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Bar-coding plan aims at cutting drug mistakes

Troy May

El Camino Hospital will be the first hospital in Silicon Valley to install a drug bar-coding system that's expected to minimize errors with patients' medicines.

The hospital has signed a three-year contract with Cardinal Health, a Dublin, Ohio, pharmaceutical distribution company, to supply all drugs and general hospital supplies. In addition, Cardinal will install its drug bar coding system at the patient bedside.

The National Academies Institute of Medicine has reported that an estimated 98,000 people die each year in hospitals from medication errors, though some reports estimate the number of deaths at about 44,000.

Either way, experts agree that hospitals are making many errors when drugs are administered to patients, and while not all errors result in death, they could cause illness or simply slow down patient recovery.

In response, the federal government, health-care organizations and employer groups have requested that hospitals install technology that tracks medicine every step of the way through the hospital to the patient. In March, the U.S. Food and Drug Administration proposed a regulation requiring hospitals to adopt drug bar coding technology. Currently no mandate exists.

Only an estimated 2 percent of hospitals nationwide have drug bar coding technology in place. Sacramento-based hospital chain Sutter Health is spending more than $50 million to install systems in all

26 of its hospitals in Northern California within three years, including Mills-Peninsula Health Services in San Mateo.

El Camino got a jump-start on other Silicon Valley hospitals. El Camino plans to install what's called a "patient station" at 100 of its 270 beds.

Before giving a patient any medicine, the nurse must scan the bar code on the patient's wristband, then scan her own badge and scan the medication. The system will alert the nurse to any problem.

The patient station, which replaces the television set at the bedside, also will offer Internet access, on-demand movies and other services. Cardinal Health's Pyxis division, located in San Diego, will lease the technology to El Camino for about $360,000 a year. Patient stations are expected to be installed by the first quarter of next year, says Mark Zielazinski, chief information officer at El Camino.

Rooms that have fewer than four beds or don't have good cable access will not get a patient station. Instead, the nurse will use a handheld device to scan the drugs, Mr. Zielazinski says.

The cost for El Camino is less than usual because the hospital signed an exclusive contract with Cardinal for all its medical supplies, Mr. Zielazinski says. Other hospitals pay more than $1 million to install the equipment.

About 30 percent of the drugs from manufacturers are pre-packaged with bar codes on individual doses, says Kris Rollin, senior project manager for Pyxis. Another 50 percent are packaged and bar coded by Cardinal. Pharmacists at El Camino will bar code the remaining 20 percent, which mostly includes intravenous drugs.

Officials at El Camino and experts nationwide say the new system will significantly reduce the chance of medication errors. About half of all medication errors occur when a pharmacist tries to interpret a written prescription. But that hasn't been a problem at El Camino, which has been using an electronic order entry system for years.

About 38 percent of medication errors occur at the point of giving the drugs to a patient.

"We want to drive that down to zero as much as we can," says Mr. Zielazinski.

The FDA has proposed creating a standard drug bar-coding system nationwide, but right now there is none, leaving hospitals, drug distributors and drug manufacturers to create their own.

Sutter Health is testing three major drug bar-coding technologies that include Cardinal Health and two California companies: AmerisourceBergen Corp. and McKesson Corp., says Dean Inami, vice president of pharmacy at Sutter. Sutter plans to let its individual hospitals choose their own system.

Mr. Inami says hospital pharmacists are trained to be experts on medicines, rather than just pill-counters. The technology takes the mundane work out of drug delivery, allowing more time for the pharmacist to work with doctors and nurses.

"What a pharmacist should be doing is monitoring the clinical outcome of the patient," he says.

Troy May covers health care and health sciences for the Business Journal.