LESSONS LEARNED FROM A BAR CODE PILOT
By Tim Silfies
Implementing bar code technology has become a hot topic in patient care settings within the last five years.
However, implementing these technologies can present quite a challenge to all parties involved.
Although these types of projects rely on information technologies to make them work, the pharmacy department
is an integral player in the success of the project.
Prior to finalizing a project plan, a readiness assessment of the hardware and software should be completed
to identify potential incompatibility problems that may occur due to software of hardware. Often, a hardware
vendor will lend a client the equipment required to perform a test.
Process flows for both current and future state will need to be developed for not only medication
administration but also for inventory management in the pharmacy. The pharmacy department plays a critical
role in the success of these projects because they are responsible for the medication supply in most cases. Also
changes to the pharmacy inventory need to be properly tested to ensure that the new inventory item will scan
and can be identified correctly by the system software. Remember that this process will need to be in place
prior to the “Live” event and will continue as the new inventory management workflow. One should
also consider a process flow and policy to alert the pharmacy of a medication that cannot be scanned at the
time of administration so that this problem can be quickly corrected so the scanning process
will not be bypassed which could result in a medication error.
Some points to consider are as follows:
- What will be the unique identifier used for identifying medications and orders
- Which barcodes will be scanned from the manufacturer’s package (the inner or outer barcode)
- What will be the process used to add bar codes to items that currently have none (ex. inhalers out of
the original package).
If tablets, capsules, liquids, etc are repackaged before being dispensed, ensure that a bar code can be placed
on the repackaged item. If this cannot be done at the time of repackaging a process will need to be developed
in order to scan these mediations. If the machine does assign a bar code at the time of repackaging, ensure
that the bar code can be scanned by the system software and correctly identifies the medication from the
pharmacy formulary. Some systems cannot utilize the eleven digit NDC number so testing is essential.
Develop a test plan that includes all items in the pharmacy and floor stock inventory that are expected to
be “scanable”. Once an item has been tested, keep a close watch to ensure that if there is a change
to the inventory, the new item is tested appropriately. Also include in the test plan all positions that will
be expected to scan medications. This will ensure that the position has the correct tasks associated to it as
well as the correct preferences and privileges.
Ensure that all of the scanners have been programmed exactly the same to avoid scanner format errors when
conducting the test plans. Also, understand that if working in a spreadsheet (ex. Excel) there may be cell
formatting differences between spreadsheets. Verifying the scanned results in Notepad, or WordPad can help to
determine if there are format differences as these applications do not have a “format” associated
with them.
Verify that the “Route/Form Compatibility” has been set up. This will help to ensure that a
scanned item will not return a system message stating that the form is not compatible with the route in the
order. Also verify that WTS is set up for all PC and scanners that will be used by the staff that will be
using “Care Admin” as a charting tool.
Compliance is another problem that must be addressed. Reports as well as policies and procedures must be
written to address this problem. Success of the project will largely depend upon the willingness of the staff
to comply and support these new processes.
Remember that when using bar coding technologies the ultimate goal is to improve patient safety by ensuring
the right medication is given to the right patient at the right time via the right route in the right dose
prescribed.