ABSTRACT

Estimates of rates of adverse events in hospital settings range from 3.7% based on chart review [1] to 17.7% based on direct observation, [2] with medication errors the most commonly documented cause of adverse events in hospitals. [3] In an analysis of 334 medication errors from 11 acute care wards, 38% of the problems occurred at the time of administration by nursing personnel. [4] Although some believe that bar-code technology reduces medication errors and tracks near misses, supporting empirical evidence is limited. [5,6]

Bar-code scanning is the oldest machine-readable identifi cation system and has been widely used in industrial manufacturing, shipping, and inventory control. [7,8] Compared with typing, which produces about one error every 300 keystrokes, bar-code scanning error rates range from one character in 15,000 to one in 36 trillion. [9] The use of bar-code medication administration (BCMA) systems to improve patient safety has been recommended by many organizations, including the Institute of Medicine, the National Patient Safety Foundation, the American Society of HealthSystem Pharmacists, and the National Alliance for Health Information Technology. On February 25, 2004, the U.S. Food and Drug Administration fi nalized a rule for bar-code labeling medications and blood components to prevent adverse events. [10] The rule requires placement of a linear bar-code label containing the National Drug Code number on most

prescription drugs and certain over-the-counter drugs within two years. In addition, the Joint Commission on Accreditation of Healthcare Organizations is considering requiring that bar-code technology for patient identifi cation and for matching patients to their medications and other treatments be operational in all health care accreditation programs by January 1, 2007. [11]

VHA has used its relatively mature BCMA system since 2000, and BCMA is deployed in all VHA facilities across the United States. Nurses access BCMA software by using a laptop computer attached to a wheeled medication cart and linked by a wireless network to electronic databases. If the scanned medication bar-code data do not match what is ordered for a patient identifi ed by scanning a bar-coded wristband, the nurse is alerted to the discrepancy by the software (Figure 1, page 357).