58.9 F
San Diego
Monday, Mar 18, 2024
-Advertisement-

VA Statistics Show Computer Program Cuts Drug Error Rate

VA Statistics Show Computer Program Cuts Drug Error Rate

Pharmaceuticals Urged to Adopt Bar Code System





As nurse Tess Grindulo gets ready to dispense medication by scanning a patient’s wristband against the computerized doctor’s order, she runs into a problem.

The computer tells her it’s not clear whether the medication had been given, not given or was held, Grindulo explains.

Pointing to an empty status field on the computer screen, she said that had the drug been given, the letter G should pop up.

Adhering to the Veterans Affairs San Diego Healthcare System’s guidelines, Grindulo checks with the head nurse and the pharmacist to get answers.

Dr. Robert Smith, associate chief of staff at the VA San Diego’s bar code administration system, which was specifically designed to protect patients from medication errors, remains calm.

“Did they give you the medicine at 9 a.m.?” Smith asks the elderly woman.

“No,” she replies.

After verifying the order with the pharmacist, Grindulo returns with a single-dose tablet. Using a bar code scanner, the nurse once again matches the drug against the patient’s wristband to ensure it’s the correct dose and medication.

The computer notices that the “drug administration time” is 83 minutes late and demands an explanation.

Grindulo types in “medication not yet available from pharmacy,” then proceeds to unwrap the package and hands the tablet to the patient.

– Drug Errors Drop

By 50 Percent

It’s a time-consuming process, but necessary to save lives.

Since the 240-bed facility in La Jolla started tracing the handling of medications in 2000 , from the doctor’s order to the pharmacy to the nurse at the patient’s bedside , inpatient drug errors have dropped by 50 percent, Smith said.

If it was up to Bobby Jindal, chief policy adviser to U.S. Health and Human Services Secretary Tommy Thompson, bar codes and scanners such the ones used in the nation’s network of veterans hospitals would be the rule, not the exception.

Statistics have shown that between 48,000 and 98,000 Americans die each year from medication errors, bringing the economic toll into the hundreds of millions of dollars, Jindal stated in published reports.

A proposal to mandate bar codes on all medicines to ensure a patient’s safety is facing opposition by some drug manufacturers, who cited high costs.

Hospitals, already operating on tight budgets, would be hard-pressed to invest the millions of dollars needed to adopt such high-tech solutions.

Smith said the local VA alone invested about $1 million to convert to the bar code administration system in mid-2000.

It is part of a network of 3,000 PCs, including a $500,000 investment to buy the 60 wireless PCs on the carts nurses wheel into a patient’s room. The rest of the money went toward buying scanning machines, bar code printers and devices for sorting and labeling unit-dose medications, Smith said.

– Process Focuses on Safety,

Rather Than Efficiency

Grindulo admits not everyone was thrilled with the conversion.

Nurses were told early on that the process was geared to keep patients safe, not help the nurses become more efficient.

“It takes much more time, because it now has to go through several checks and balances,” she said.

Nurses can still take verbal orders from the doctors and then enter them into the system. However, the order must still be verified by a pharmacist and then be scanned before administering the medication to the patient.

For Anthony Morreale, the VA’s chief pharmacist, the bar coding process remains a technical and time-consuming effort.

Since only about half of all medications are bar-coded by drug makers, discounting inconsistencies in the labeling process, the VA pharmacy had to build their own “re-labeling plant” to make the process consistent.

Two computerized machines , one for liquid drugs and another for pills , convert the bulk medications from drug makers into bar coded single-dose units.

It’s a tedious process.

The pharmacy technician uses the machine to fill consistent amounts of liquid from the bulk bottle into tiny brown cups, sealing each cup with the VA’s homemade label.

Morreale estimated the VA repackages some 20 different medications into individual doses every day to create enough inventory, adding between $75,000 and $100,000 in personnel costs alone every year.

The re-labeling of ampules is especially irksome.

Said Morreale: “We use a computer to run the tiny bar codes to label the ampules. Once the machine generates this bar code, the technician has to cut every one of these bar codes out with scissors and stick them onto these ampules.”

Pharmacists have long been frustrated in their efforts to convince drug makers to put bar codes on all medication packages.

“I have talked to a lot of companies that have said they are committed to doing that, but (they say), ‘It takes time for us to change over our machinery and labeling,'” Morreale said.

Drug makers would need to make huge investments to change the production process, Morreale said. As long as there is no standard for bar coding, these firms are unlikely to endorse it.

Ironically, he said, those companies with the smallest profit margin , generic drug makers , bar-code the bulk of medications.

Morreale said the ideal bar code would contain a wealth of information, such as the drug’s unique product number, an expiration date and a lot number to help pharmacists track inventory and match each drug with a patient.

Thus far, the VA’s bar coding system has the drug name and dosage. While this keeps patients safe, without a lot number in case of a recall, for instance, pharmacists have no way to track individual packages.

Smith said the system isn’t perfect, and each added step costs money.

While the system hasn’t brought much savings in administrative costs, it has helped improve patient care, he said.

Statistics have shown that drug errors can occur along the drug-handling route: From harried doctors writing incorrect orders to the transcriber who may misinterpret them to the pharmacists dispensing the wrong medication to the nurse at the bedside.

At the VA, doctors type each order into the computer and send it directly to the pharmacy. This has filtered out the need for transcription.

Smith, who divides his time between doing research, clinical work and overseeing information technology, likes the idea of being able to tap into an electronic patient chart anywhere at any time.

Some doctors didn’t embrace the system, saying it takes too much time. The reality is, customized electronic ordering takes half as long as hand-writing them, he said.

So with all that patient data floating around on the VA’s intranet, privacy is an issue. Smith said the potential for hackers to gain access to sensitive data is real, but so far , he knocks on wood , attempts to gain access have been thwarted by the system’s firewalls.

And what do patients think about the VA’s bar coding system?

Grindulo’s patient hasn’t put much thought into the system, but likes its simplicity.

Computers can go “berserk” too, the patient said when asked if she feels safer knowing her medication is being tracked. But, she added, it’s humans who feed wrong information to machines, not the other way around.

-Advertisement-

Featured Articles

-Advertisement-
-Advertisement-

Related Articles

-Advertisement-
-Advertisement-
-Advertisement-