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Health IT

Raising the Bar Code Requirement?

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Patient safety experts press government to increase bar code threshold for hospital medications.

Hospitals will be required next year to use bar codes to verify 10 percent of medication orders under government health IT rules. But for some patient safety advocates and bar code proponents, that threshold is too low.

The bar code requirements, along with electronic medication administration record (eMAR) tracking guidelines, are mandated under Stage 2 of government Meaningful Use standards aimed at modernizing the country’s health IT system.

The eMAR helps reduce transcription errors by ensuring medication is tracked from the point of the physician order, to the pharmacist, to the nurse administering the drugs. Bar coding, experts contend, improves that safety component even more.

When bar-code eMAR is used, the nurse at the patient’s bedside scans the bar code on the medication and the patient ID band. Referring to the medication administration record, the nurse can make sure the right drug and dosage is given to the right patient at the right time. There are multiple uses for bar coding in a hospital pharmacy, such as inventory, dose preparation and dispensing.

Numerous industry studies show that bar coding in conjunction with eMARs could have a significant impact on patient safety by reducing medication errors at the bedside.

According to a 2010 study conducted at Brigham and Women’s Hospital in Boston, the marriage of bar code technology with eMAR substantially reduced the rate of errors in order transcription and in medication administration, as well as potential adverse drug events. The study found a 41 percent reduction in errors in cases using bar-code eMAR.

Mark Neuenschwander, a Bellevue, Wash.-based consultant who specializes in drug dispensing and bar code point-of-care automation, calls the addition of bar-coding requirements at Stage 2 a good start.

“We should be striving for a higher percentage because errors can happen in the other 90 percent as easily as they can happen in the 10 percent,” Neuenschwander told HealthBiz Decoded.

While acknowledging that 100 percent would be an unrealistic level to start with, he made a comparison to car safety — asking how effective seat belts would be if they were only used 10 percent of the time.

“Meaningful Use is more than technology, it’s using that technology to reduce medical errors and improve patient safety,” Neuenschwander said, adding that he doesn’t expect the requirement to reach 100 percent anytime soon.

The Centers for Medicare & Medicaid Services (CMS) says that 10 percent is the minimum threshold for medication orders, but some hospitals are requiring a higher percentage of medications to be bar coded at the point of care.

In its final rule on Stage 2, CMS notes that the bar code threshold enables hospitals to “implement eMAR in a limited capacity,” since tracking medication orders in a single ward or combination of wards could achieve the 10 percent target.

“We believe the percentage measure of this objective yields maximum flexibility for a hospital to implement eMAR in a way that is clinically relevant to its individual workflow,” CMS said in the rule.

Nevertheless, some healthcare professionals are hoping that under Stage 3, scheduled to take place in 2016, the threshold will increase.

“I would think that 50 percent could be a good number when we get to Stage 3, but for now 10 percent might be good enough,” said Karl F. Gumpper, director of pharmacy informatics and technology at the American Society of Health-System Pharmacists (ASHP).

Gumpper says that although 10 percent is a very low adoption level, many hospitals are operating at 90 percent.

It’s important to keep in mind that bar-code-assisted medication administration (BCMA) may not be implemented in all areas of a hospital, he said, such as emergency rooms, operating rooms, and procedural areas. But underestimating the demand for bar coding would be a mistake, said Gumpper.

“The bar code at the bedside is that last defense for the patient to not get the wrong medication,” he said. “And if it’s tied to an EMR that’s being populated by the physician orders that are verified by a pharmacist, that allows for even greater patient safety and patient protection.”

 According to ASHP, the BCMA usage is on the rise in hospitals. The group’s latest survey of pharmacy practice in hospital settings found that during the past 10 years, the use of BCMA in U.S. hospitals has grown steadily. Only 1.5 percent were using the technology in 2002, but two-thirds of hospitals reported using it in 2012, following a significant ramp up over the previous two years.

Gumpper said that for now, things are heading in the right direction when it comes to bar coding. But while the 10 percent level is an appropriate starting point because at least most hospitals probably can meet that requirement, he said the bigger question is whether or not it is really “meaningful.”


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