Procedure for Dispensing Meds

Medication Administration Tech Policy and Procedure Change Bar Code Reader System for Medication Administration Though the Utah State Hospital has an integrated electronic prescription system there is no evidence that the institution utilizes bar code reading technology either on the unit or in the pharmacy itself. This is evidenced by the lack of such information in the institutions policies and procedures manual, and specifically in their policies and procedures associated with controlled drugs, which is an area where inventory controls, accountability and patient safety are particularly important.

Such a system would serve the patient population well, helping to ensure that fewer errors were made and more observation of possible conflicts between medications as well as other issues could be more closely monitored. This work will describe in detail from the literature both the types of systems available, their use and the research effects associated with them to aide in the development of a policy and procedure change recommendation for Utah State Hospital.

There have been countless advances in the technology associated with patient care, across the health care industry. With those advances in technology none are probably more patient centered and effective than the advances in information technology associated with electronic patient records and other integrated institutional systems ("ASHP statement on bar-code verification…," 2011). The advances have been so profound that some of them are even being mandated and supported by federal legislation.

Among those advances are many technologies that attempt to increase checks and balances in the delivery of patient care and most importantly in the delivery of medications to patients (Agrawal, 2009). The Institute of Medicine (1999) suggested that preventable adverse drug events or harmful medication errors occur in 1%-10% of hospital admissions. Information technology such as bar codes can reduce errors throughout the medication process (Poon et al., 2006). Point-of-care administration of medications with bar-code scanning allows verification of the five rights of medication administration (Fowler, Sohler & Zarillo, 2009, pp. 103-104).

In the institutional setting where there is often and in house pharmacy such as a large hospital, rehabilitation center, nursing care home or even a psychiatric hospital there is great potential for integration of electronic patient records with other functions of the institution such as inventory control, ordering and accountability (Prusch, Suess, Paoletti, Olin & Watts, 2011).

Among the advances associated with medication and integration of information are bar code reading systems that further the knowledge of all stakeholders, allowing every person who is involved in medication for patient delivery to have immediate access to information regarding inventory, patient orders, simultaneous laboratory issues and even in the case of controlled drugs a higher level of accountability ("ASHP statement on bar-code verification…," 2011).

Ultimately these systems decrease the odds of traditional medication errors (wrong patient, wrong drug, wrong dose, wrong route, wrong time) (Fowler, Sohler & Zarillo, 2009) (Wild, Szczepura & Nelson, 2001, 26-30). There is in fact evidence that indicates staff satisfaction is increased by the use of trusted technologies such as bar code reading systems from filling to delivery after the change was fully integrated and accepted (Fowler, Sohler & Zarillo, 2009).

Bar code systems can be utilized in the pharmacy to reduce errors in delivery of the wrong medication, and especially look alike and sound alike drugs. Yet, within the system of delivery and administration bar code systems could follow the drug all the way to the patients' hands.

Each drug be it stock bottled and stored in the drug room to drugs that are packaged specifically for each patient, often in blister cards on the nursing floor, can be accompanied with a label that contains a barcode that can be scanned in conjunction with a patients electronic chart to ensure that the drug, dose, route, and time are all ordered and up-to-date for that specific patient (Fowler, Sohler & Zarillo, 2009).

The system could also go farther if the institution decided to implement a patient bracelet system such as are found in nearly all hospitals and many other medical institutions in the U.S. This type of barcode system, referred to as a point of care system works basically like this: The basic concept for a bar code point-of-care test is that information is encoded in bar codes, allowing for the comparison of the medication being administered with what was ordered for the individual patient (Sakowski et al.,2005).

After a medication order is written (electronically or manually), a pharmacist enters, verifies, and profiles the order. Prior to administration of the first dose, the nurse confirms a match between the written and electronically profiled order. When the nurse is ready to administer a medication to a patient, he or she uses a handheld bar-code reader to scan the patient's special wristband and medication, at which time the software verifies it is the correct medication and dose as well as the correct time and patient. (Fowler, Sohler & Zarillo, 2009, p.

106) This system would then allow the nursing staff to be assured that traditional medication errors error are rarely made, especially at the point of delivery and with the integrated inventory and manufacturer bar code system in place and accuracy of pharmacist fill and physician orders many fewer errors are made from order to delivery (Fowler, Sohler & Zarillo, 2009).

Research on bar code reading systems in both the pharmacy and at point of care is relatively new, but is very promising in its results of long-term reduction in medication errors (Fowler, Sohler & Zarillo, 2009). More research clearly needs to be done as more and more of such systems are implemented.

This research is integral to a greater understanding of how the systems need to be altered to best meet the goal of excellent patient safety with regard to medication errors as well as ease of use and practicality for staff. The most important research should be focused on how to best develop and tweak bar code systems so they are both most effective in reducing medication errors and.