Hospitals adopt supermarket-style bar-code systems to enhance patient safetyFREEHOLD – New Jersey hospitals are turning to information technology normally found in retail settings to help caregivers reduce medication errors.

Nurses at Palisades Medical Center in North Bergen and CentraState Medical Center in Freehold are among those matching medicine to patients by scanning bar codes on medicine containers and patient bracelets to make sure they match. The procedure is part of a trend that has been making its way into hospitals across the country as a way to improve patient safety.

Ron Czajkowski, spokesman for the New Jersey Hospital Association, says the use of bar-code systems has been growing in health care settings, and the technology is “cheaper in the long run, more efficient and safer [than manual methods.]”

Medication errors injure at least 1.5 million hospital patients every year, according to a 2006 study by the Institute of Medicine, a federally funded nonprofit in Washington, D.C.

The study put the cost of treating these injuries at $3.5 billion per year, not counting lost wages and productivity.

Such errors can involve prescription drugs, over-the-counter medications and vitamin, mineral and herbal supplements.

At Palisades Medical Center, which is launching a bar-code program this month, nurses will push carts carrying coded medicine containers, scanners and computers into patients’ rooms.

Information about the drugs, dosage and time of administration for each patient is stored in electronic files linked to the system and available on the computers. If the wrong medicine is about to be given to a patient, the computer screen should alert the nurse, says Richard Salvia, chief financial officer of Palisades Medical Center.

Salvia says the system costs about $650,000 and was purchased without a cost-benefit analysis. “We didn’t look at it that way,” he says. “The technology is meant to improve the quality of patient care and patient safety.”

“About half the hospitals [in New Jersey] are losing money and have limited access to capital resources,” notes Salvia, who adds that Palisades broke even in fiscal 2006. “When it comes down to making investments in things like bar coding, it really has to be ranked against other items,” he says.

Daniel Messina, chief operating officer of CentraState Medical Center, says the hospital paid $1.2 million for the bar-code system it began using last year, and is now evaluating the return on that investment. The purchase was part of an $8.2 million package from Siemens Medical Solutions that integrates the technology with electronic medical records and physician ordering systems. “It’s a significant investment in a world of declining reimbursement [from Medicaid, Medicare and the state’s charity fund],” Messina says.

He says CentraState’s relatively healthy operating margin—which came to 3 percent in fiscal 2006, or two-to-three times the average for the hospitals in the state—has allowed it to invest heavily in information technology during the past four years. “There’s an old saying, ‘no margin, no mission,’” Messina says.

He says CentraState, which is part of the eight-facility CentraState Healthcare System, records about 17,000 admissions per year plus 60,000 emergency-room visits. Medication errors have dropped sharply from 65 cases out 258,825 doses in the first quarter of 2006, to 44 cases out of 300,813 in the first quarter this year, he says.

In percentage terms, the errors fell from .025 percent of doses a year ago to .015 percent this year.

Messina attributes the drop to the new technology and a nonpunitive environment for the reporting of errors that provides “the opportunity to meet regularly to discuss mistakes, educate staff and put processes in place so that the same mistakes don’t happen again.”

Siemens also made the system installed at Palisades Medical Center, which Salvia says admits about 11,000 patients per year and sees an additional 30,000 people in its emergency room.

Siemens says he is uncertain about the number of medication errors that occur at the hospital, which is a member of the 43-facility New York-Presbyterian Healthcare System.

Mike McBride, editor-in-chief of the trade publication Health Management Technology, says a 1999 Institute of Medicine report that found a rising rate of medication errors drew widespread attention to the problem.

Since then “the push from Washington has been to drive the rates lower through technology, such as bar coding,” says McBride. He observes that a big effort came in 2004 when the U.S. Food and Drug Administration began requiring bar codes on most prescription drugs and some OTC preparations.

The technology is costly, he says, and can run into problems because it “often must be integrated into a hospital’s existing clinical systems, including pharmacy and computerized physician order entry.”

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