A common misconception is that medication management is the sole responsibility of pharmacists. However, enhancement of such a complex system requires a collaborative and multidisciplinary approach, since diverse healthcare professionals touch upon medication management in one way or another. Numerous innovative technologies have been implemented to improve medication prescribing and to ensure safe and accurate distribution of drugs such as computerized physician order entry (CPOE) and automated dispensing cabinets. A landmark study in 1995 by Leape, Bates et al.1 showed that 34% of preventable adverse drug events occurred at time of administration, of which 51% resulted in patient harm. Barcoded medication administration is one of the strategies developed to alleviate risk associated with this process: a patient’s wristband and the medication barcode label are scanned before each dose is administered. This reinforces the 5 rights of medication administration so that the right drug, in the right dose, by the right route gets to the right patient, at the right time.
In 2012, Dwibedi et al.2-3 published their findings of a prospective observational study comparing paper-based medication administration (PBMA) with barcode medication administration (BCMA) in the intensive care unit (ICU). The primary objectives were to measure the amount of time nurses spent on diverse tasks with PBMA (n = 101) and BCMA (n = 151). Results revealed that with BCMA, nurses spent more time preparing drugs (p < 0.05), helping doctors (p < 0.05) and interacting with patients (p < 0.05). Additionally, medication administration with BCMA required less time than the PBMA process (p < 0.05), as did medication administration documentation (p < 0.05) and checking medications against prescribed orders (p = 0.04). This allowed for more nursing time to be spent on direct patient care activities.
Another evaluation, conducted by Richardson et al.4, assessed the effect of barcode technology on the safety of drug administration whereby medication verification by nursing is performed through scanning within an electronic medication administration record (eMAR). The percentage of scan rates was maintained at more than 97%, resulting in a decrease in medication incidents from 2.89 errors per 10,000 doses pre-implementation of an eMAR to 1.48 errors per 10,000 doses once this was rolled out. This clearly illustrates the positive outcomes of automated processes on safer medication administration.
DeYoung and his colleagues5 also found a decrease in medication errors when comparing incident rates pre- and post-implementation of BCMA in an adult intensive care unit, 19.7% versus 8.7% respectively (p < 0.001). Most of the errors prevented were with regard to incorrect administration times. Poon et al.6 disclosed similar findings published in The New England Journal Medicine. Of 14,041 observed medication administrations, a decrease of 27.3% in errors related to wrong administration time was noted as a result of implementation of a barcode eMAR (p < 0.001).
Although integrated medication related systems may mitigate potential risks at the stage of medication administration, it is crucial that clinical decision support be incorporated into these technologies. In the absence of such safety nets, BCMA would not add much benefit in catching potential errors. Moreover, additional studies are needed to validate the impact of BCMA on medication errors, beyond those related to inaccurate administration times.
1. Leape L, Bates D, Cullen D, et al. Systems analysis of adverse drug events. JAMA