Barcoding Technology May Improve Medication Accuracy

Use of a barcode-assisted medication administration system led to a significant increase in overall medication accuracy in most hospital settings, according to the results of a new study.

Using barcode-assisted medication administration systems with electronic medication administration records may help reduce medication errors within hospitals, according to the results of a study published in the February 1, 2014, issue of the American Journal of Health-System Pharmacy.

Despite the promise that barcode medication administration systems will reduce medication errors at the point of care, there is little evidence of their effectiveness. Using a pretest-posttest comparison group, the study analyzed the effects of a barcode-assisted medication administration with electronic medication administration record (BCMA-eMAR) system on medication administration accuracy rates at 2 community hospitals.

Pharmacists and nurses certified in medication observation collected data on medication administration accuracy and errors in a random sample of nurses who administered medications to adult inpatients, intensive care unit (ICU) patients, emergency department patients, oncology unit inpatients, and patients receiving an outpatient oncology service provided by one of the hospitals. Direct observations were conducted before implementation of BCMA-eMAR and at 6 and 12 months after the hospitals implemented the technology in 2007. Observation notes were compared with the physicians’ orders to detect any discrepancies between what was written and what had been observed. The researchers also analyzed differences in event rates associated with combined use of BCMA-eMAR and direct observation compared with voluntary reporting of errors.

The results indicated that the BCMA-eMAR system was associated with a significant increase in overall medication accuracy in most study units without introducing new types of error. The overall accuracy rate among inpatients at the first hospital increased significantly from 89% before BCMA-eMAR was used to 90% after the technology had been used for 12 months. When medications that were administered at the wrong time were eliminated from the analysis, the accuracy rate was found to have improved even more—from 92% to 96%. At the second hospital, the overall accuracy rate did not change significantly, although when wrong-time errors were excluded, accuracy improved from 93% before implementation to 96% a year after implementation.

Similar improvements in accuracy rates were observed in the emergency department. At the first hospital, emergency department accuracy rates increased from 86% before the system was implemented to 95% after 1 year of use, and from 87% to 99% when wrong-time errors were excluded from the analysis. However, there was no significant increase in accuracy rates in the outpatient oncology unit, and accuracy rates significantly decreased in the ICU at the second hospital. The number of errors greatly increased in the ICU, although most of these were technique errors that are not identified or prevented using BCMA technology.

The results also found that BCMA-eMAR did not introduce new types of errors into the administration process, an important finding that supports the use of the technology, the study authors note. BCMA-eMAR and direct observation were also more effective at intercepting, recording, and preventing errors than was voluntary reporting.

“When used together, these systems provide rich information for process improvements,” the authors write.