Bar-coding is familiar to everyone who shops, with electronic scanners reading product information and price after a quick swipe of a tag through a scanner. This technology is now being used at the University of California, San Diego (UCSD) Medical Center to assure a higher level of patient safety and service.
Hospital patients now get a bar-code on their hospital identification wristband which improves how medication is delivered to each individual patient. The new barcoding program, launched recently at UCSD’s Thornton and Hillcrest Hospitals, is the only such system in the San Diego region, outside of the Veterans Affairs San Diego Medical Center.
“The bar-coded wrist band is one additional safety feature of our computerized integrated medication system. With this system, the physician enters the prescription on-line, and the pharmacist can immediately review the medication order. The nurse will also see the medication order on the electronic medication record,” said Thornton Hospital’s Director of Nursing, Deborah Wayne, R.N., (MSN, MBA). The computerized system eliminates the possibility of transcription errors.
The bar-code on the patient’s wristband corresponds to the patient identified in the medication order, to ensure the correct patient is receiving the correct medication. The health care provider can scan the information easily using a portable computer and scanner. The computer program contains a profile of all the medications that specific patient is taking, and how the drug needs to be administered – whether orally or by syringe, for instance – as well as the time.
“This new system ensures what are commonly known as ‘the five rights’: the right medicine at the right dose, given at the right time to the right patient via the right route,” said Debbie Winter, Director of Nursing Informatics who helped to lead the initiative. The bar-code on the medication packaging itself corresponds to the exact prescription ordered by the physician, ensuring that the correct medication has been dispensed by the pharmacy and chosen by the nurse.
The new system incorporates several important medical safety recommendations outlined in the July 2006 report by The Institute of Medicine (IOM) of the National Academies of Health. According to the report, more than 1.5 million Americans are injured every year by drug errors in hospitals, nursing homes and doctor’s offices.
Preventing drug errors is challenging because of the sheer volume and complexity of today’s medications, with more than 10,000 prescription drugs on the market – not to mention trying to decipher doctors’ handwriting – which, in the past, could lead to medication errors.
The bar-coded wristbands offer patients at UCSD Medical Center and their families added peace of mind. The IOM report recommended that hospitals adopt computerized systems for prescribing drugs and other information technology that shows promise for reducing the number of drug-related mistakes.
“The IOM stated that, by 2010, all providers should be using e-prescribing systems and all pharmacies should be able to receive prescriptions electronically, so UCSD Medical Center is ahead of the curve,” said Josh Lee, M.D., Assistant Clinical Professor and Medical Director of Information Systems at the UCSD School of Medicine.
"With this fully integrated system we can capture potential mistakes, such as adverse drug interactions or the wrong dose, before they happen," said Charles E. Daniels, Ph.D., R.Ph., Pharmacist-in-Chief for UCSD Medical Center . "Changes in prescriptions made by a doctor are shown immediately, so there's no wait in response time for taking a patient off a medication or adding one."
Wayne says that while the bar-coding system has meant a large investment of people, time and money, “Our nurses are very comfortable with the new system, and the initial transition to the new process has gone seamlessly. Most importantly there is a greater safety measure for patients and staff.”
The UCSD team spent several months preparing to launch the bar-coding system with tasks ranging from trouble shooting computer interfaces to creating an entire bar-code library of all the drugs in the UCSD pharmacies. While the FDA has issued regulations requiring the standardized bar-coding of all packaged medications, there are still a small percentage that require local bar coding. Not all medications had bar-codes that were readable.
“What’s exciting about the bar-code system is that it provides an accurate record of the drug’s exact dosage as well as the time it was administered,” said Daniels. “That’s really important in the area of pharmacokinetics, which monitors how drugs are metabolized by the body based on these factors along with the individual patient’s characteristics.”
“The new system will close the loop between the doctors’ orders and the patient in our hospital bed being given their meds,” said Daniels.
The University of California, San Diego (UCSD) Medical Center is one of the 100 “Most-Wired” Hospitals in the nation, according to a list of hospitals and health systems with the most advanced information technology compiled by Hospitals & Health Networks, a publication of the American Hospital Association. In keeping with this tradition, UCSD hospitals were among the first in the country to institute a bi-directional computerized physician order entry (CPOE) system, enabling a doctor to enter a prescription order on line in a program that is linked directly to the pharmacy’s computer system.
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