Is bar-coding the best medicine?
In a large hospital, a nurse bustles into a patient's room and unclips a palm-sized computer and scanner from her waistband. She swipes the scanner across the patient's wristband, scans her own identification and then scans the vial of medicine in her hand. The computer beeps, warning her that this is the wrong drug for her patient — and alleviating what could have been a serious medical error.
Given the prospect of reducing the likelihood of such mistakes, a few hospitals have implemented bar-coded medication-administration systems and many more are considering installing them. "Theoretically, it sounds like a no-brainer," says Industrial and Systems Engineering Assistant Professor Ben-Tzion Karsh. "This obviously should reduce medication-administration errors, but in fact, we don't know that to be the case right now. There's been scant evidence."
Limited studies have examined how bar-coding technology affects medication-administration errors, he says. However, with a $1.36 million grant from the Agency for Healthcare Research and Quality, Karsh is leading an effort to study the technology's effect on an entire organization.
"Any technology change is tantamount to an organizational change," he says. "The way people do their work will change. And by not understanding people's jobs — how the different processes, including communication, supervision, auditing and quality control are all going to change — then by implementing the technology we're putting a health-care organization and the patients and the employees at risk. This study is designed to fill that gap."
In addition, it is unique, he says, because it will be the first major study of the technology as it's applied in pediatric hospitals, which have their own set of potential medication errors. There are additional calculations for a dose based on a child's weight. Very young children can't say what's wrong when they don't feel well. And can you put a bar-coded wristband on a premature baby?
Working with similar pediatric hospitals in Wisconsin and Tennessee, Karsh's group will assess the technology's overall effect. One hospital is implementing a bar-coding system; the other will be a comparison group. Prior to the implementation, researchers will collect medication error data, conduct a work-system analysis, and interview employees about their perception of the way they currently work and of the safety and quality of the processes they use.
Once the bar-coding technology is in place, the researchers will gather the same data three more times. "We're expecting that maybe three months after the implementation, things may still be a little hectic and there'll be a lot of problems," says Karsh. "Maybe six months later, things will have calmed down and maybe a year later they'll have new problems."
When the study concludes, Karsh's team will establish guidelines to help health-care organizations prepare their entire facility to implement bar-coding technology and understand and navigate the changes and "bumps" that may occur afterward. "That will hopefully benefit the employees in terms of less wasted time, potentially even more satisfaction with their jobs because they feel that the care they're providing is safer and of higher quality, and certainly importantly, more safety and higher quality care for the patients," he says.