2002; Wachter et al., 2003; Pierce, 2006). Anesthesiologists administer anesthetics and observe the condition of their patients aided by multiple electronic monitors (e.g., electrocardiograph, pulse-oximeter, blood pressure monitors), which determine real-time decision making and actions. The AIMS records electronically all data generated by these technologies. The simulation programs allow clinicians to test themselves under various surgical situations. More recently, the Leapfrog Group commissioned the development of a simulation application both to test the decision-support algorithms of CPOE systems implemented in health care organizations and to train clinicians (Kilbridge et al., 2006). The methodology simulates different clinical scenarios using a wide variety of test patients and orders to evaluate how a hospital’s CPOE system responds to unsafe medication ordering and clinical situations.

Bar Coding

Another area requiring standardization is the bar codes used for drug labels and bar code medication administration systems. The ability of bar coding to affect medication error rates depends largely on the ability of hospitals to scan and interpret the data in the bar codes. A commonly used standard that scanners can easily read will have a greater impact on patient safety than a unique symbology that few scanners are programmed to read (FR, 2004).

A number of different stakeholders—drug manufacturers, distributors, repackagers/relabelers, manufacturers of bar code medication administration systems, and hospitals—use bar codes on drug products. As with the lack of a common drug nomenclature, there is no single, common bar code standard or symbology. Among hospitals, repackagers, and vendors of bar code medication administration systems, up to six different bar code standards are being used, each with its own special characteristics, features, and methods for encoding product information (see Figure 6-2). This situation creates several problems. First, the lack of a common standard drives costs up throughout the drug delivery system, particularly for hospitals that incur the expense of repackaging/relabeling drugs to the unit dose level and/or purchasing additional software or technology to read the different bar codes. Second, error rates associated with hospital relabeling are estimated at 17 percent nationwide, increasing the risk of ADEs (FR, 2004). Third, the multitude of standards inhibits integration of clinical systems. Designation of a single, common bar code standard could resolve these problems.

Efforts to standardize bar codes are linked to a rule establishing federal requirements for labeling of products down to the unit dose level. In the rule, the FDA requires all stakeholders using bar codes to choose one of two standards: (1) European Article Number/Uniform Code Council (EAN/



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