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Medication Barcode Optimization

Posted By Administration, Monday, May 2, 2016

Is it ever okay to override the barcode on a medication? That’s one of the questions that will be addressed
during Breakout Session 304 at the NPSF Patient Safety Congress.

by Patricia McTiernan, MS

Joe Melucci, MBA, RPh, will share
lessons learned about barcoding
at the 2016 NPSF Patient Safety Congress.


According to the Agency for Health Care Research and Quality’s PSNet, about 5% of hospitalized patients experience a medication error, and the rate may be even higher for patients treated in ambulatory settings. The use of barcodes on medications, mandated by the Food and Drug Administration back in 2004, has led to widespread adoption of barcode technology in hospitals, with studies showing broad reductions in medication errors.


Joe Melucci, MBA, RPh, medication safety officer at Ohio State University Wexner Medical Center (OSUWMC) and an alumnus of the AHA-NPSF Patient Safety Leadership Fellowship (class 12), points out that the literature shows that workarounds to barcode workflows are still too common in inpatient settings. For example, a nurse may scan the medication after, rather than before, administering it. Or the nurse may print a duplicate wrist band if it is perceived to be more practical to scan an ID band that is not attached to the patient’s wrist.


“In some cases, the nurse may not realize the importance of barcoding as a safety measure,” says Mr. Melucci. “They may only consider it as a way of documenting what they have done.”


At OSUWMC, the team wanted to bring this technology to Emergency Departments, ambulatory infusion centers, and outpatient clinics. They addressed the challenges in inpatient care, eventually raising scanning compliance to their goal of 97%, or 97 of every 100 doses being scanned. That target allows for necessary exceptions, such as emergencies where taking the time to scan would compromise the care.


They recognized that different settings would present unique challenges. “The workflows are different, the pace is different. In procedural areas, they have to totally change the workflow to have orders in the system prior to the procedure to be able to have something to check the medication scan against,” says Mr. Melucci.


“Still other challenges are presented by dialysis units, because dialysate solution is considered a medical device, not a medication, and therefore does not exist in the pharmacy database. “We have to create medication records to allow nurses to scan those, because they can still make mistakes with grabbing the wrong concentration or the wrong formulation of solution,” says Mr. Melucci.


In psychiatric settings, patients can harm themselves with wrist bands, or the wrist band may become a distraction to the patient, interfering with their treatment.That’s where the question arose of whether it is ever okay to administer medication when a wrist band is not attached to the patient. “In the literature it is a no-no, because there is no evidence it is effective,” says Mr. Melucci, even though an organized method of scanning was created for this purpose.


One of the chief lessons learned in implementing barcode technology and sustaining compliance, says Mr. Melucci, is the importance of being transparent and consistent in the information provided to nurses and managers. It’s also important to know when to make an exception to the rule.


“Outpatient areas simply do not administer the same volume of medications as do inpatient areas,” he adds. “Making the investment in the technology and training reflects a deliberate decision to set the same standard of care for outpatient and inpatient settings.”

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Representatives of Ohio State University Wexner Medical Center and Hospital Sisters Health System will present lessons learned and challenge attendees to think about exceptions to bar code scanning during a joint Breakout Session at the NPSF Patient Safety Congress. Find out more about the Congress agenda at


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Patricia McTiernan, MS is assistant vice president for communications at the National Patient Safety Foundation and editor of the P.S. Blog. Contact her at

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Tags:  2016 NPSF Congress  medication 

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