The July issue of Pharmacy Practice News has a great article describing posters presented at the 2013 ASHP Summer Meeting in Minneapolis. The posters represent some new uses for healthcare technology that has been around for quite some time.
The article presents information from posters covering barcode scanning for non-sterile compounding, Automated Dispensing Cabinets (ADCs) tied to Computerized Provider Order Entry (CPOE) in the emergency department (ED), using clinical surveillance software to save money, and the use of clinical decision support systems (CDSS) to check medication orders against patient indications to reduce medication errors.
While none of these technologies are new per se, the use of barcode scanning and CDSS to root out potential medication errors is creative.
Indiana University Health (IUH), a 355-bed hospital in Bloomington has adapted barcode technology from their sterile compounding process for use in preparing nonsterile compounds. According to Stephen L. Speth, RPh, MS, the hospital’s inpatient pharmacy manager “The technician scans the ingredients and takes pictures of the amounts. That information is electronically captured and used by the pharmacist for verification.” The system has been successful in capturing potential errors before leaving the pharmacy. According to the article the system captured 21 oral liquid syringe errors in the first five months, representing 0.9% of all doses processed. In addition, the system has helped reduce waste from intercepted compounding errors as well as reduce preparation time.
Researchers at the Center for Education and Research on Therapeutics (CERT) at the University Of Illinois Chicago College Of Pharmacy are utilizing a clinical decision support system (CDSS) to root out potential errors associated with Sound-Alike-Look-Alike Drugs (SALAD). The system compares orders entered via the hospital’s CPOE system to the patients list of indications. If the indication for the medication is not documented on the patient’s problem list, an alert prompts the prescriber to cancel the order, ignore the alert or add an indication to the problem list. According to Michelle L. Brayson, PharmD, a co-investigator, “A lot of mistakes were discovered. Often, it was very clear that the mistakes were pick-list errors where the prescriber made the wrong choice from several similar options, or the drug names were next to each other in certain order sets, as with nimodipine and famotidine.”
Sound-Alike-Look-Alike Drugs have been a problem within healthcare for many years. Both the Joint Commission and ISMP have attempted to decrease errors involving these medications through guidelines and regulatory requirements. Most of these recommendations have been aimed at the medication distribution problem. The system described at the University Of Illinois Chicago College Of Pharmacy is one of the few that approaches the problem from the beginning of the medication use process.
Both the use of barcode scanning for nonsterile compounding and the use of CDSS to crosscheck medication orders against patient indications are simple approaches to significant problems within the medication use process. Sometimes the simple approach is the best.