Welcome to the Emergency Department of the Future. Soft chimes play in the background. Screaming children are appropriately muffled. There is natural light and you can hear the ocean. Patients and doctors alike are polite and respectful, and a benign happiness seems to radiate from all directions. A young nurse wafts through the patient care areas with a handheld barcode scanner, verifying and dispensing medications in a timely and accurate fashion.
Everything about that vision is coming to your Emergency Department, everything except the chimes, the quiet, the politeness, and the happiness. The bar-code scanners, however, perhaps.
This is a pre- and post- study from The Ohio State University regarding their use of handheld scanners for medication verification (BCMA). Our hospital system uses these throughout the inpatient services to verify and provide decision-support for nurses at the final step of the medication delivery process. However, given the chaotic nature of the Emergency Department, we have not yet implemented them in that environment. Ohio State, on the other hand, has forged ahead – requiring all medication administrations be verified by bar-code scanner, excepting a small number of "emergency" medications that may be given via override. They also excluded patients in their resuscitation areas from this requirement.
Across the 2,000 medication administrations observed in the pre- and post- implementation periods, there were reductions in essentially all types various drug administration errors, leading to 63/996 errors in pre- and 12/982 in the post-. Therefore, these authors conclude – hurrah!
However, none of these errors were serious – and only one even met criteria for "possible temporary harm". The majority of errors were "wrong dose", and involved sedatives, narcotics, and nausea medications the most. Certainly, the potential for prevention of a significant drug event may be reduced with this system, but it would require much greater statistical power to detect such an effect. These authors do not touch much upon any unintended consequences of their implementation – such as delays in treatment, changes in LOS, or qualitative frustration with the system. A better accounting for these effects would assist in fully assessing the utility of this intervention in the Emergency Department.
"Effect of Barcode-assisted Medication Administration on Emergency Department Medication Errors"