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"There are reasons why unidose packaging is decreasing,
having to do with [pharmacy company] marketing and cost
reasons," Phillips said. "It's really our
hope at the FDA that we don't see a decrease in unit-of-use
packaging. We hope we'll see the opposite, that the
industry will see a great patient safety need for this
and will rise to the occasion."
One thing that seems certain is that different hospitals
will introduce bar coded medications in different ways.
At Central Washington Hospital in Wenatchee, Wash.,
the pharmacy was using a McKesson robotic drug distribution
system 2½ years ago, said Connect-RX coordinator
Paul Stringham, RN.
"We chose to test [the bar coded meds] on a rehab
and OB unit," Stringham said. The hospital started
there "mainly because the rehab unit was on separate
ID systems from the hospital, requiring a discharge
and readmittance, which cut out confusion between the
old and new systems. The OB unit, of course, had a high
turnover rate, with new mothers coming and going at
the rate they do, so this let us see how the bar codes
worked with a high rate of discharge."
By contrast, Ohio Valley General Hospital started with
the most intense pilot possible, the critical care suite.
"I wanted to see virtually everything that could
happen to the system while we had the support of the
company [McKesson] during the first days," Spisak
said. "I'm glad we did, though apparently everyone
else is afraid to do their ICU. I get conference calls
to have our ICU nurses talk through other ICU nurses"
from other hospitals that are adopting bar coding. "Some
[nurses] are afraid that bar code scanning will stop
them from reacting quickly, giving stat medications."
Central Washington's Stringham notes that in some of
the hospital's fastest-paced areas, such as the ER and
recovery rooms, bar codes still are not used at the
bedside because bar code generation normally routes
through the hospital pharmacy. However, the pharmacy
is able to do all the checks and input stat orders into
the system shortly afterward to keep records accurate.
Bar coded medication delivery appears to enhance quality
of care. Now, organizations are starting to quantify
cost savings and returns on investments. Often, the
bar coding is part of a total upgrade to a paperless
electronic medical record-keeping system.
The FDA estimates its proposed rule, when finalized,
will result in more than 413,000 fewer adverse drug
events over 20 years. The present value of avoiding
related hospital stays and patient pain and suffering
is estimated to be about $41.4 billion, discounted at
7 percent. Hospitals are expected to realize a present
value from $4.8 billion to $7.6 billion in savings related
to record-keeping and reporting activities.
In addition, the FDA expects that hospitals could avoid
litigation associated with preventable adverse events,
reduce malpractice liability insurance premiums and
increase receipts with more accurate billing procedures.
Stringham sees quantifiable savings, too. "Every
drug error in the hospital has an average cost of $2,500
to $3,500 for that patient," he said.
Still, a transition awaits most nurses.
"It's something new between the nurse and the
patient," said Mary Beth Navarra, RN, director
of automation planning at McKesson Automation in Pittsburgh.
"But if the patient said his incision is bothering
him and wants to know the last time he had his pain
medication, if that history is on a paper chart, there's
a delay while the nurse has to go back to that paper.
The nurse with the handheld device can say, 'Sure, I
can tell you right now.' "
In addition, Navarra said, a patient's electronic medical
record can tell the nurse if a physician has discontinued
a medication that morning, something that busy nurses
might not notice on a paper chart.
"The goal of point-of-care bedside scanning is
to provide that safety net," Navarra said.
While the up-front costs of implementing a paperless
system are considerable, ever-present drug bar coding
also could have benefits far beyond hospitals, including
long-term care, home health care and nursing home situations,
Navarra said.
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