Originally Published PMPN April 2003
EDITORIAL
Hospitals Are Prepared for Bar Codes
When the Institute of Medicine released its 1999 report on medical errors, John Tourville wasn't shocked by the numbers. He thought they would be higher. "Not all errors are reported," says Tourville, director of pharmacy for Children's Medical Center of Dallas. "Children often don't react to a drug mistake, so a mistake may not even be noticed."
But one mistake is too much, at least for Children's Medical Center. Back in 1994, the center's COO set a zero-tolerance policy for mistakes. Since then, Tourville and his colleagues have done much to reduce errors. Their approach is a multiyear, multistep effort. Its latest step is using bar codes and radio-frequency identification. Their success shows that FDA's bar coding regulation, proposed on March 14, is the right step for the healthcare industry.
Tourville's team saw that many errors occur when processes depend upon human short-term memory and attention. So they set out to design processes that minimize these dependencies. One process prone to errors is IV drug infusion.Typically, nurses must program a pump by hand. "One-third of major medical errors are IV pump errors," says Tourville. "It takes time to program them correctly." Identification errors are also possible.
To reduce such errors, Tourville set up a process by which IV bags are automatically identified and pumps automatically programmed. The hospital is now using B. Braun's Outlook Safety Infusion System as part of a pilot to test Tourville's approach. IV bags bear both drug-specific manufacturer-generated bar codes and patient-specific pharmacy-generated bar codes. Nurses scan them to match bags to patients. Initial bar code scanning identifies a patient and programs the pump to follow that patient's prescription, explains Mike Zakrewski, B. Braun's product director, IV systems.
B. Braun's goal was to make IV drug administration safer and faster, says Carla Carpenter, director of business development. "Weight-based dosing can be critical, especially when nurses are treating children ranging from 6 to 40 lb," she says. B. Braun now bar codes all IV bags it manufactures and fills. Of its line of 4000 products, 2900 are bar coded at the unit level, she says, with NDC, lot code, and expiry date.
Tourville believes that this system can prevent all of the types of adverse events that occurred at Children's Medical Center last year. But he doesn't plan to stop there. His team has been involved in B. Braun's efforts to incorporate radio-frequency technology into the Outlook device. This patent-pending technology will allow real-time monitoring of infusion via standard Web browsers while providing the ability to send infusion data to reporting/documentation programs. The RF technology will be compatible with most bedside administration systems and allow infusion data to be uploaded to the device to further automate programming.
Excited about FDA's proposed bar coding rule, Tourville does see some challenges ahead—but they aren't technological. "I would like to think that insurance companies would see the value in reducing errors and therefore reimburse hospitals that take steps to reduce them," he says. Tourville will present his approach at Premier's annual Breakthroughs Conference May 13–16 in Las Vegas.
As more pilot programs like this succeed, more players in healthcare will support automatic drug identification and take steps to employ it. So, perhaps the question of whether hospitals are ready or willing to use bar codes—often a rebuttal to FDA's proposed bar coding regulation—no longer needs asking.
Daphne Allen, Editor
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