Bar codes have been around for a while. Bernard Silver is credited with inventing the idea in 1948 while a graduate student at Drexel Institute of Technology in Philadelphia, Pennsylvania. After recruiting fellow graduate student, Norman Joseph Woodland, Silver worked through several ideas before filing their first patent for the “Classifying Apparatus and Method” on October 20, 1948. In the patent, Silver and Woodland describe the linear and bullseye printing patterns, as well as the mechanical and electronic systems needed to read the code. The patent was issued on October 7, 1952 as US Patent 2,612,994. The rest, as they say, is history.

While bar codes have become fully integrated into many industries such as manufacturing, commercial sales, publishing and shipping, they remain relatively uncommon in the healthcare industry with only about a third (34.5%) of healthcare systems adopting bedside scanning.(1) This is partly due to the relative newness of barcoding to the healthcare industry. It wasn’t until 2004 that the FDA issued a requirement for that manufacturers and repackagers to include bar codes containing National Drug Code (NDC) numbers on all immediate drug packages. While the regulation was disappointing for several reasons it was at least a starting point. Unfortunately, the industry has failed to grow the regulation, and as a result healthcare continues to struggle with barcoding technology.

A recent article in the American Journal of Health-System Pharmacy illustrates this point.(2) In the article Baystate Medical Center (BMC), a 656-bed acute care and academic medical center in western Massachusetts, discovered that large-volume parenteral infusion bags (LVPs) generated scanning problems for nursing. Problems with LVPs are all too common; I myself have experienced problems with these bar codes.
The problem with LVP bar codes is multifaceted and include (see image below):

•  Scanners recognize the bag of many LVPs as a black background, hence the reason for the white bar code.
• Flexibility of the LVP bag and location of the bar code make it difficult to scan. Bar codes on curved are notorious for this.
• Many LVPs are imprinted with two bar codes. One barcode contains the unique identifier for the medication, i.e. the NDC number, while the other (typically the larger) contains the product’s lot number and expiration information. The lot and expiration would be potentially useful if today’s technology could make use of them. Unfortunately, many scanners and HIT systems fail to recognize the additional information, and in return generate an error.

There is no question in my mind that the healthcare industry should make use of bar code technology to improve patient safety and workplace efficiency. The question, however, is when will manufacturers and industry leaders come together to clean up issues like those associated with LVPs? Until we solve problems like these, the adoption of bar code technology will continue to move slowly, and the pharmacy profession will continue to see articles like those cited above.

References

1. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing – 2010. Am J Health-Syst Pharm. 2011; 68:669-88.
2. Raman K, Heelon M, Kerr G, et al. Addressing challenges in bar code scanning of large-volume infusion bags. Am J Health-Syst Pharm. 2011; 68:1450-3.