To the select number of nurses who've already implemented bar coded medicine, the improved accuracy and delivery speed of drugs has been stunning.

"It has caught errors we didn't even know we were making," said Peg Spisak, RN, director of quality and risk management and patient safety officer at Ohio Valley General Hospital in McKees Rocks, Pa.

Ohio Valley's pilot use of bar coded medications went live Sept. 18, 2001, using McKesson Corp.'s Admin-RX, with which bedside nurses scan patient wristband and medication bar codes into a handheld terminal that communicates to a wireless hospital network where electronic medical records are kept.

"Busy nurses make mistakes without realizing it," Spisak said. "Now, if someone tried to take this away, we'd have a problem."

However, many nurses still rely on paper charts to administer the "five rights" (right medication, right patient, right dose, right route, at the right time), as the lack of standards and concerns over the cost of technology and training have kept many drug companies from placing bar codes on most medicines.

A rash of stories on medication errors in the United States prompted a call for a federal role. Department of Health and Human Services Secretary Tommy Thompson announced March 13 a proposed rule requiring bar codes on drug labels, similar in appearance to the bar codes present for years on retail products.

The proposed rule would apply to prescription drugs, excluding physician samples, and to over-the-counter drugs commonly used in hospitals and dispensed pursuant to an order. The rule would apply to drug manufacturers, repackers, relabelers and private-label distributors of drugs. The proposal would require the bar code to contain, at a minimum, the drug's National Drug Code number, a unique number that identifies each drug, its dosage form and its strength.

The nurses interviewed for this story welcomed the FDA move.

The FDA intends to make the rule effective three years after it publishes a final rule. However, some drugs already have bar codes, and some firms have announced their intention to place bar codes on their drugs sooner.

Health care providers are under no obligation to implement systems to read and record the information contained on the bar codes. However, hospitals such as Ohio Valley have acted as vanguards in doing so.

Veterans Administration hospitals have adopted bar coding for pharmaceutical products used at patients' bedsides, according to Jerry Phillips, associate director of the FDA's Office of Drug Safety.

"We use this as a role model," Phillips said.

Several national hospital purchasing alliances, including Premier Inc., Novation and Amerinet, plan to preferentially award contracts to those pharmaceutical companies that provide bar coded medications, said Allen Vaida, executive director of the Institute for Safe Medication Practices in Huntingdon Valley, Pa.

"What really drives the market is what people will buy, and the good sign is that the purchasing alliances are on board," Vaida said.

Today, 30 percent to 35 percent of drugs already have bar codes. However, firms use different, incompatible standards. So even as hospitals print bar codes for medications that don't have them, they also may have to print bar codes to replace incompatible ones.

The FDA's mandate replaces such conflicting standards with a unified one that permits extensions to a basic set of information. The 90-day public comment period that ends June 13 is also an invitation for advocates of extended information to argue for its inclusion and standardization. For instance, the Institute for Safe Medication Practices wants each drug's expiration date and lot number to be required and standardized across all FDA-mandated drug bar codes.

Other health care providers are concerned that the regulations will encourage pharmaceutical companies to continue a recent trend in which some drugs are packaged in bulk instead of single doses. Hospital pharmacies can divide such packages into smaller containers and apply new bar codes, which adds to drug costs.

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