The Promise and Reality of Barcodes

Try as we might, healthcare will never be error-free. But we healthcare professionals must do whatever we can to ensure that it is harm-free.

  • by Staff Writer, MedPage Today

One area where we can have a significant impact, and where there is much room for improvement, is in the reduction of medication errors.

One attempt at that goal was the introduction of barcodes to match medications with patients in the hospital setting.

But barcodes have not proven to be a "silver bullet" solution to preventable medication errors. In fact, barcodes have actually caused unintended headaches for hospitals that continuously attempt to perform at higher standards.

In their paper "Workarounds to barcode administration systems: Their occurrences, causes and threats to patient safety," in the July/August edition of the Journal of the American Medical Informatics Association, Dr. Ross Koppell and colleagues provide a detailed look at the errors that can occur with the use of barcoded medication administration systems.

They explain that these systems were designed to improve patient safety by requiring providers to scan a unique barcode on a patient's ID bracelet and a barcode affixed to a medication intended for administration. In this way, the computer could record the medication therapy for a specific patient and confirm the five "rights" of the medication administration: right patient, right drug, right dose, right route, and right time.

Unfortunately, Koppell and colleagues describe what they term "user workarounds" -- which intentionally ignore process or procedure -- that have sabotaged the effectiveness of the barcode system.

For example, staff make multiple copies of the barcode for placement in a convenient central location (creating the possibility of scanning the wrong barcode) and disable the audio alarm (because it's annoying) that alerts of an incorrect medication.

How many patients have suffered or died as a result of these interruptions in process? Hopefully, zero, but that's not likely, because Koppell and colleagues found a total of 15 types of workarounds with 31 different probable causes.

The number and variety of user modifications to the process highlight the need for a significant change in the implementation of barcoded medication administration systems.

A bar code is a wonderful idea, but without a culture of safety, it is not nearly as valuable as everybody believes. It is imperative that we, as a medical community, continuously put the safety of our patients first and foremost, despite the extra time, effort, and education this assurance requires.

Despite the problems with provider operation, barcode systems are a significant step in the right direction for quality improvement in American hospitals.

A computerized system, when used appropriately, has the potential to prevent such horror stories as the infants who died or suffered permanent damage as a result of having received adult doses of blood-thinning medication because of a stocking error. Barcoded medication administration offers an additional check to ensure the safety of patients by alerting the user when a medication is about to be inappropriately administered.

In addition, the system utilizes an electronic medical record, which offers numerous benefits to a hospital. In a healthcare community where pay-for-performance (which relies on medical reporting) is becoming increasingly widespread, barcoded medication administration can be incorporated into the documentation and reporting process for simple and easy compliance.

Unfortunately, as Koppell and colleagues conclude, "with any technology in complex organizations, workarounds will occur." The goal of the quality improvement community is to minimize these workarounds through education, oversight, and continuous reevaluation. Although the work of Dr. Koppell and colleagues focuses on medication administration, this agenda should be applied to every aspect of medical care where preventable errors are a possibility.

In a time when the medical profession is under unprecedented scrutiny and asked to provide unprecedented transparency, measures to advance performance and quality are more important than ever.

Exposing the pitfalls of barcoded medication administration systems and proposing solutions to improve patient care are certainly steps in the right direction.