When you go to a doctor’s office, clinic, or hospital you expect safely and correctly administered medication. This is an expectation not only supported but mandated by the Food and Drug Administration (FDA). These strict regulations require the tracking of medication as it is distributed and administered to patients.
In February 2004, the FDA made barcodes central to their drug regulation by requiring a barcode be placed on the medication. At a minimum, the barcode must include the National Drug Code (NDC) number – which contains the name of the medication, dosage, and the drug company producing the medication. Effective barcoding prevents serious medical errors and reduces mortality rates – since 2010, one study found that barcode use prevented about 90,000 errors each year and reduced the mortality rate by 20%. Barcode use also helps nurses and doctors fulfill the “five rights” of medication management: right patient, right medication, right dose, right time, and right route of administration.
- Right Patient
The National Patient Safety Goals (NPSG) of 2013 set “identify patients correctly” as its first goal – a top goal since 2003. Compliance with this patient ID goal requires at least two patient identifiers be used any time blood samples are taken or when medication is administered. Clinics and hospitals utilizing a barcode system can easily provide new patients a uniquely barcoded wristband with those two identifiers.
Jefferson, Indiana’s Clark Memorial Hospital began a barcode initiative to reduce medication errors. Their first step was to generate patient wristbands. The barcodes on the wristband are then connected to that patient’s records within their patient tracking system. All medication orders are added to the medical record – effectively linking the patient’s barcodes with the medication’s barcode.
- Right Medication, Right Time, Right Dose & Right Route
Before any medication is administered, the patient’s unique barcode is scanned to access the medical record. The nurse or physician then scans the medication’s barcode. The software application compares the medication to the information in the patient’s record. This comparison allows for medication verification: type, time, dosage, and route.
According to a study performed by the Archives of Internal Medicine, approximately one in five doses of medication administered in hospitals is given in error. Many patient tracking applications – in conjunction with barcodes – utilize an alert system to prevent these errors. Alerts range from reminders to administer medication, collect specimens, or check vital signs to bedside alerts that a medication, dosage, or delivery route is incorrect for the patient.
Error Rates (Balas 2004): Wrong time – 33.6% | Wrong dosage – 24.1% | Wrong Drug – 17.2%
The FDA estimated that the use of an automated tracking application would intercept 50% of all medication administration errors when combined with its barcode mandate. For example, the Department of Veteran Affairs (VA) uses barcodes nationally within their hospitals; their VA medical center in Topeka, Kansas, reported an 86% reduction of medication errors over a nine-year period due to barcode use.
- Right Direction, Wrong Implementation
Although the FDA mandates barcodes be placed on medications, they have not mandated the legibility of those barcodes or the symbology that is used. Unfortunately, many clinics and hospitals are now faced with the task of relabeling any medication with an illegible barcode.
Labeling software that produces both 1D linear barcodes and 2D barcodes allows flexibility when designing and printing both patient and medication barcodes. Vial medications, due to small size and curvature, frequently require smaller labels. Additionally, those vials with 1D linear barcodes are often illegible because of the curvature. Disposing of expensive medication because of an illegible barcode is an unnecessary and easily avoided expense.
Clark Memorial Hospital relabeled their Patient Control Anesthesia medication cartridges with barcodes readable by the hospital’s Smart IV Pumps. The medication cartridge inserted into the IV pump includes a new barcode that, when scanned, crosschecks the drug and assures compatibility with the type of medication being dispensed. As stated by Clark’s Pharmacy Systems Administrator, Gary Pollock, “The WaspLabeler +2D barcode Labeling Software is great. It saves us money and time, and it will have an impact on decreasing medication administration errors and will improve patient safety.”
Although relabeling does involve an initial investment (software/labels/printers), the benefits save money over time, ensure efficiency, comply with federal regulations, and, most importantly, protect patients by meeting the five rights of medication administration.