Bar-code technology cuts medication errors: study

Using bar-code verification technology for medication administration can significantly reduce error rates and decrease the likelihood of adverse events, according to a newly published study in the New England Journal of Medicine.

In the study funded by the Agency for Healthcare Research and Quality, researchers at Brigham and Women's Hospital, Boston, examined data from several units in the hospital as they rolled out a staggered implementation of an electronic medication administration record, or eMAR, with bar-coding technology. The use of a bar-code eMAR was associated with a 27% decrease in timing errors, such as late or early medication administration, and a 41% drop in the rate of errors not related to timing, which include incorrect dosages and administration without an order.

Also, researchers noted that the rate of potential adverse events associated with errors not related to timing fell from 3.1% to 1.6%—what they described as a nearly 51% relative reduction. Not surprisingly, use of a bar-code eMAR also eliminated transcription errors, which occurred at a rate of 6% on units that did not yet have the system in place.

Bar-code eMAR systems allow nurses to receive medication orders electronically from a pharmacist or from a computerized physician order-entry system, and then use a bar-code scanner to verify medications at the patient's bedside.

The results of the study demonstrate that bar-coding can have a substantial effect on safety, according to Eric Poon, director of clinical informatics at Brigham and Women's, and lead author of the study. Poon also expressed confidence that the observed improvements were due to the implementation of bar-code eMAR systems and not another factor.

“We took measurements within a pretty small time frame, and the implementation was the main project we were doing at the hospital during that time period,” Poon said.

Still unclear, however, is whether hospitals with limited resources should implement a CPOE or bar-code eMAR system, Poon said, adding that Brigham and Women's has had a CPOE system in place for many years. The two systems catch different types of errors and complement one another, he said.

For instance, a CPOE system is more likely to prevent errors related to incorrect judgment or insufficient clinical knowledge when choosing a treatment plan, while a bar-code eMAR usually catches errors associated with lapses in memory or mental slips, the study said.

“If a hospital can only afford one, we need to know which one makes the most sense to implement first,” Poon said. “That question is still unanswered.”