Bar Codes Prescribed For Hospitals
Supermarkets track mayonnaise more carefully than some hospitals track morphine, said the head of a Harvard team that analyzed drug errors at two top hospitals.
“I think that is pretty ridiculous,” said Dr. Lucian L. Leape of the Harvard School of Public Health, who advocates a computerized bar code system to help prevent dosing and prescribing errors.
Leape’s team found one in 20 patients is being prescribed incorrect drugs. There were 334 drug errors at Brigham and Women’s Hospital and Massachusetts General Hospital, both in Boston, in the six months ending in July 1993.
Thirty-nine percent of errors were made by doctors who did such things as order a drug that the patient was allergic to or prescribe the wrong dose; 38 percent were made by nurses who made such mistakes as administering the wrong amount or mixing it with the wrong solution; the rest came when secretaries transcribed orders or when pharmacists dispensed medication.
Most errors were caught or didn’t cause a problem, but 70 patients suffered complications. None was fatal, but 14 were life-threatening and 30 were serious, according to the data gathered at the hospitals and reported in today’s issue of The Journal of the American Medical Association.
Many errors could have been averted if the hospitals had a bar coding system at bedsides so staff could check drugs before administering them, Leape said.
“We currently do bar coding for mayonnaise in supermarkets but not for morphine in hospitals,” said Leape.
In hospitals using the system, a nurse passes a portable sensor wand over the code on the drug and over a code on the patient’s I.D. bracelet to verify that the drug is appropriate.
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