This document summarizes research on the impact of bar-code medication administration (BCMA) technology in reducing medication errors. Studies show BCMA reduced dispensing errors by 36-63% and potential adverse drug events by 63%. BCMA also reduced medication administration errors in intensive care units by 19.7% to 8.7%. While BCMA's impact varied between ICUs and general wards, it reduced clinically important error types. 9% of intercepted errors using BCMA were considered moderate or severe risks. BCMA has potential to reduce errors but continued improvements are still needed given medication errors can still occur.

1. Improving Patient Safety Outcomes:
Impact of Bar-code Technology
Bar-
Mitchell Buckley, PharmD, BCPS
Clinical Pharmacy Specialist
Banner Good Samaritan Medical Center
Phoenix, AZ
January 11, 2010
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2. Disclosure
• No financial disclosures
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3. Objectives
• Review medication error epidemiology
• Evaluate bar-code technology studies impacting dispensing and
bar-
administration errors
• Discuss types and severity of errors affected by bar-coding
bar-
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4. Technology Prevention Strategies
Electronic Medication Automated Medication Bar-
Bar-coded Medication
Administration Record Dispensing Machine Administration
Prescribing Transcription Dispensing Administration
Computerized Physician IV Infusion
Order Entry Safety Pumps
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Oren E. Am J Health Syst Pharm 2003;60:1447-1458
2003;60:1447-

5. Medication Error Epidemiology
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6. Background
• 1.5 million patients harmed by medications in U.S. annually
• Hospitalized patients at risk for medication errors
• 19% of all medical errors were medication-related
medication-
• 400,000 preventable ADEs per year
(~1 medication error / patient / year)
• 78% of medical errors in ICU associated with medications
• 28% of ADEs estimated to be preventable
• Increased hospital length of stay, cost and mortality
Bates DW. Am J Health Syst Pharm 2007;64(Suppl 9):S3-S9
9):S3-
Rothschild JM. Crit Care Med 2005;33:533-540
2005;33:533- 6
Leape LL. N Engl J Med 1991;324:377-384
1991;324:377-
Bates DW. JAMA 1995;274:29-34
1995;274:29-

7. Overall Medication Error Rate:
Distribution in Medication Use Process
Administration Prescribing
38% 39%
Dispensing Transcription
11% 12%
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Leape LL. N Engl J Med 1991;324:377-384
1991;324:377-

8. Incidence of ICU Medication Errors:
Distribution in Medication Use Process
Potential ADEs (n=110)
100
Actual Preventable ADEs (n=22)
77
Percentage (%)
80
60
40 34 34
28
23
20
5
0 0
0
Prescribing Transcription Dispensing Administration
Stage of the Medication Use Process
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Kopp BJ. Crit Care Med 2006;34:415-425
2006;34:415-

9. Severity of ICU Medication Errors:
Distribution in Medication Use Process
Fatal Serious
Life-
Life-Threatening Significant
100
80
Percentage (%)
60
40
20
0
Prescribing Transcription Dispensing Administration
(n=48) (n=5) (n=37) (n=42) 9
Kopp BJ. Crit Care Med 2006;34:415-425
2006;34:415-

10. BCMA Technology Impact:
Published Data
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11. Medication Errors & Potential ADEs:
Before and After BCMA Implementation
• Objective
• Evaluate BCMAs impact of on dispensing errors
• Methods
• 735-bed tertiary care academic center
• Before and after observational study
• Data collected over 20 month period
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Poon EG. Ann Intern Med 2006;145:426-434
2006;145:426-

12. Medication Errors & Potential ADEs:
Before and After BCMA Implementation
p<0.0001
100
1.0
Annual Error Prevention Projections
• >13,500 dispensing errors
Percentage (%)
80
0.8 36% • >6000 potential ADEs
Reduction
60
0.6
0.4
40 p<0.0001
0.2
20 63%
Reduction
0
0
Dispensing Error Rate Potential ADE Rate
Pre-
Pre-Bar Code Period Post-Bar Code Period
Post-
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Poon EG. Ann Intern Med 2006;145:426-434
2006;145:426-

13. Medication Errors in the ICU:
Before and After BCMA Implementation
• Objective
• Measure the impact of BCMA on medication
administration error rates in MICU
• Methods
• 744-bed community, teaching hospital
• 38-bed MICU
• Direct observation technique
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DeYoung JL. Am J Health Syst Pharm 2009;66:1110-5
2009;66:1110-

14. Incidence of Medication Errors:
Impact of BCMA in the ICU
40
35
p<0.001
30
• Before BCMA
Incidence (%)
25 • n=47 patients
19.7
20 • 153 errors / 775 administrations
• After BCMA
15
• n=45 patients
10 8.7
• 60 errors / 690 administrations
5
0
Before After
Implementation Phase
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DeYoung JL. Am J Health Syst Pharm 2009;66:1110-5
2009;66:1110-

15. Type of Error
p<0.001
Percentage (%)
p=NS
p=NS
p=NS
Wrong Time Omission Wrong Drug Documentation
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DeYoung JL. Am J Health Syst Pharm 2009;66:1110-5
2009;66:1110-

16. BCMA Impact on Medication Errors:
ICU vs. General Ward
• Objective
• Measure the impact of BCMA on administration
error rates in multiple patient care areas
• Methods
• Prospective, observational study
• 386-bed academic teaching hospital
• Multiple patient care areas
• 2 medical-surgical wards
• MICU
• SICU
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Helmons PJ. Am J Health Syst Pharm 2009;66:12021210

17. Overall and “Wrong-Time” Error Types:
ICU vs. General Ward
p=NS
Overall
• No difference in error rate
p=NS
(ICU or non-ICU)
General Ward
• Increase in “wrong-time
errors” after BCMA
• 58% decrease after BCMA
(excluding “wrong-time”errors)
ICU
• No differences
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Helmons PJ. Am J Health Syst Pharm 2009;66:12021210

18. Types of Errors Excluding “Wrong-Time”:
ICU vs. General Ward
General Ward
• Decrease in “omission” errors
(p<0.0001)
• Decrease in “drugs not available” errors
(p<0.05)
ICU
• No differences
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Helmons PJ. Am J Health Syst Pharm 2009;66:12021210

19. Severity of Drug Administration Errors
• Objective
• Evaluate the severity of potential medication errors
during administration phase intercepted by BCMA
• Methods
• 6 community hospitals
• Same BCMA system
• Multidisciplinary reviewing panel (n=6)
• Medication Errors classified by severity
• Minimal
• Moderate
• Severe
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Sakowski J. Am J Health-Syst Pharm 2008;65:1661-1666
Health- 2008;65:1661-

20. Results
• Overall severity
• 945 total errors detected
• 9% (n=81) were “Moderate” or “Severe”
• “Moderate” or “Severe” errors by type
• 21% “no order”
• 9% “discontinued or expired order”
• 4% “dose early”
• 4% “wrong dose”
• Errors involving “high-alert” medications
• 20% = insulin, narcotics, potassium, sodium, anticoagulants
• Narcotics most common of “high-alert” drugs (74%)
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Sakowski J. Am J Health-Syst Pharm 2008;65:1661-1666
Health- 2008;65:1661-

21. Conclusion
• Types of errors impacted by BCMA varied between ICU and
non-ICU patient care areas
• Although the clinical significance of “wrong-time” errors remains
controversial, BCMA has the potential reduce other clinically
important medication errors
• Medication errors still occur despite BCMA suggesting the
necessity for continued process improvement and further
system changes to compliment this technology
• Studies limited by low baseline prevalence of medication error
• Dispensing and administration errors were significantly
decreased with BCMA technology
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22. Questions
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23. Incidence of Medication Errors:
Intensive Care Unit vs. General Ward
ICU General Ward p=NS
50
p=NS
Percentage (%)
40
30
p=NS p=NS
20
10
0
Prescribing Transcription Dispensing Administration
Stage of the Medication Use Process
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Cullen D. Crit Care Med 1997;1289-1297
1997;1289-

24. Bar-code Medication Administration
Technology Prevalence
U.S. Hospitals with BCMA 40 BCMA Acquisition Plans
40
Percentage (%)
Percentage (%)
30 30
20 20
10 10
0 0
<1 1- 3 >3 No Plan
2002 2005 2007 2008
Implementation Timeframe (Years)
Year
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Pedersen C. Am J Health Syst Pharm 2008;65:2244-2264
2008;65:2244-