prof. pascal bonnabry - pharmacie à genève aux hug · pdf file1 healthcare...

1

Healthcare provider perspectiveVision from a hospital pharmacist on bar coding of

pharmaceuticals and implementation of GS1 standards

Prof. Pascal BONNABRY

Brussels, February 23, 2010

GS1 Global Forum

Pascal BONNABRY Barcoding in the hospital, February 23, 2010

Errors from prescription to administration

Handwritten prescription Administration

Manual dispensation Retranscription

Avoidable ADE : 6.5% of admissions

Bates DW, JAMA 1995;274:29

39%

12% 11%

38%

2


Human reliability

« On the 6th day, God created man … »

… but God was tired, and hiscreation was not perfect …


The addition of two errors

Commission error AND Control failure

SelectionCalculationCounting

CheckDouble-check

Check-listElectronic

3


Limited performance of controls

• Introduction of errors during unit dose dispensing

• Detection ability during human-performed control:

• Pharmacists: 87.7%• Nurses: 82.1%

Facchinetti NJ, Med Care 1999;37:39-43

Efficiency ≈ 85%(known value in the industry)

Do not be too confident with the double-checks !


Potential interests of IT

• To improve• The safety

by improving the reliability of controls• five “R”

• authentication of drugs

• The traceabilityby facilitating the registration of logs

• The efficiencyby increasing the working performance

• The communicationby connecting the different steps of the processes

4


The medication process

Pharmacy stock

Industry stock

Production stock

Raw-materialsanalysisProductionEnd-product

analysis

Ward stock

Prescription

Dispensation Production

Physical flowInformation flow

EPR

CytosTPNMP

Administrationto patients


Electronic systemsto catch errors

Pharmacy stock

Industry stock

Production stock


analysis

Ward stock

Prescription



EPR

CytosTPNMP


( )

Delivery

5


Electronic systemsto avoid errors

Pharmacy stock

Industry stock

Production stock


analysis

Ward stock

Prescription



EPR

CytosTPNMP


EDI

CPOE


• Error rate during manual distribution = 1 %

Pharmacy stockDistribution errors

Gschwind L, HUG, 2006

24%

21%55%

Count

OmissionSelection

6


• Stock exit• Product ID quantity validation in software

Pharmacy stockManagement with barcodes

B. Hirschi, CHUV, 2009


Pharmacy stockImpact of barcoding

Poon EG, Ann Intern Med 2006;145:426-34

• Errors with the potential to harm: 0.19 0.07%

7


Pharmacy stockCost-benefit analysis

Maviglia SM, Arch Intern Med 2007;167:788-94

Cost savingassociated withpreventing ADE

• Net benefit (5 years): $ 3.5 million

Launch ROI


• 19% errors

Administration to patientsError rates

Observation study in 36 institutions Barker KN, Arch Intern Med 2002;162:1897

8


Administration to patientsBenefit of bedside scanning

• Positive impact

• Wrong drug - 75%

• Wrong dose - 62%

• Wrong patient - 93%

• Wrong administration time - 87%

Globally - 80%

Johnson, J Healthcare Inf Manag 2002;16:1


Administration to patientsCytotoxics

Database

Drug

Patient

NursePhysicians

9


Administration to patientsCytotoxics – cost-efficacy analysis

R. Balbaaki, HUG, 2006

(already existing electronic prescription)

Cost /avoided error [CHF]

Scanning vs check-list

Scanning vs no help

Rate of use CL/scan [%]

Datamatrix

3’450355100 / 100Without error cost

- 2’550- 5’645100 / 100With error cost


Prerequisite to successfulscanning

• Electronic management of processes (CPOE, stocks, …)

• Technical infrastructure (hard-, soft-)

• Actors identification (caregivers, patients, drugs)

• Acceptability (patients, caregivers)

• Adaptation to processes

• Project leadership

• Financing

10


Actors identification

The patient

The caregiver

The drug


Drug identification

Unit dose

Secondary package

Hospital package

• Hierarchy

GS1 = international standard

Box

Pallet

11


Unit doses identification

Panadol 500 mgparacétamol

n°lot 420607Exp. 08.2009

SafetyID product(minimal)

Easily human readable

TraceabilityBatch numberExpiry date(ideal)


Secondary package

SafetyID product(minimal)

TraceabilityBatch numberExpiry date(Serial number)(ideal)

EAN-13

or

GS1-128 Datamatrix

12


Unit dose identificationEurope - EAHP

• Unit doses blisters, with each single dose containing the wholeinformation• Trade name• Active substance• Dosage• Expiry date• Batch number• Barcode

• Including product ID, expiry date and batch number• Use of a recognized international standard (i.e GS1)• Datamatrix

EAHP, 2007


Labelling of parenteral drugsSwitzerland

13


Conclusion

• Barcoding can improve the safety and the traceability of drug use at each step of the process

• The implementation requires• an exhaustive identification of drugs without reducing the human

readability (industry)• the development of information technologies in the medication

process (hospital)

• Hospitals are in action and work in close collaboration with the industry and GS1

• The implementation is a real challenge and will take severalyears !


Perspective

• Will we be able to be as effective as supermarkets?

Yes, we scan !

prof. pascal bonnabry - pharmacie à genève aux hug · pdf file1 healthcare...

Documents