Originally created 12/15/03

Bar codes on drugs aim to reduce hospital errors, deaths



WASHINGTON -- Inside hospital pharmacies, tiny bar codes just an eighth of an inch tall adorn the blister packs that hold single-pill doses of certain drugs, like Dilantin for seizures and Lipitor for cholesterol.

With a handheld scanner, health care workers guard against medication mixups by matching each pill's bar code to a hospitalized patient's wristband and medical chart. It is to ensure the right person swallows the right dose of the right drug at the right time. If anything's off, an alarm beeps.

Yet only a few drugs today bear bar codes, and very few hospitals have the scanners needed to read them. That's about to change.

By February, the Food and Drug Administration will issue orders requiring that every medication sold to hospitals soon bear supermarket-style bar codes.

It's a major move that, once fully phased in, is expected to protect many of the estimated 7,000 hospitalized patients who die every year because of drug errors.

The impact promises to go beyond routine drug mistakes. For example, printing a matching bar code for the vial of Mr. Jones' blood before the nurse leaves his bedside guards against mixed up samples is crucial in ensuring patients receive the right blood type and other test results.

Patients get the wrong blood in one of every 14,000 transfusions, causing at least 20 deaths a year.

"Those are totally preventable tragedies," says Dr. Gerald Sandler, Georgetown University Hospital's transfusion chief. He began pushing for electronic solutions five years ago when his hospital had a near-miss - two children awaiting transfusions switched seats after the nurses double-checked who was supposed to get which bag of blood. But he says hospitals can't afford the systems unless drug and blood safety are paired.

Also, hospitals can buy bar-code scanners that come with even more sophisticated software that flags patients' allergies and other important information, guiding doctors to prescribe the safest treatment choice.

Still, bar-code labeling is just the first step in a promised wave of safety technology. A bar-coded wristband isn't easy to read if the patient gets it wet or is sleeping on top of that arm. It's even harder when the patient is on an emergency room gurney or operating table - busy times when mistakes in medication or blood transfusion can be easy to make.

Next-generation systems promise to pair bar codes with tiny transmitters like those used by highway toll booths to read speed passes, letting nurses identify patients from across the room.

Consider this scenario: An alarm blares if a nurse tries to carry into the operating room the wrong type blood for the patient on the table. Simply hook the radiofrequency chip in the patient's ID to the door, and if the patient chip doesn't match the one on the blood bag, everyone knows.

Next month, Sandler begins studying how well a new transmitter-plus-bar code system called SmartBand works and envisions the alarm scenario in the not-too-distant future. "This is the next frontier in patient safety," he said.

First-generation bar coding promises to have a huge impact.

Only about 125 of the nation's 5,000-plus hospitals use bar-code systems now, partly because only about 35 percent of their pharmaceutical supplies come with the codes affixed to them, says Russell Lewis of Bridge Medical Inc., a leading manufacturer of bar-code systems.

But when veterans hospitals adopted bar codes - relabeling their own drugs so they could be electronically identified - medication errors plummeted.

Commercially, two medication giants are leading the way on bar coding. Last year, Pfizer Inc. figured out how to fit tiny versions of supermarket bar codes on the blister packs of Dilantin, Lipitor and other pills sold to hospitals. Abbott Laboratories first put bar codes on injected drugs and will start selling hospitals bar-coded pills early next year.

By February, the FDA will issue new rules forcing other manufacturers to begin phasing in bar codes on hospital-sold drugs, too.

Hospitals won't be required to use the codes. But the rules do set standards to ensure any scanner will recognize any medicine - good news for cash-strapped hospitals, says FDA pharmacist Tom McGinnis.

"You can do this with minimal equipment," he says. "You don't have to buy the Cadillac, you can buy the Chevy to make this work."

Hospitals know the change is coming; sales of bar-code systems began rising in recent months, says Lewis. The cost ranges from $200,000 to over $1 million, depending on the hospital's size and the complexity of the system.