Many staff at BWH may have already heard that bar-coding is coming to BWH. When mentioned among peers, the initiative is probably mentioned in the context of boosting patient safety measures and advancing care delivery overall at BWH, which is accurate. However, what will this cutting-edge technology specifically mean for the hospital?
A Sneak Preview:
Bar-coding means another great stride in patient safety for BWH. Under the new BWH bar-coding system, it is estimated that 80 percent of medication errors will be eliminated. In fact, BWH will be the first hospital to track medications up to the point of care for each patient.
Bar-coding means the creation of a groundbreaking Drug Repackaging Center at BWH.
Only half of all pharmaceutical manufacturers barcode their products. Recent FDA-proposed bar-coding regulations for pharmaceutical manufacturers will be phased-in over the next three years. Therefore, BWH is partnering with Cardinal Health to create an innovative solution to the need for barcodes on drugs. An estimated 3.8 million drugs, which is about half of the BWH allotment, will be repackaged at the new BWH Drug Repackaging Center, scheduled to open in May 2003. Four machines will handle the bar-coding process, completing 20 labels per minute or 1000 per hour. Taking it one step further, BWH will be the first hospital to use “data matrix” barcodes that are three-dimensional, as opposed to the standard, linear barcodes. These new barcodes, which are 39 times smaller than standard barcodes, contain five times the amount of information, including the drug’s product number, expiration date and lot number. Additionally, the error rate for the 3D barcode is approximately one in
10.5 million.
Bar-coding means learning the art of scanning.
Eventually bar-coding will extend beyond just our medications here at BWH. The Admitting team is hard at work creating patient wristbands with data matrix barcodes and Human Resources and Security are in the process of developing ID badges with barcodes for all BWH staff. Future applications are being planned for the clinical lab, blood bank and equipment tracking. Ultimately, nurses will be able to log on to the computer by scanning their ID, look up their patient to determine which drugs need to be administered, scan the patient to verify they have the correct individual, and finally scan the drug dispensed to the patient. Today, nurses spend an average of three to four hours of their shift administering medications. Once up to speed, the project will save time for the medication administration process, allowing nurses more time for patient assessment and education.
Bar-coding means web-based Pharmacy, MAR and OE systems that are all linked.
BWH currently has separate Pharmacy, Medication Administration Record (MAR) and Order Entry (OE) systems to capture patient medication information. However, Pharmacy and IS staff are working to bring all three systems on-line hospital-wide, and furthermore, to allow them to inter-operate with each other. As it stands, the web-based Pharmacy system should be rolled out in August 2003, with the in-patient eMAR to follow at the end of the year and eOE going live sometime in 2005.
Bar-coding means being able to program an IV pump from the eMar.
The new Alaris IV pumps, introduced hospital-wide this March, will eventually be linked directly to the eMAR, allowing nurses to program the pump electronically. IV pumps are currently the second largest source of medication errors. Linking them to the eMar is expected to further facilitate an 85 percent reduction in errors.
Bar-coding means BWH will be the first hospital to maintain a wireless infrastructure.
No longer will patient care require a paper trail. By the time fall settles in, BWH nurses will have access to Fujitsu Lifebooks – wireless, hand-held computers, nicknamed at BWH as the “clamshell” – to track all medication information. When logging on, nurses will be alerted as to all due and overdue medications and all PRNs. Likewise, they will receive patient reassessment reminders and be able to record that information on the clamshell. These are just a few of the new features which will be available
as part of the clamshell. As the Pharmacy, MAR and OE systems become web-based, the clamshell will, in turn, synch up to each of these systems as well.
BWH has invested $3 million and more than two years of planning to support the bar-coding project, including hardware, software, infrastructure, equipment, etc. Hospital leaders Gary L. Gottlieb, MD, MBA, BWH president; Andy Whittemore, MD, chief medical officer; Matt Van Vranken, MBA, chief operating officer; Nancy Kruger, DNSc, RN, chief nursing officer; and Sue Schade, chief information officer are spearheading the bar-coding project, which will have a vast impact on the hospital as a whole. Pharmacy Service’s Bill Churchill and Nursing Administration’s Judy Hayes are the project leaders.