Michael J. Gaunt, PharmD MedicationSafety
Bar-code scanning can prevent many medication errors.
Maximizing the Effectivenessof Bar-Code Scanning
Bar-code scanning of medication containers during the dispensing process is one way patient safety can be improved by information technology. It serves to verify that the drug product and strength selected from storage matches what has been entered into the pharmacy computer system. When fully and properly implemented and used, bar-code scanning will not permit the dispensing process to continue if a match does not occur. When used together with computerized patient information systems, bar-code technology can prevent many medication errors, including dispensing the wrong drug, strength, or dosage form.
The biggest barriers to maximizing the usefulness of many technologies are system problems that exist in the medication use process. These problems encourage staff to work around the technology’s safety features or to use the technology in a way in which it is not intended. For example, the pharmacy staff at one community pharmacy used a sheet of bar codes prepared from the codes printed on the bulk cartons of frequently dispensed unit-of-use products (eg, various oral contraceptive products). This was done because the bar codes on the unit-of-use packages were not recognized by the system.
Keep in mind that even bar-code scanning cannot prevent all medication errors. If the wrong medication is prescribed, the wrong patient is selected, or the wrong strength is entered into the system, these errors will not be captured by the system.
SAFE PRACTICE RECOMMENDATIONS
When performing bar-code scanning, ensure that it is done consistently and as intended each time a medication is dispensed, including refills and owed quantities. Other ways you can maximize safety when using bar-code scanning systems include:
• Always scan the bar code printed from the pharmacy computer systemand the bar code on the medication product being dispensed. Avoid verifying product selection by typing the National Drug Code (NDC) number from the patient’s label or the computer screen, because this undermines the system safeguards. If you must type the NDC number because the bar code will not scan, type it from the medication product.
• During order entry, either type the drug name and strength or use the computer system’s drug look-up feature. Do not first retrieve the product from storage and scan the bar code as a way of entering the drug. If the wrong product is selected from storage, there will be no opportunity to catch the error later in the dispensing process by scanning the bar code.
• When more than 1 stock bottle is needed for a specific drug quantity, scan each one.
• If more than 1 container will be dispensed, ensure that each one has a pharmacy-generated label. Scan each medication product for verification. For example, dispensing 3 albuterol inhalers should require 3 individual computer-generated labels and the scanning of each albuterol inhaler package bar code.
• Review system reports on overrides of scans to discover problems in workflow and make necessary changes. This also can help identify issues with specific products (eg, the barcode is illegible or is bent around the curve of the bottle, making it difficult to scan).
• Never bypass a bar-code scan in the interest of delivering a prescription more quickly. Correcting a misfilled prescription after it reaches the patient and is later returned to the pharmacy is more labor-intensive and decreases trust. Most importantly, the error could result in harm to the patient.
• If a mismatched scan is identified, investigate the cause. Sometimes the generic manufacturer may have changed since the last refill, or portions of the NDC number may be correct except for the last 2 numbers, which represent the product size. Correct the patient’s label with the NDC of the medication actually being dispensed. In all circumstances, the best practice is to void the prescription and reprocess it with the correct NDC, which can be scanned for verification. PT
Dr. Gaunt is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/ Ambulatory Care Edition.