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Clinical question: Does the incorporation of bar-code verification technology within an electronic medication-administration system (eMAR) reduce the rate of medication errors?

Background: More than a fourth of medication-related inpatient adverse events are due to errors. Bar-code verification technology reduces the incidence of such errors; however, the quantitative effect of implementing such technology is unknown.

Study design: Before-and-after quasi-experimental study.

Setting: Single academic tertiary-care medical center in Boston.

Synopsis: Investigators directly observed 14,041 medication administrations in patient units that did and did not have bar-code eMAR. They reported a 41.4% relative reduction (RR) in medication administration errors (11.5% error rate before versus 6.8% after adoption of this technology) and 50.8% RR in the rate of potential adverse drug events (3.1% versus 1.6%). Significant reductions in wrong medication, dose, and administration documentation errors were noted. Order transcription errors were completely eliminated (6% versus 0%). Although errors in medication administration timing fell by 27.3%, no significant difference in the number of potential adverse events related to timing errors was found.

The investigators estimated that approximately 145,000 potential adverse drug events would be prevented from amongst an annual 1.69 million medication orders.

Pre-existent computerized physician order entry and bar-code verification technology in the pharmacy at the study hospital might limit the generalization of these results. Additionally, potential, not actual, adverse drug events were reported. Lastly, the study compared early implementers with late implementers.

Bottom line: Bar-code verification technology substantially reduced the number of medication administration errors and associated adverse drug events and completely eliminated the occurrence of transcription errors.

Citation: Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med. 2010;362(18):1698-1707.

Reviewed for TH eWire by Robert Chang, MD, Anita Hart, MD, Hae-won Kim, MD, Robert Paretti, MD, Helena Pasieka, MD, and Matt Smitherman, MD, University of Michigan, Ann Arbor.

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