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Flaws in the barcoded technology used to reduce medication administration errors identified
Date:7/1/2008

medications charted. In contrast, vendors of barcode medication administration (BCMA) systems report error rates that are a small fraction of this study's numbers; but vendors focus primarily on the ability to physically affix and read barcodes, not on the totality of the many processes in actual use. In addition to examining the million scans, Dr. Koppel and colleagues spent years shadowing nurses using the technology, participated in many BCMA implementation meetings, and conducted scores of interviews with pharmacists, nurses, and IT leaders.

Hospital patients, on average, are subject to one medication administration error a day, according to the Institute of Medicine, and in hospitals, medication administration accounts for 26% to 32% of adult patient medication errors. Thus, an automated system using barcodes to reconcile a patient's medications and orders with the patient's identity would be a great advance, helping to ensure the right patient receives the right dose at the right time.

But what Penn's Professor Koppel and his colleagues found in the five study hospitals were 31 "causes" of problems that engendered workarounds by the nurses. These causes included: unreadable medication-barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient-ID-wristbands (chewed, soaked, missing); non-barcoded-medications; medications in distant refrigerators, lost wireless connectivity; problems with patients in contact isolation, and emergencies. In some cases, if the pharmacy sent two 10mg tablets for a 20mg order, the scanners/computers would not accept the medications. Nurses devised workarounds to compensate for the awkward and inconvenient aspects of the barcode technology. These nonstandard procedures consisted of, for example, affixing extra copies of patient ID barcodes on desks, scanning machines, clipboards, supply room, and doorjambs, as well as carrying several pre-scan
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Contact: Marc Kaplan
marc.kaplan@uphs.upenn.edu
215-662-2560
University of Pennsylvania School of Medicine
Source:Eurekalert

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