Evaluation of barcode-assisted medication preparation technology for liquid medication doses.

Abstract

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The purpose of this study was to evaluate the outcomes associated with barcode-assisted medication preparation (BCMP) technology and practice workflows for oral syringe dose preparation in a health-system pharmacy department. This evaluative study was conducted at a flagship quaternary academic medical center. An electronic medical record (EMR)-integrated BCMP workflow was implemented in the central pharmacy operational area to enhance the safety of oral syringe dose preparation. The primary endpoints assessed compliance with BCMP implementation and the rate at which potential preparation errors were identified. The secondary endpoints evaluated operational markers of dose preparation batching, information technology enhancement needs, and medication waste avoidance. A 95% rate of compliance with the BCMP workflow was observed over 2 years. The composite near-miss detection rate improved from year 1 to year 2 of implementation (0.89% vs 0.94%). The composite rate was influenced by increased yearly compliance with BCMP (93.8% vs 95.3%). A total of 176,679 preparations were reviewed in the 2-year period, including 81,240 in year 1 and 89,638 in year 2. The rate at which orders were rejected by pharmacists decreased over time (0.26% in year 1 vs 0.24% in year 2). Of the 1,005 wrong ingredient warnings, only 4 were overridden; in all other instances, the order was rejected at pharmacist checking due to use of an incorrect product in the preparation history. Wrong ingredient warnings led to canceled preparations in 96.1% of alert instances. EMR-integrated BCMP technology aligned with safety efforts in the oral syringe dose preparation process reduced potential waste of medications and allowed insight into operational performance and volume indicators.