Once in a while something really annoys me. The older I get, the harder that is to occur (I guess I have just given up on some things), but there are still some things that just get under my skin and itch like crazy. One of those things is the apparent lack of understanding about just how important bar coding could be in ensuring patient safety. I say
could be because, while the concept is compelling, there are still holes in implementation that make it harder than it should be to ensure that bar coding is sufficiently ubiquitous that we can treat it as reliable.
My staff encountered one of the holes that I
thought was closed the other day, that being universal encoding of unit-of-use containers.
Now let's be clear, there is only one real reason someone would encode a unit-of-use container, and that is to permit the use of that container to be verified at the point of use. While the largest use of that is still at the bedside (BCMA), we are seeing a growing interest in bar code medication preparation (BCMP) in pharmacies, where it is equally applicable, and equally vital in ensuring that a pharmacy-compounded preparation contains what it is labeled to contain. In contrast, supply chain activities generally use encoding at the shelf pack (e.g., box of 10) or case level.
So, while testing a new scanning system, we visited a customer account and scanned their inventory. To my amazement, we found:
- A significant number (10-15%) of the vials scanned were not found in our commercial database or were mischaracterized as shelf-packaging rather than unit-of-use.
- Vials packed in individual boxes where the bar code on the individual box was different than the bar code on the vial and only the bar code on the box contained an NDC that was referenced in our commercial database.
- Vials packed in individual boxes where the only NDC bar code for the product was on the box; there was a bar code on the vial, but it was unreadable and could not have contained the NDC (we typically see this type of encoding containing a 3-4 digit number that is a vendor's internal code for the product).
- Premixed solution containers where the bar code was on the overwrap, but not on the actual bag.
So, if the purpose for placing a bar code on the unit-of-use container is for verification at the point of use, why would a vendor supply a commercial database company with a bar code that is unlikely to be present when verification needs to be performed? Why would a vendor encode an outer wrap and not encode the actual container being used with a bar code that could be verified during use? And why is it that this information is often not present in commercial databases until after the product is in the supply chain, if at all?
Do we really think a nurse is going to carry the box to the bedside? We know that it is inappropriate to take that waste into the clean room in the pharmacy. We also know that pharmacies spend an inordinate amount of time scanning everything that comes into their back door because they cannot rely on available databases to recognize the bar codes on the products they use.
It's not that encoding the containers is all that hard; too many people are doing it. It can't be that hard to get complete and accurate information to the third-party information vendors who must support it, either.
I don't know the answers to these questions, and to a large degree I suppose I am not interested in hearing excuses. If patient safety is really important to us, and if the reason for encoding these containers is to help assure patient safety, then it seems to me that the various stakeholders involved in this process would be working hard to ensure that:
- Every unit-of-use container is encoded with its NDC - AND -
- Every encoded unit-of-use NDC on its container is accurately represented in a commercial database before that NDC hits the supply chain.
Is that too much to ask?
Dennis A. Tribble, Pharm. D., FASHP
Daytona Beach, FL
DATdoc@aol.com
The opinions expressed in this blog are my own, and not those of my employer, or of the American Society of Health-System Pharmacists
#MedicationSafety #Technology #Informatics #Informaticists