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Rice Hospital implements bar-coding system in newest effort to improve medication safety

The same bar-code technology used at the supermarket is being introduced at Rice Memorial Hospital this week to help ensure the right patient and the right medication are correctly matched. The bar-coding project has been in the works since last fall. Tribune photo by Anne Polta

The same technology that scans your lettuce and ground beef at the grocery store checkout is being used at Rice Memorial Hospital to increase medication safety.

By bar-coding both the patient's ID band and medication, hospital officials hope to provide one final check -- right patient, right medication, right dose, right route, right time -- before the medication is given.

"All of us who work in the hospital here want to help people, so how can we do that in the safest way we can find? That's why we're doing this," said Lachelle Below, a pharmacist at Rice Hospital.

The system, which has been in the works since last fall, goes into effect today on all of Rice's inpatient units.

Before nurses hand out a pill or hang an IV solution, they'll be required to scan the patient ID and the medication to ensure everything matches -- and if something isn't right, an alert will pop up that stops them from going any further.

Martha Tack calls it "that final check."

"I think it'll give us that confidence as nurses that we are giving the patient the best care we possibly can," said Tack, a registered nurse in Rice's intensive care unit.

In the drive to make health care safer, medication safety looms large. It's a complex process that can break down at any of multiple points: how the drug is prescribed, how the order is read and dispensed by a pharmacist, how the drug is administered by a nurse.

Adverse events don't happen often. Last year at Rice Hospital, reportable errors took place in approximately 3 percent of 3,300 inpatient admissions during the year. Just under half -- 226 out of 458 in all -- involved medication errors, making them the largest category of mistakes.

None resulted in patient harm, Maureen Ideker, the hospital's chief nursing officer, told the board of directors last month as she presented a safety report.

But given the number of medications handed out each day, there's significant potential for something to go wrong, she said.

More than 450 new drug orders are processed and more than 1,000 doses of medication are given daily at Rice.

Some errors can be caught upstream, in the pharmacy or during the ordering process, and fixed before reaching the patient. Nurses, however, remain the final stopgap in ensuring a patient's medication is administered correctly.

"You can tell by the numbers here the risks nurses are at in making a mistake," Ideker said. "Bar coding will help us with that."

Below and Tack are on a hospital team that has been working since last fall to implement bar coding. Financial support came from a Rice Health Foundation grant.

The adoption of an electronic medication administration record two years ago gave Rice a head start. Nevertheless, the project hasn't been simple.

For one thing, the hospital pharmacy contains thousands of medications to be bar-coded. For another, the team had to figure out an efficient way to implement the process.

"It is a little bit overwhelming for nurses. It is a whole new process for them," Below said. "I don't think anybody on the team ever pretended this was going to be a quicker way to give meds."

Input from nurses was valuable in identifying potential problems up front, Tack said. For instance, it was at the suggestion of nurses that bar codes were placed at intervals around the patient ID bands, making them easier to scan without disturbing the patient.

"They were able to make it work. Our voices were heard," Tack said.

In other hospitals that use bar-coded medication administration, errors at the bedside have been reduced by as much as 33 percent.

Rice Hospital will be evaluating its bar-coding project for the next several months, Below said. For instance, the number of "good catches" -- times when an error is caught by the final bar-coding scan at the bedside -- will be tracked. So will the number of times a medication is given without scanning it first, something that might be necessary in an emergency or if the scanner or bar code is faulty.

"This isn't a roll-it-out-and-done thing," Below said. "It's going to be constant improvement."

Only a minority of hospitals have adopted this technology, but the long-term goal is to implement bar coding hospital-wide and possibly at Rice Care Center nursing home too. The next safety step, computerized entry of drug orders, will likely be tackled at some future point.

Tack said she appreciates the layer of security that bar coding will add to patient care. From the time a nurse obtains a drug until it's given to the patient, numerous distractions and interruptions can occur, she said. "You're pulled in so many directions."

Now, she'll not only have that final double-check, but the system also will automatically document that the medication was given.

"You don't have to go home at night worrying that you missed something," she said. "It's a really big plus for the nurse. This will ultimately make patient safety that much better."