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Keeping Patients Safe: Transforming the Work Environment of Nurses
Unit dose dispensing—Murray and Shojania (2001) review the evidence associated with “unit dose dispensing”—the practice of having hospital pharmacies dispense medications to nursing stations in individually packaged doses ready to be given to the patient. Unit dose dispensing is common on general medical and surgical hospital units, but less so in intensive care units, operating rooms, and emergency departments. In the latter areas, bulk medication stock systems are still found. In a 1999 survey of hospital pharmacy directors, 80 percent reported that unit dose dispensing was used for 75 percent or more of oral doses and 52 percent of medications for injection. Murray and Shojania (2001:104-105) conclude that although the evidence for the effectiveness of unit dose dispensing is “modest,” studies evaluating the practice are “overall relatively consistent in showing a positive impact on error reduction.” The Institute for Safe Medication Practices notes, however, that the unavailability of unit dose packaging by manufacturers is becoming more widespread (Young, 2002). Information on the use of unit dose dispensing in nursing homes was not found.
Bar code medication administration—The Veterans Administration (VA) health system has used a bar code medication administration (BCMA) assistance device in almost all of its medical centers since 1999. This device, consisting of a wireless laptop computer atop a medication cart and a bar code reader, enables nurses to administer and document medications online at the point of administration. The nurse logs on to the BCMA computer, scans the patient’s ID bracelet, and brings the patient’s medication record up on the screen. The nurse then scans the medication bar code (placed there by the pharmacy) and verifies the patient’s identity and medications against active orders. If there are any issues, an alert appears. If not, the nurse administers the medication and documents this on the computer. A comparison of errors committed in 1993 (the last full year of completely manual drug administration) and those committed in 2001 at the VA medical center initiating the project revealed a 86 percent reduction in the overall medication error rate (Johnson et al., 2002). Despite similar findings at other VA facilities and endorsement by the Institute for Safe Medication Practices, a survey conducted by the American Society of Health Systems Pharmacists in 1999 found that only 1.1 percent of U.S. hospitals used bar code technology to scan a patient’s ID wristband, nurse’s badge, and prescribed drug at the bedside (Young, 2002). To encourage more widespread use of this practice, the U.S. Food and Drug Administration (FDA) proposed a new regulation on March 14, 2003, that would require human drug and blood products to be bar-coded. “The proposed rule would not require hospitals to introduce the new automated technologies, but the development of consistent bar codes on pharmaceutical and blood products would greatly encourage hospitals