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A Safe Practice Standard for Barcode Technology

Leung, Alexander A. MD, MPH*; Denham, Charles R. MD; Gandhi, Tejal K. MD, MPH*; Bane, Anne RN, MSN*; Churchill, William W. MS, RPh*; Bates, David W. MD, MSc*; Poon, Eric G. MD, MPH

doi: 10.1097/PTS.0000000000000049
Original Articles

Objective Safety advocates have identified barcode verification technology as an important tool to improve health-care practices.

Methods We evaluated the evidence for the role of barcode technology in improving a wide range of medication safety outcomes across a broad range of settings. Important implementation issues were highlighted to guide standards for the safe adoption of barcode technology.

Results Adverse drug events are common, occurring frequently in both inpatient and outpatient settings. Although approximately half of all preventable adverse drug events in inpatients result from medication errors arising from transcription, dispensing, and administration, these errors are far less likely to be caught than in any of the earlier stages of the medication use process and are therefore most amenable to improvement. When integrated with electronic medication administration records, barcode systems are associated with complete elimination of transcription errors. Furthermore, barcode-assisted dispensing systems are associated with 93% to 96% reductions in dispensing errors, and 85% reductions in potential adverse drug events in dispensing. Most studies have reported large and significant reductions in administration errors by up to 80% after implementation of barcode medication administration systems. Although most studies of barcode technology have been conducted in the adult inpatient setting, the limited data available also support their benefit in pediatric and outpatient settings.

Conclusions There is growing evidence for the efficacy of barcode solutions in improving overall medication safety. Standards for the implementation of barcode technology are proposed.

From the *Brigham and Women’s Hospital, Boston, Massachusetts; †Texas Medical Institute of Technology, Austin, Texas; and ‡Boston Medical Center, Boston, Massachusetts.

Correspondence: Eric G. Poon, MD, MPH, Boston Medical Center, Room 1005, BCD Building, 800 Harrison Avenue, Boston, MA 02118 (e-mail:

Dr. Leung receives salary support through the Clinical Fellowship Award from Alberta Innovates Health Solutions and by a Fellowship Award from the Canadian Institutes for Health Research. Dr. Gandhi has been a consultant for QuantiaMD and is faculty at the Institute for Healthcare Improvement. She also serves on the Board of Governors for the National Patient Safety Foundation. Dr. Bates serves on the board for SEA Medical Systems, which makes intravenous pump technology. He has previously served on the clinical advisory board for Patient Safety Systems, which provides a set of approaches to help hospitals improve safety, including bar coding.

Funding: This study received no financial support.

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