ASHP Statement on Bar-Code-Enabled Medication Administration Technology
The American Society of Health-System Pharmacists (ASHP) encourages health systems to adopt bar-code-enabled medication administration (BCMA) technology to improve patient safety and the accuracy of medication administration and documentation. To support the goal of having all medications electronically verified before they are administered, BCMA systems should be used in all areas of health systems in which medications are used. Pharmacists must be involved in the interdisciplinary planning, development, implementation, and management of BCMA systems and must ultimately be responsible for developing and maintaining the infrastructure required to ensure BCMA success. Health systems deploying BCMA programs must provide the funding and staffing necessary to permit pharmacists to fulfill this role.
ASHP urges the Food and Drug Administration (FDA) and other regulatory agencies, standard-setting bodies, contracting entities, health systems, and others to mandate that pharmaceutical manufacturers use symbologies that are readily deciphered by commonly used scanning equipment to code for the National Drug Code (NDC), lot number, and expiration date on all unit dose, unit-of-use, and injectable drug packaging. Pharmaceutical manufacturers should also provide all medications used in health systems in unit dose packages. FDA, pharmaceutical manufacturers and packagers, and the manufacturers of BCMA systems should collaborate to minimize or eliminate the causes of false rejection of valid medication doses. Certain characteristics of the current NDC identification system contribute to the burden of implementing BCMA systems, and ASHP urges stakeholders to participate in efforts to develop a system that more reliably identifies the unique drug (or combination of drugs), strength, dosage form, and route of administration.
Although bar-coding systems are currently a widely used point-of-care technology, ASHP recognizes that other types of machine-readable coding (e.g., radio-frequency identification) may evolve. ASHP supports the use of new technologies that are as effective as or improve upon existing systems and believes the principles outlined in this statement apply to such systems. ASHP urges further research on such systems as well as research that will definitively determine the extent to which BCMA systems reduce preventable medication errors and provide a financial return on investment for health systems.
Since the 1980s, health care practitioners and policymakers have recognized the potential benefits of using bar-coding technology in the medication dispensing and administration process.1–5 Although there is a consensus of professional judgment and expert opinion on the advancement of BCMA technology, more studies are needed to definitively determine the impact of BCMA systems on medication errors and the finances of health systems. ASHP believes that optimally implemented BCMA systems have tremendous potential to improve patient safety. In addition, the reengineering of the medication-use process required to implement a BCMA system can provide opportunities for performance improvement in patient care and clinical documentation.
A 2005 ASHP survey estimated that only 13.2% of hospitals used a BCMA system.6 Although this percentage is small, it represents an almost 10-fold increase since 2002.7 The rapid adoption of BCMA systems presents challenges to health systems, and ASHP believes that pharmacists have a crucial role in responding to those challenges.
Role of the Pharmacist
Pharmacists should take the lead in ensuring that the implementation of BCMA systems and the reengineering of the medication-use system address the complexities of the process and that the goal of improving patient safety is achieved. Poor design and inadequate planning can compromise the effectiveness of a BCMA system and may even introduce new sources of error into the medication-use process.8 Growing experience with BCMA systems has produced a body of knowledge that will aid hospitals and health systems in the adoption of BCMA systems.9–12
Pharmacy leadership needs to engage the chief information officer, chief nursing officer, and other key stakeholders in planning for BCMA systems as early as possible. Pharmacists and nurses should be involved with the preinstallation evaluation and selection of the BCMA system. Allowing end users to provide crucial advice about system design will increase acceptance and utility of the system.