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Bar coding at the bedside: New England hospital implements an automated administration system to reduce medication errors and their associated complications.

North Adams Regional Hospital administrators wanted to automate the hospital's medication delivery process to enhance clinical operations and reduce the potential for medication errors, especially at the point of care. The hospital provides primary care services, specialty physician services, and diagnostic and treatment services to citizens in northern Berkshire County, Mass., and southern Vermont. Each year, North Adams performs more than 2,200 surgeries, and its emergency department treats more than 20,000 patients.

To help meet its medication delivery goals, the hospital chose Deerfield, Ill-based Baxter Healthcare's Patient Care System, an integrated medication management system that uses bar code scanning technology and personal digital assistants (PDAs).

Before automation, North Adams' nurses relied on a traditional hospital unit-dose system with a 24-hour cart exchange. Automated dispensing from electronic medication carts on the nursing unit now provides the nurse with immediate access to new medications as soon as the order is entered in the pharmacy system. This improves patient care by eliminating the delivery time involved in 24-hour cart dispensing. In addition, pharmacy staff can view the exact time when a medication is administered compared to the scheduled time.

Reporting from this system will provide North Adams with very discrete data regarding medication administration times and any problems that might arise. Pharmacy technicians can now restock the electronic medication carts based on inventory data in the pharmacy since they no longer fill 24-hour medication carts. Pharmacist time is saved, since checking medication carts is no longer necessary.

North Adams installed the pharmacy system in April 2003 and began deployment of medication carts and bedside bar-coded medication verification the following December. The hospital is working unit by unit, and the next golive is scheduled for this spring. The manual system is still in place on units that have not yet implemented the Baxter system. Pharmacy Manager Mark Kester expects that nurses on all hospital units will use the new program by late summer or early fall.

Bedside Bar Codes

Upon admission, every patient receives a bar-coded bracelet. New medication orders are electronically entered into the system, and nurses and pharmacists can immediately view the information. The pharmacist then checks all orders electronically for drug interactions, allergies, duplicate therapy and dosage errors. Next, the pharmacist prepares unit-dose prescriptions, which are packaged, bar-coded and sent to the nursing floor. There, the doses are stored in a wireless mobile medication cart.

Before she begins her rounds, the nurse reviews a to-do list from a handheld PDA or the nurse workstation. She accesses the medication for each patient from the medication cart and pulls up the patient's electronic medication administration record on a handheld scanner or touchscreen computer on the mobile cart. Only medications requiring administration at that time are shown, and the nurse is directed to the correct drawer, bin and medication within the mobile cart.

She then scans the bar-coded medication to confirm the right medication and dose, and the patient's bar-coded bracelet to ensure that the right patient is receiving the right dose of the right medication at the right time via the right administration route. The medication is administered, the patient profile is automatically updated and then it is tracked to the patient's electronic medical record. Information is also tracked by the pharmacy and updated in the hospital's inventory and patient billing records.

Seamless Integration

Clinicians were hesitant to integrate a medication management system with North Adams' legacy healthcare information system architecture. North Adams' has relied on its MEDITECH HIS for 12 years, so the new pharmacy system had to integrate with the existing network. "When we replaced the pharmacy system, we had to make sure the new system would integrate with our current billing application, the application for transferring and admitting patients, and the laboratory information system," Kester says. Patient Care System interfaced seamlessly with ADT (admissions, discharge, transfer) and the billing applications, and the hospital currently is testing the laboratory interface.

Change management has also played a key role. Baxter provided client service representatives to aid the North Adams team in building the database, training the staff and helping to work through the change management process that's needed to successfully implement the system. Baxter also worked with North Adams' IT organization to ensure that all interfaces were seamless.

North Adams experienced few training issues with its pharmacy system, but training nurses was "a more intense situation. A bar code system presents a very different practice environment for nurses that required a lot of practice change and workflow examinations," Kester says. "In pharmacy, we have to be much more cognizant of the nurses, because what we do affects them in real time. If we don't have the order entered by the time they want to give it, they're looking for the order." The biggest challenge, he adds, was helping the nurses become more familiar with the handheld computers they use to verify medication at the bedside.

End Results

Nurses on 3N, North Adams' live, point-of-care unit, have administered 16,380 doses using Patient Care System over a two-month period. Kester notes that North Adams experienced immediate benefits with the automated program, such as missed-dose monitoring, accurate administration time tracking and simplified reporting for drug use statistics. While implementation is still under way, Kester expects that North Adams will realize significant improvements to its medication delivery process. "We're also looking for a big increase in the type of information that we're able to capture. Once we have established a baseline, we'll be able to examine in more detail the types of errors we find," he notes. "Until now, we've tracked errors based on human beings reporting them."

Through the automation of many manual medication delivery processes, North Adams says it will use the resulting information to make adjustments to its medication delivery process. The system will help North Adams achieve its goal of helping its clinicians verify the "five rights" of patient safety.


Mark Kester

Pharmacy Manager

North Adams Regional Hospital

North Adams, Mass.


Patient Care System

Baxter Healthcare

Deerfield, Ill.
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Title Annotation:Medication Management Case History
Publication:Health Management Technology
Geographic Code:1USA
Date:May 1, 2004
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