Integration of a Commercial Barcode-Assisted Medication Dispensing System in a Teaching Hospital

Abstract

Objectives A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process. Methods We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study. Results There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget). Conclusion This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.

Interventions to decrease the incidence of dispensing errors in hospital pharmacy: a systematic review and meta‐analysis

“…Six of the included studies utilised a pre and post-intervention methodology with prospective observations, [24][25][26][30][31][32] four were parallel arm prospective observational studies 22,[27][28][29] and one was a multi-phase prospective observational study. 23 The data collection periods ranged from 6 days to 1 year.…”

“…The majority of studies used a research pharmacist observer who identified dispensing errors independent to the dispensing process, 22,[24][25][26][27]30 while others incorporated the identification and documentation of dispensing errors into the final verification stage of the dispensing process. 23,24,29,31,32 In all but one study, those evaluating the presence of dispensing errors were not blinded to the study allocation of the medication orders or prescriptions being assessed. One study utilised a blinded research pharmacist to review dispensed items after completion of the final verification by pharmacy staff.…”

“…One study utilised a blinded research pharmacist to review dispensed items after completion of the final verification by pharmacy staff. 28 The interventions evaluated included the implementation of technological interventions within the dispensing process, [23][24][25][26]29,30,32 engagement of accredited technicians to perform the final verification of dispensed items 22,28 and one study assessed a range of interventions to address look-alike medications. 31 The control group comprised manual product selection and dispensing by a technician or pharmacist, [23][24][25][26][27]29,31,32 manual dispensing with barcode scanning 30 and pharmacist verification of dispensed items.…”

“…Eleven studies met the inclusion criteria for this review (Table 1). Six of the studies were conducted in the United States, [22][23][24][25][26][27] and one each in Australia, 28 France, 29 Spain, 30 Taiwan 31 and the United Kingdom. 32…”

“…These are variably described as filling errors, internal errors, near-miss incidents or prevented dispensing errors. 23,26,29,31,32 Five studies identified errors after the completion of the dispensing process, referring to these as dispensing errors, external errors or unprevented dispensing errors. 22,25,27,28,30 One study detected both prevented incidents and unprevented dispensing errors.…”