Point-of-care bar-coded medication administration: experience in the United States.

1 , hospitals have increased their focus on the prevention of medical errors especially those involving medications. This report noted that bar coding is " an effective remedy " for medication errors, a " simple way to ensure that the identity and dose of the drug are as prescribed, that it is being given to the right patient, and that all of the steps in the dispensing and administration processes are checked for timeliness and accuracy. " The IOM estimated the financial costs of drug-related morbidity and mortality at about $77 billion a year. A second report by the IOM, Crossing the Quality Chasm 2 , urged that health systems begin a greater emphasis on adoption of technology to provide a safer, more efficient, and higher quality healthcare system. Although not the panacea for error prevention, the safe use of technology can provide a decreased reliance on manual systems of redundancies and the dependence on individual performance to prevent errors from reaching patients. Some of the technologies that can improve medication safety include: electronic prescribing (Computerized Prescriber Order Entry [CPOE]) with medication alerts and clinical decision support , automated drug storage and dispensing devices that include review of orders by pharmacists before medications are available as well as provide medication safety alerts to nurses, medication robotic storage and dispensing systems, and bar coded identification of medications before they are administered to patients (bar coded enabled point-of-care [BPOC]) systems. This last use of technology, BPOC, has been gaining popularity due to the number of errors that can occur at drug administration and the impact on error prevention at a vulnerable point in patient care. The results of the ADE Prevention Study 3 revealed that one of the areas in which serious medication errors are most likely to occur is at drug administration. They noted that 39% of errors occur during the prescribing phase, 12% occur during transcription, 11% occur during dispensing, and 38% occur during administration. More importantly, they revealed that 48% of the prescribing errors were intercepted before they reached patients but only 2% of the administration errors were intercepted. This would be expected since drug administration is the last line of defense. There are very few system safeguards at the point of drug administration whereas pharmacists and nurses may have several opportunities to intercept a prescribing error before it would reach the patient. A direct observation study of drug …