Optimizing Safety With Bar-Code Scanning

Ensure correct med selection in the pharmacy (e.g., for inventory management, compounding, dispensing).

• Scan meds when placing them in pharmacy stock and when dispensing (e.g., pulling meds for a pick list, pulling meds to fill an individual patient’s order). This can help prevent mix-ups between look-alike/sound-alike meds, different doses or formulations of the same med, etc.^1,5
  
• Whenever possible, scan each med package rather than the same med package multiple times. There are reports of errors where different meds (e.g., tablets, vials) were accidentally mixed together, and the problem wasn’t caught because bar-code scanning was not used properly.
  
• Scan the actual med package you’re using and avoid scanning labels that have been saved instead.
  
• Scan source ingredients during compounding, repackaging, etc, to ensure the appropriate med is dispensed and for tracking purposes.¹
  
• Keep in mind that manually adding a bar-code label to the wrong med is an error that is unlikely to be caught prior to med administration.⁵ Take extra precautions, such as getting a double-check of these meds as required by your pharmacy’s policies and procedures.
  

Use strategies to help nurses (and others who administer meds) avoid bar-code scanning issues.

• Avoid covering bar codes with patient labels, auxiliary labels, or beyond-use date labels, or folding labels on the bar code.^2,3
  
• Follow pharmacy policies on adding bar-code labels when meds don’t have bar codes. For example, some OTC meds don’t have bar codes on the actual med package, just on the outer carton.
  
• Check that bar codes are readable before dispensing a med, such as by making sure they aren’t wrinkled, torn, or faded. If this is the case, rectify the situation before dispensing the med.^1,6
  
• Whenever possible, ensure that the manufacturer’s bar code is the one that the nurse will scan. This will help reduce the risk associated with manually adding bar codes to meds.
  
• If a med has more than one bar code, such as one on the package and one on a patient label, help ensure just the one that should be scanned is visible to the nurse.
  
• Help investigate issues rather than recommending overriding bar-code scanners when there are error messages.³
  
• Be aware of possible remedies to suggest when problems arise. For example, recommend placing a med on white paper before scanning or slowly zooming the scanner in and out from the bar code if there is difficulty scanning (e.g., bar code on a curved or shiny surface).
  

Provide tips for nurses (and others who administer meds) to ensure successful scanning and administration of the right med.

• Scan meds and patient bar codes in real-time and at the bedside. Scanning these before entering a patient room can lead to errors if the wrong patient room is entered.
  
• Avoid interruptions between scanning a med and patient bar code and administering the med. Interruptions can lead to errors, such as if you lay the med down and then pick up a different med.⁴
  
• Check for warnings AFTER scanning a med and patient bar code and BEFORE administering the med, such as by looking at your workstation computer screen.⁴
  
• Investigate any warnings that come up when you scan a med for a patient, such as “no order in system,” “dose too early,” or “exceeding maximum daily dose” BEFORE administering the med.⁴
  
• Call the pharmacy if a med bar code won’t scan due to fading, tearing, or other reasons, or if you can’t figure out why you get an error message. They can help by replacing the label and/or helping investigate the error message.³
  
• Scan bar codes on manufacturer labels rather than bar codes on pharmacy labels if possible. Errors can occur if a pharmacy label is attached to the wrong med, so scanning the manufacturer label may be more likely to catch errors.^3,4
  
• Double-check the actual med package if a bar code you’re scanning was added manually by the pharmacy, such as by attaching a pharmacy label with a bar code to an inhaler or premixed IV piggyback. This can help catch any pharmacy errors such as wrong med or strength.⁴
  
• Double-check orders that require you to administer a partial dose of a med, such as half of a tablet. The scanner may indicate you have the correct strength of a WHOLE tablet, but it won’t stop you from GIVING the whole tablet instead of a half tablet.⁴
  
• Scan bar codes on each part of two-part products such as ADD-Vantage IV piggybacks.
  
• Follow your hospital’s policy on cleaning bar-code scanners, especially after use in isolation.³
  
• Send a patient’s own supply of meds to the pharmacy for identification and bar-code labeling if a patient will be taking the meds during their hospital stay.
  

Bring attention to potential system issues.

Keep in mind that scanning can help with data collection regarding errors and other problems to help drive system improvements.¹

• Report issues that result in use of bar-code scanning workarounds.^1,2,4
  
• Report if meds are routinely missing bar codes or are labeled with bar codes that are difficult to scan.^1,6
  
• Alert your admin or med safety officer if there are too few functioning scanners in your work area, leading to delays or compromising patient care.