INNOVATIONS IN PHARMACY PRACTICE: SOCIAL AND ADMINISTRATIVE PHARMACY Bar Code Medication Administration Technology: A Systematic Review of Impact on Patient Safety When Used with Computerized Prescriber Order Entry and Automated Dispensing Devices

Medication errors (any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer) that lead to adverse drug events (any undesirable experience associated with a patient’s use of a drug) are known to represent a major threat to patient safety, despite widespread preventive programs and extensive education of hospital personnel.1-4 It has been estimated that when adverse drug events occur in the hospital setting, they increase the patient’s length of stay by an average of 4.6 days, and the cost to the Canadian health care system is $4685 per event4 ($6655 in 2016 Canadian dollars, adjusted for inflation). Fortunately, many medication errors are preventable, and the implementation of health information technologies, such as bar code medication administration (BCMA) systems, is increasingly being considered as one solution.4-6 In fact, the American Society of Health-System Pharmacists and the Healthcare Information and Management Systems Society both recommend the use of BCMA.7,8 BCMA systems reduce medication errors by electronically verifying the “5 rights” of medication administration—right patient, right dose, right drug, right time, right route—at the patient’s bedside.7 For example, when a nurse scans a bar code on his or her identification badge, on the patient’s wristband, and on the medication to be administered, the data are delivered to a computer software system where algorithms check various databases and generate real-time warnings or approvals.7 Most systems then automatically document, in real time, the administration of the medication in an electronic medication administration record (eMAR). Other than cost, one of the barriers to widespread adoption of BCMA technology is the lack of definitive evidence that BCMA actually reduces preventable medication errors, especially in hospitals that are already using other safety systems, such as computerized prescriber order entry (CPOE) and automated dispensing devices (ADDs).7,9 The objective of this systematic review was to determine the impact of BCMA on medication errors when used as part of a closed-loop medication administration system (i.e., BCMA with CPOE and ADD).