Pediatric Informatics: Computer Applications in Child Health (Health ...

360 C. Garger et al.
28.4 Information Technology in Medication
Administration
The medication administration step represents a “last chance” to intercept an
error. Interventions to reduce errors include those in the prescribing/ordering and
transcribing/dispensing steps plus:
28.4.1 Bar-Coding
Bar-coding technology involves labeling of an object (medication package, patient
identification bracelet) with a machine-readable printed tag and identification
with an optical scanner at the point of administration. For individual medication
doses, the bar code contains the National Drug Code (NDC), which includes the
drug company labeling the package for sale, the name of the drug and its dose.
For inpatients, the patient identification bracelet bar code contains the hospital
patient number, 7 and scanning allows and enforces matching of patient medical
record number to drug dose.
In pediatrics (and in other domains), medications from the manufacturer may be
supplied in multidose packs that must be separated and recoded (with the possibility
of mislabeling). Use of bar-coding has been associated with interception of “wrong
drug” and “wrong dose” errors, as well as “wrong time” and drug storage errors, and
doses for which no order was given. Reported errors and failure points associated
with the use of bar-coding include: mislabeling of drug dose, missing bar codes,
inability to scan bar codes, manual overrides or workarounds (such as scanning a
patient identification from the patient chart instead of the patient’s identification
bracelet), failure to scan bar codes, wrong patient and system unavailability.
In neonatal intensive care units, infants are at risk for medication errors, 8
including “wrong route” errors 9,10 and patient misidentification, particularly in the
case of multiple births 11 and with similar medical record numbers, similar sounding
surnames. Wristbands that are missing or that contain incorrect or incomplete
information may be a frequent occurrence. 12 For errors in breast milk administration,
a comprehensive approach has been proposed. 13
28.4.2 Radio-Frequency Identification (RFID)
RFID appliances or “tags” consist of an embedded integrated circuit that can
process and store information from a radio-frequency signal and an antenna that
receives and transmits the signal. 14 Current RFID (approved for patient use) consists
of passive devices that require an external radio transmitter to operate, while
active (self-powered) devices have yet to be approved. Identifying information