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Vital Signs:
Improving safety, one bar code at a time

It's a daunting task, to accurately dispense nearly a million doses of medication a year. But at DHMC, that job is handled by an indefatigable "employee," a robot named MAC. Thanks to bar-coding technology, MAC never makes a mistake.

MAC-short for Medication Access Computer-been working behind the scenes at DHMC since November 1999, long before a February 2004 proposal by the Food and Drug Administration (FDA) to require bar codes on all human drug, biologic, and blood products. The FDA estimates that the new rule will help prevent nearly 500,000 adverse events nationwide, while saving $93 billion over 20 years. According to a recent article in American Medical News, only 2% of hospitals in the country currently use bar-coding technology.

Photo by Mario Morgado
A technician stocks the DHMC pharmacy's most reliable "employee."

At DHMC, under a pharmacist's review, a pharmacy technician uses an automated bar-coding system to label and package medications-from tablets to vials. Then, explains Robert Theriault, director of pharmacy services, MAC fills most medication requests; the only orders filled manually are for intravenous and pediatric drugs.

In 2005, DHMC plans to roll out an even more sophisticated pharmacy system. Theriault describes how it will work: "MAC picks the dose or the IV room manufactures the dose. Then a nurse does a check with a handheld scanner at the patient bedside, scanning the patient's wrist, the medication, then themselves for documentation. A green light indicates go. If it's the wrong dose, the wrong time, or the wrong person, the scanner provides decision support for the next step."

Unfortunately, broad bar-code standards have yet to be developed; the FDA mandate covers only the product code number. So DHMC will continue to do its own coding. "I'd love to see manufacturers package robot-ready doses and include information such as lot and expiration in their bar codes," says Theriault. "The more information you have, the safer and more effective the medical management process will be."


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