Healthcare provider perspective. Vision from a hospital pharmacist on bar coding of pharmaceuticals and implementation of GS1 standards

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Isabel Wiggins
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1 Healthcare provider perspective Vision from a hospital pharmacist on bar coding of pharmaceuticals and implementation of GS1 standards Prof. Pascal BONNABRY GS1 Global Forum Brussels, February 23, 2010 Errors from prescription to administration 12% Retranscription Manual dispensation 11% 39% Handwritten prescription Avoidable ADE : 6.5% of admissions Administration Bates DW, JAMA 1995;274:29 38% 1

two errors Commission error AND Control failure Selection

2 Human reliability «On the 6th day, God created man» but God was tired, and his creation was not perfect The addition of two errors Commission error AND Control failure Selection Calculation Counting Check Double-check Check-list Electronic 2

Limited performance of controls Introduction of errors during unit dose dispensing Detection ability during human-performed control: Pharmacists: 87.7% Nurses: 82.

3 Limited performance of controls Introduction of errors during unit dose dispensing Detection ability during human-performed control: Pharmacists: 87.7% Nurses: 82.1% Facchinetti NJ, Med Care 1999;37:39-43 Efficiency 85% (known value in the industry) Do not be too confident with the double-checks! Potential interests of IT To improve The safety by improving the reliability of controls five R authentication of drugs The traceability by facilitating the registration of logs The efficiency by increasing the working performance The communication by connecting the different steps of the processes 3

4 The medication process Physical flow Information flow Industry stock Prescription Cytos TPN MP Pharmacy stock Ward stock Dispensation Production EPR Production stock End-product analysis Production Raw-materials analysis Administration to patients Electronic systems to catch errors Physical flow Information flow Industry stock Pharmacy stock Delivery Ward stock ( ) Dispensation Prescription Cytos TPN MP Production EPR Production stock End-product analysis Production Raw-materials analysis Administration to patients 4

5 Electronic systems to avoid errors Physical flow Information flow Industry stock CPOE Prescription Cytos TPN MP EDI Pharmacy stock Ward stock Dispensation Production EPR Production stock End-product analysis Production Raw-materials analysis Administration to patients Pharmacy stock Distribution errors Error rate during manual distribution = 1 % 24% Count Selection 55% 21% Omission Gschwind L, HUG,

6 Pharmacy stock Management with barcodes Stock exit Product ID quantity validation in software B. Hirschi, CHUV, 2009 Pharmacy stock Impact of barcoding Errors with the potential to harm: % Poon EG, Ann Intern Med 2006;145:

SM, Arch Intern Med 2007;167:788-94 Administration to patients Error rates

7 Pharmacy stock Cost-benefit analysis Net benefit (5 years): $ 3.5 million Launch ROI Cost saving associated with preventing ADE Maviglia SM, Arch Intern Med 2007;167: Administration to patients Error rates 19% errors Observation study in 36 institutions Barker KN, Arch Intern Med 2002;162:1897 7

8 Administration to patients Benefit of bedside scanning Positive impact Wrong drug - 75% Wrong dose - 62% Wrong patient - 93% Wrong administration time - 87% Globally - 80% Johnson, J Healthcare Inf Manag 2002;16:1 Administration to patients Cytotoxics Physicians Nurse Drug Database Patient 8

Administration to patients Cytotoxics cost-efficacy analysis (already existing electronic prescription) Cost /avoided error [CHF] Datamatrix Rate of use CL/scan [%] Scanning vs no help Scanning vs

9 Administration to patients Cytotoxics cost-efficacy analysis (already existing electronic prescription) Cost /avoided error [CHF] Datamatrix Rate of use CL/scan [%] Scanning vs no help Scanning vs check-list Without error cost 100 / With error cost 100 / R. Balbaaki, HUG, 2006 Prerequisite to successful scanning Electronic management of processes (CPOE, stocks, ) Technical infrastructure (hard-, soft-) Actors identification (caregivers, patients, drugs) Acceptability (patients, caregivers) Adaptation to processes Project leadership Financing 9

10 Actors identification The caregiver The patient The drug Drug identification Hierarchy Unit dose Secondary package Hospital package Box Pallet GS1 = international standard 10

Unit doses identification Easily human readable

2009 Safety ID product (minimal) Traceability Batch

ID product (minimal) EAN-13 Traceability Batch

11 Unit doses identification Easily human readable Panadol 500 mg paracétamol n lot Exp Safety ID product (minimal) Traceability Batch number Expiry date (ideal) Secondary package Safety ID product (minimal) EAN-13 Traceability Batch number Expiry date (Serial number) (ideal) GS1-128 or Datamatrix 11

number Barcode Including product ID, expiry date and batch number Use of a recognized

12 Unit dose identification Europe - EAHP Unit doses blisters, with each single dose containing the whole information Trade name Active substance Dosage Expiry date Batch number Barcode Including product ID, expiry date and batch number Use of a recognized international standard (i.e GS1) Datamatrix EAHP, 2007 Labelling of parenteral drugs Switzerland 12

in the medication process (hospital) Hospitals are in action and work in close collaboration with the industry and GS1 The

13 Conclusion Barcoding can improve the safety and the traceability of drug use at each step of the process The implementation requires an exhaustive identification of drugs without reducing the human readability (industry) the development of information technologies in the medication process (hospital) Hospitals are in action and work in close collaboration with the industry and GS1 The implementation is a real challenge and will take several years! Perspective Will we be able to be as effective as supermarkets? Yes, we scan! 13

Drug distribution in hospitals and barcoding. The needs of traceability of medicines in hospitals

Drug distribution in hospitals and barcoding The needs of traceability of medicines in hospitals Dr. Roberto Frontini, President EAHP president@eahp.eu Conflict of interest Nothing to disclose Dr. Roberto