Shortcuts in using bar coding technology at hospitals undermines systems' safeguards, study finds

Bar coding in hospitals has not yet been proven to reduce medical errors, and shortcuts staff have developed to work around problems with bar codes often undermine the systems' safeguards, according to a report published online Monday in the Journal of the American Medical Informatics Association, the Philadelphia Inquirer reports.

For the study, a team of researchers, led by Ross Koppel of the University of Pennsylvania School of Medicine, examined the use of bar coding technology at five hospitals over a period of several years. Researchers also analyzed half a million medication scans to determine how efficient the systems were in reducing errors.

Bar code systems consist of handheld devices for scanning and mobile computers that can be taken into patient rooms. However, in some cases, nurses cannot take the computers into patient rooms because they are crowded with other medical equipment or the patient is contagious. In such cases, nurses use the portable scanner to scan patients' wrist bands and medication codes, but because the nurses are not near the computer they might not hear error alerts. In addition, researchers found bar code bands for patients were taped to doorjambs, nurses' stations, scanners, medication dispensers and nurses' clipboards, or they were worn as key chains on belts. In some instances, the battery power on the computers had run out or there was a connection breakdown in the scanners' wireless system. The study also found that nurses overrode patient ID scans 4.2% of the time, often because the system failed to read the bar codes due to damage or other factors.

Koppel said, "In 99% of the cases," the bar code systems, not the nurses, were the cause of problems, and sometimes they were "easily fixed by reprogramming." He said that four of the hospitals involved in the study significantly reduced errors by following eight recommendations. Koppel added that two of the most important recommendations were for hospital executives to monitor use of the bar code systems and demand that manufacturers develop useful systems (Goldstein, Philadelphia Inquirer, 7/1).

An abstract of the study is available online.