STUDY POINTS TO METHODS FOR SAFE DRUG DISPENSING VIA COMPUTER
COLUMBUS, Ohio -- Researchers have found that a new computer system that uses bar codes to safeguard patients’ medications will work successfully, but not without creating new, serious problems for nurses charged with patient care.
“In general, we viewed the system as successful. There are no magic bullet solutions to human error in any setting, and even the best systems will require constant maintenance and flexible redesign after implementation,” said Emily Patterson, a research specialist in Ohio State’s Institute for Ergonomics.
At issue is whether bar codes could enable healthcare professionals to verify that a patient is receiving the right drug, at the right dose, at the right time.
Patterson conducted the research with the VA Midwest Patient Safety Center of Inquiry in Cincinnati and published the results in a recent issue of the Journal of the American Medical Informatics Association. Her coauthors include Marta Render, director of the center and adjunct associate professor of internal medicine at the University of Cincinnati, and Richard Cook, director of the Cognitive Technologies Laboratory at the University of Chicago. The Department of Veterans Affairs funded the study.
With BCMA, hospital pharmacies label medications with bar codes, and patients wear bar-coded wristbands. Nurses scan a patient’s wristband, and a laptop computer on the medication cart displays that patient’s prescriptions. Before giving the medicine, the nurse scans the medicine bottle or other container, and BCMA records the drug as delivered. If the nurse accidentally scans the wrong medicine or dosage, or tries to give medicine at the wrong time, a warning pops up on the computer screen.
Patterson followed the activities of 26 nurses at three VA hospitals as they dispensed medication with BCMA. She also watched as doctors entered new prescriptions into the electronic medical record, and pharmacists labeled prescriptions. Then she interviewed these people as well as hospital computer support personnel and nurse managers, to gauge everyone’s opinion of the system.
The study did not specifically examine errors caught or prevented by BCMA, but focused instead on the interaction of users with the system, in order to find ways to make the system work better.
Nearly all VA hospitals are now using BCMA software version 2.0, and Patterson and her colleagues are helping create version 3.0, which will address some of the problems found during the study. After that, Patterson and her colleagues will continue to help the system evolve over time.
Patterson cited a 1999 study at Brigham and Women’s Hospital and Harvard Medical School that found medication errors fell 86 percent when doctors began entering their prescriptions orders via computer. When computer systems are optimized for taking human factors into account, errors can decrease even further, she said.
The new Ohio State study found five unanticipated negative side effects of introducing BCMA to hospitals:
In the future, Patterson and her colleagues will examine how BCMA is used differently in acute care wards, nursing homes, and intensive care units. Roger Chapman, another research specialist in Ohio State’s Institute for Ergonomics, is going to investigate how nurses’ use of PDAs, or personal digital assistants, instead of laptop computers will affect the use of BCMA.
The Food and Drug Administration (FDA) is currently considering whether to require labeling of all prescription drugs with bar codes. In a recent public meeting, the FDA stated that Patterson’s paper “highlights the importance of ensuring that bar-coding medical administration systems are flexible enough to be modified” when problems occur.