The author of a report on improving patient safety in hospitals says identifying patients and their medications with a barcode is a more acceptable solution than radio-frequency identification (RFID).
Some experts, such as IBM partner Bill Doak, have advocated RFID as a state-of-the-art tool for patient identification.
However, report author Bruce Anderson says given the current state of technology, RFID markers are too expensive for the bedside verification procedures advanced as an answer to reducing medication errors.
The scheme envisaged would involve marking each single dose of medication with the patient’s identifier and other data. There would be so many markers that RFID costs would quickly mount, he says. Barcodes are far less costly.
RFID scanners are, moreover, less tightly focused than a barcode beam. With many containers of medication closely packed in a trolley, Anderson says there is a risk that the scanner will read the container next to the one the operator thinks is being read. This could mean a needless alarm or falsely approve administration of the wrong medication — the very problem the system is designed to prevent.
Thirdly, there is a small risk that stray radio waves from the scanners and markers could interfere with the functioning of vital medical equipment, Anderson says.
The markers, referred to as barcodes, could in fact be two-dimensional black-and-white printed patterns of squares within a square label, as well as the rectangular sequence of bars familiar from supermarket goods. The two-dimensional marker carries information in a smaller space and is suited to smaller packets of drugs.
Although Anderson’s report is a draft, much of the discussion of the remedies it suggests has already been done and he expects fairly quick approval by the Ministry of Health and a move into implementation.
Pilot implementations are likely first, within particular wards but, given success, these would quickly expand to whole hospitals and whole district health boards, he says. Most parts of most hospitals could be equipped with the new systems within two years, Anderson says.
Some parts of hospitals will be difficult to equip, such as paediatric wards, where the doses are more variable in size, having to be matched to the weight of the infant, and these will be slower to be barcode-equipped than regular medical and surgical wards, he says.
Barcode use will be complemented by a computer-based medication “chart”, where administration of the treatment will be checked off, preventing the same dose being administered twice and alerting staff to missed doses. The aim is to ensure that the right medication is given to the right patient in the correct dosage at the right time and “by the right route” (orally or by injection or some other method), the report says.
Surveys of previous errors show 39% occur at the prescribing stage, and this risk will not be remedied by improving labelling accuracy. The answer to errors here might be support-software for the doctor and pharmacist so they can cross-check with recorded expert opinion that the medication, dose and route are appropriate to the condition, says the report.
However, this software will have to be brought in from overseas or developed locally and is unlikely to be in operation widely within the next few years, Anderson says.
Mistaken drug administration came to public attention last year through a report into a 2004 incident when Mervin McAlpine died after a medication mix-up at Auckland City Hospital. He was a diabetic and was given another patient’s drugs.