Effect of Bar-Code Technology on the Safety of Medication Administration

Hospital patients are at risk of serious medication errors that may result in patient harm. Such errors commonly occur during the ordering of medication, drug administration, or the transcription and dispensing stages. Previous studies have shown that use of bar-code technology can prevent errors by providing automatic verification of a patientʼs identity and the medication to be administered. Bar-code technology is usually implemented in conjunction with an electronic medication administration system (eMAR). Bar-code eMAR records physician and pharmacy medication orders electronically; its implementation may reduce medication errors and protect patients from potential adverse events. Use of this technology has been increasing, but there is only limited and mixed evidence of its effectiveness.This prospective study evaluated the effectiveness of bar-code eMAR technology to reduce administration and transcription errors, as well as lower potential adverse drug events. Over a 9-month period in 2005 in a tertiary academic medical center, error rates in units that were using this technology were compared with the rates in units that were not. The 2 primary study outcomes were errors in timing, involving early and late administration of drugs, and errors unrelated to timing. Identified errors were reviewed by 2 members of a medical panel to confirm the presence of an error and the potential for adverse drug events and patient harm.A total of 7318 medication administrations were observed on patient units implementing bar-code eMAR and 6723 medication administrations on patient units that did not. Transcription orders were reviewed for 1283 units that used the bar-code eMAR and for 1799 that did not use this technology. On units not using the bar-code eMAR, there was an error rate of 11.5% (776/6723) for nontiming medication-administration errors, whereas on units with the bar-code eMAR, the error rate for nontiming-errors was 6.8% (495/7318). The difference represents a 41.4% relative reduction in the rate of nontiming errors (P < 0.001). Compared with units without bar-code eMAR, use of this technology reduced the rate of potential adverse drug events because of nontiming administration errors from 3.1% to 1.6%, representing a relative reduction of 50.8% (P < 0.001). The overall rate of timing errors decreased from 16.7% without the bar-code eMAR to 12.2% with its use, a reduction of 27.3% (P = 0.001), but there was no significant difference in the incidence of