Methodist Medical Center Uses Bar Coding to Reduce Errors
Challenge
In 1999, Methodist Medical Center in Peoria, Illinois, recorded an incidence rate of five adverse drug events (ADEs) per 10,000 doses of medications administered. At the same time, the Institute of Medicine released its report “To Err is Human,” which highlighted an alarming rate of patient deaths due to preventable medical errors, thus reinforcing the urgency to implement an automated system to reduce the risk of potential ADEs.
Solution
That same year, Methodist’s new chief executive officer, Michael Bryant, formed an executive IT steering committee to find solutions to the patient safety issue. “The bar coding strategy was selected because it provides the opportunity to close the loop of medication ordering and administration, and offers the added benefit of providing a second check for nurses,” said Tom Rippeto, Methodist’s chief information officer. The bar coding system also offered a more accurate, less subjective method of capturing and reporting medication errors.
As the hospital’s first step, its pharmacy department committed to bar coding all medications at the unit-of-use level. This was essential to the success of medications being scanned for the “five rights” (right dose, right medication, right patient, right time, and right route) at the bedside prior to administration. The entire inventory was converted to items that either came with bar codes from the manufacturer on each unit dose, or bulk items that could be unit-dose packaged with a bar code by the pharmacy. Items that could not go through the packager had bar codes applied to them. Methodist chose solutions from Zebra to create on-demand bar code medication management labels in the pharmacy for bulk multi-dose items and on-site compounds (mixtures). Thermal printers from Zebra were chosen for their superior flexibility, functionality, and bar code readability.
The oncology unit was chosen as the first to implement the bar code solution, followed by other units throughout the hospital. Today, nurses scan medications at bedside with wall-mounted computers/scanners. Software by McKesson documents medication and IV administrations at the point of administration. Nurses can add notes to provide further details about a medication administration. Pharmacists review all documented orders, which are screened for allergies, interactions, and therapeutic duplications. Pharmacists also can insert comments relating to medications that nurses can view by hard copy report or electronically via the patient online order review. Bar coded data is combined with other patient data charted in an integrated flow sheet that is viewed by physicians, nurses, pharmacists, and other caregivers throughout the institution.
Furthermore, Methodist has instituted a “no penalty” error reporting system that allows clinicians to report not only errors but also observations and recommendations for process improvements.
Results
Within one year of rolling out the bar coding technology facility-wide, the rate of adverse drug events fell to 2.3 per 10,000 doses—a 50 percent reduction. After an early swell of incidence reports, the error reporting system has recorded less activity, indicating that observations and recommendations from the error reporting system are being incorporated into mainstream processes.
