Barcode scanning: The five rights and closed-loop administration

In the summer of 2020 in partnership with ICU Medical and Genesis Care, iQ HealthTech embarked on a ground-breaking project to enable a patient’s entire treatment administration journey through the iQemo system to be fully tracked and audited via 3D barcodes. This included a patient’s wristband, drug labelling, and infusion pump linkup.

Historically, patients would have been identified solely by confirming with the patient that their name, date of birth and address matched the electronic record that the clinical user had available on screen, a process that’s clearly open to error. Further to this, the historic workflow would have relied upon the clinical user to manually select the correct administration record (electronic prescription) and manually obtain the correct bag of medication to be administered. Lastly the nursing team would have been required to manually record the administration of the medication against the electronic administration chart, open to error and inaccuracy. 

End-to-end administration tracking

This project enabled the clinical teams across Genesis Care to scan and identify the patient and their appropriate treatment day via a patient’s wristband, scan the barcoded drugs to ensure that the drug, dose, route, and day are appropriate and match the electronic prescription, and finally scan the infusion pump to be used for administration allowing the live infusion data to automatically be fed into the patient’s iQemo administration record.  

Overall, the advantages associated with this new workflow and technology are numerous, not only does this process ensure that the workflow is in keeping with the ‘five rights’ of medication administration: Right Patient, Right Medication, Right Route, Right Time, Right Dose (2) but also reduces the burden on clinical staff in relation to data input and ensures that the data collected is truly accurate. 

Closed-loop administration

The recent iQemo implementation project at Bedford Hospital saw the introduction of label generation and barcode scanning technology, in a significant step towards closed-loop medicines administration and enhanced patient safety in the delivery of chemotherapy. 

The feature requires the user to scan the 3D barcode printed on the label for all parenteral Systemic Anti-Cancer Therapy (SACT) items, confirming that the medication being prepared for dispensing, checking, release, or administration is indeed correct for the patient and prescription. Conversely, any mismatches detected with the information on the prescription or patient details when scanning the barcode are flagged to the clinician and prevents any further action on iQemo until the issue is resolved.  

The clear advantage of utilising this system is the potential to prevent the incorrect administration of SACT to a patient, ensuring that the delivery of SACT is in keeping with the five rights.

Since the introduction of iQemo and barcode scanning at Bedford Hospital, the types of errors detected and thus prevented include changes made to a prescription by a pharmacist but not communicated to the dispensary after the SACT item has been dispensed and released from pharmacy; and attempts to administer a SACT item meant for a different patient or meant for the correct patient but on a different treatment day. 

GS1 Standard barcodes

The future state of barcode scanning will further enhance the types of barcodes that IQemo will be able to scan and read GS1 standard barcodes. This will allow the direct scanning of products produced through 3rd party pharmacy systems such as BD Cato or Baxters compounding system Merlin. When 3rd party pharmacy systems are used to compound patient specific doses and a label is generated iQemo will be able to scan the associated barcode produced by the 3rd party system. This will ensure that the scan for safety process can be completed and brings iQemo inline with closed loop dispensing and administration.  

GTINs are the global trade item number and are a core standard for GS1 barcodes. The ability so scan GTINs will allow iQemo to scan any off the shelf product that contains a GTIN which allow scan for safety to be completed for ward stock items. These are not dispensed for an individual patient and are available off the shelf. Examples include standard bags of chemotherapy such as Gemcitabine or pre-medication antiemetics. 

iQemo will interface with the GTIN through First data bank which has a repository of GTIN information which is kept updated. This will ensure that the scan for safety process can be completed and brings iQemo in line with closed loop dispensing and administration.

(2)The Pharmaceutical Journal, August 2019; Online:DOI:10.1211/PJ.2019.20206864