A System for Anesthesia Drug Administration Using Barcode Technology: The Codonics Safe Label System and Smart Anesthesia Manager™

BACKGROUND:Many anesthetic drug errors result from vial or syringe swaps. Scanning the barcodes on vials before drug preparation, creating syringe labels that include barcodes, and scanning the syringe label barcodes before drug administration may help to prevent errors. In contrast, making syringe labels by hand that comply with the recommendations of regulatory agencies and standards-setting bodies is tedious and time consuming. A computerized system that uses vial barcodes and generates barcoded syringe labels could address both safety issues and labeling recommendations. METHODS:We measured compliance of syringe labels in multiple operating rooms (ORs) with the recommendations of regulatory agencies and standards-setting bodies before and after the introduction of the Codonics Safe Label System (SLS). The Codonics SLS was then combined with Smart Anesthesia Manager software to create an anesthesia barcode drug administration system, which allowed us to measure the rate of scanning syringe label barcodes at the time of drug administration in 2 cardiothoracic ORs before and after introducing a coffee card incentive. Twelve attending cardiothoracic anesthesiologists and the OR satellite pharmacy participated. RESULTS:The use of the Codonics SLS drug labeling system resulted in >75% compliant syringe labels (95% confidence interval, 75%–98%). All syringe labels made using the Codonics SLS system were compliant. The average rate of scanning barcodes on syringe labels using Smart Anesthesia Manager was 25% (730 of 2976) over 13 weeks but increased to 58% (956 of 1645) over 8 weeks after introduction of a simple (coffee card) incentive (P < 0.001). CONCLUSIONS:An anesthesia barcode drug administration system resulted in a moderate rate of scanning syringe label barcodes at the time of drug administration. Further, adaptation of the system will be required to achieve a higher utilization rate.

[1]  A. Merry,et al.  A prospective, randomised clinical evaluation of a new safety‐orientated injectable drug administration system in comparison with conventional methods * , 2004, Anaesthesia.

[2]  Rodney W Hicks,et al.  Errors prevented by and associated with bar-code medication administration systems. , 2007, Joint Commission journal on quality and patient safety.

[3]  Papaarangi Reid,et al.  Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation , 2011, BMJ : British Medical Journal.

[4]  Maribeth Slebodnik,et al.  Bar Code Technology and Medication Administration Error , 2010, Journal of patient safety.

[5]  Matthew B. Weinger,et al.  Reengineering Intravenous Drug and Fluid Administration Processes in the Operating Room: Step One: Task Analysis of Existing Processes , 2002, Anesthesiology.

[6]  A F Merry,et al.  Evidence‐based strategies for preventing drug administration errors during anaesthesia , 2004, Anaesthesia.

[7]  Shu-Fang Newman,et al.  Smart Anesthesia Manager$^{\rm TM}$ (SAM)—A Real-time Decision Support System for Anesthesia Care during Surgery , 2013, IEEE Transactions on Biomedical Engineering.

[8]  A F Merry,et al.  The Frequency and Nature of Drug Administration Error during Anaesthesia , 2001, Anaesthesia and intensive care.

[9]  Alex Macario,et al.  Adoption of Anesthesia Information Management Systems by Academic Departments in the United States , 2008, Anesthesia and analgesia.

[10]  R. D. Paoletti,et al.  Using bar-code technology and medication observation methodology for safer medication administration. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[11]  J. Edworthy,et al.  Alarms and human behaviour: implications for medical alarms. , 2006, British journal of anaesthesia.

[12]  Shu-Fang Newman,et al.  Feedback Mechanisms Including Real-Time Electronic Alerts to Achieve Near 100% Timely Prophylactic Antibiotic Administration in Surgical Cases , 2010, Anesthesia and analgesia.

[13]  J. Barletta,et al.  Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. , 2009, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[14]  Emily S. Patterson,et al.  Research Paper: Improving Patient Safety by Identifying Side Effects from Introducing Bar Coding in Medication Administration , 2002, J. Am. Medical Informatics Assoc..

[15]  L. Glance,et al.  A Survey of the Use of Ultrasound During Central Venous Catheterization , 2007, Anesthesia and analgesia.

[16]  Clement J McDonald,et al.  Computerization Can Create Safety Hazards: A Bar-Coding Near Miss , 2006, Annals of Internal Medicine.

[17]  David W. Bates,et al.  Effect of Bar-code Technology on the Safety of Medication Administration , 2010 .

[18]  A. Merry,et al.  Clinical assessment of a new anaesthetic drug administration system: a prospective, controlled, longitudinal incident monitoring study * , 2010, Anaesthesia.

[19]  Edward Etchells,et al.  Barcoded medication administration: a last line of defense. , 2008, JAMA.

[20]  B. Franklin,et al.  The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study , 2007, Quality and Safety in Health Care.

[21]  B. Karsh Beyond usability: designing effective technology implementation systems to promote patient safety , 2004, Quality and Safety in Health Care.

[22]  D. Bell Recurrent wrong‐route drug error – a professional shame , 2007, Anaesthesia.

[23]  H. Schwid,et al.  Reducing Wastage of Inhalation Anesthetics Using Real-time Decision Support to Notify of Excessive Fresh Gas Flow , 2013, Anesthesiology.

[24]  Pieter J. Helmons,et al.  Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas. , 2009, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[25]  Philip J Schneider,et al.  ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2011. , 2012, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[26]  H. Connell,et al.  A new infusion syringe label system designed to reduce task complexity during drug preparation , 2007, Anaesthesia.

[27]  E. Cook,et al.  Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. , 2009, The Journal of pediatrics.

[28]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[29]  Lee Ann Runy,et al.  Patient safety in the operating room. , 2007, Hospitals & health networks.

[30]  Carol A. Keohane,et al.  Effect of bar-code technology on the safety of medication administration. , 2010, The New England journal of medicine.