Injecting safer practices into medication administration

A large-scale shift is coming to Nursing and Pharmacy, with the introduction of bedside barcode scanning to verify medications before they are administered to patients.

“Scanning ensures patients get the correct medication by eliminating many of the potential manual errors – it’s safer,” says Michele Babich, (now former) Executive Director, Lower Mainland Pharmacy Services.

Bedside barcode scanning completes the circle of what’s known as “closed loop medication management,” which is an integral part of the Clinical and Systems Transformation (CST) project. Laser scanning wands, similar to the ones we’ve become familiar with at the supermarket checkout, will be introduced into hospitals across VCH, PHSA and PHC.

The closed loop process injects technology into every step, including those critical seconds before patients receive medications – when so much is going on. That means all patient-specific medications, as well as what’s currently known as ward stock medication, must be packaged individually and have a barcode.

To err is human

Barcodes provide a way to ensure the right medication and dose is given to the right patient at the right time. It’s a critical leap forward; statistics tell us that up to 24,000 Canadian adults die every year because of preventable adverse events in acute care hospitals, and half of those are medication-related.

“Currently, the nurses are doing the final check and they have no technology to help them. It’s up to them,” says Tessa Valg, Regional Manager, Drug Distribution Systems and Production Centres, Lower Mainland Pharmacy Services. “Introducing barcode scanning will give us another level of checks that, in today’s world, we don’t have.”

Today, the Lower Mainland Regional Pharmacy Production Centre operates at St. Paul’s Hospital. Staff at the centre receive bulk medication from manufacturers. They package these drugs into unit dose using a high-tech automated process before distributing them to sites in metro Vancouver and along the coast.

“The volumes that we have to package are enormous; there are millions of dosages,” says Michele, “but because it’s produced centrally, our product control can be monitored very closely. This is a very efficient way to ensure quality control in one location, and it supports all the sites.”

New and improved

The Regional Production Centre has traded its cramped 700 sq. ft. space at St. Paul’s Hospital for nearly 4,000 sq. ft. at Vancouver General Hospital, allowing it to increase its capacity and output as the service is expanded to include all VCH, PHSA and PHC sites. 

The VGH facility is known as Vancouver Pharmacy Production Centre and it will package the 20-30 per cent of medications that aren’t already barcoded by the manufacturers, as well as individually packing a wider range of bulk medications. These include things like eye drops, suppositories, oral tablets and patches.

Another big change will be liquid medications. Gone will be the days of bulk 1L bottles. Soon, these will be replaced with 5mL and 10mL barcoded aliquots – or portions – for single-dose administration at the bedside.

A safer future

It’s the patient who ultimately benefits. Going digital reduces the risk of errors that come with deciphering handwriting in a paper-based system. And receiving and reviewing orders online reduces the turnaround time in getting patients the medications they need.

“In the future state, if you scan the wrong medication, the system is going to tell you, ‘Hang on, this isn’t the medication that I’m expecting.’ And to me, that’s where the huge value of this system is. We’ll be catching what we don’t even know is happening currently,” says Tessa. "There’s no question that the end result is safer.