software and hardware. And there is, as yet, no national standard.