Unit dose coding

Barcoding in the pharmaceutical profession

In (hospital) pharmacy the use of barcodes can be very profitable. The hospital pharmacy is an extensive logistic unit. All physical movements of drugs can be controlled by the use of barcodes. The integral use of barcodes on the wards in the 2 hospitals in Meppel and Hoogeveen saved 3 f.t.e.’s.

In the pharmacy the use of barcodes simplified a lot of actions and saved time. All barcodes are used according to the EHIBC-rules.

Delivering the right drug to the right patient

There are 2 main streams of drugs:

  1. Nursing articles on ward floor stock (Iodine tct, general use-creams, laxatives, emergency drugs, basic IV-solutions)
  2. Drugs in medications carts for direct delivery to the patient (prescription drugs)

1. Nursing articles

There is a substantial amount of articles in the nursing station floor stock. Approx. 100 items are stored and used for general purposes. These items consist of nursing articles, basic (IV) fluids such as Saline, Dextrose 5% in water, reconstitution vials (waters for injection) and a limited supply of real drugs for emergence use. Though these articles are of low pharmaceutical importance they consist of a substantial amount of money (basic IV fluids are expensive per unit!).

Formerly the wards supervised their stocks themselves. The frequency and amount of new supply was determined by the rule of thumb.

After analysis of frequency of use during 6 months a proposal was made for:

  • new set of drugs
  • minimum stock
  • amount to replenish

The result was a considerable reduction in articles and a reduction in the amount of each article. The stock diminished by 35% in money (from approx. euro 25000,- to 3500,- on a ward for 30 patients).

In the old system each ward needed approx. 45 minutes a day for maintenance of ward stocks. When the pharmacy took over this part the wards were not involved anymore and in both hospitals we saved 25 x 3/4h x 5 days = 80 hours a week. That is more than 2 f.t.e’s.

This could be managed by introducing barcodes.
Instead of daily stockcontrol the ward stocks are checked once a week by a pharmacytechnician by means of a handheld terminal.


New system for ward floor stock supply
Each article has a label on the shelf with the following items on it:

  • name
  • minimum amount
  • amount to replenish
  • barcode (HIBC rules)

The pharmacy technician controls for every article if the minimum amount is reached. If this is true she scans the barcode of the article with a handheld terminal. The barcode represents both the article and the ward ID. The computer knows how many tablets have to be dispensed.

After her round the memory of the handheld terminal is fed into the computer. The data are sorted in the computer and the ward is billed for the new drug supply.

After sorting the technician feeds the data back into the handheld terminal and she can begin with collecting the items on the most efficient picking order in the pharmacy inventory. Every item has to be identified by reading the barcode on the package of drugs (or on the label on the shelf when the drug is not yet barcoded by the manufacturer).

After confirmation, the amount to deliver is then shown in the display of the handheld terminal.

Resume
The weekly inventory control on the ward is done by barcode scanning of drugs below the minimum amount.
After sorting by the computer the drugs are picked form the pharmacy stocks with aid of barcodescanning.
The whole procedure is paperless.

Conclusion
The hospital pharmacy has a closed circle of drug supply on ward stocks without any paper and secured by barcodes!

  • The hopital pharmacy spared 2-3 f.t.e.'s
  • The stock on the ward floor is monitored every ½ year for consistency and min/max amount.

2. Medication carts

Every ward has 1 (or more) medication carts consisting of a drawer for every patient with the medication for the next 24 hours. The cart is used for every medication round. Each drawer is filled in the pharmacy.

As the hospital pharmacy has an accurate database of the prescriptions for each patient the drawer can be filled with the appropriate amount of each drug.

Procedure
After reading and confirmation of the patients barcode on each drawer the medication is shown on the terminal.
Every drug has to be confirmed by reading the barcode on the unit-dose cell (or on the package when the unit-dose is not yet barcoded). After approval by the computer the amount to be dispensed is shown on the display. This is repeated for every medication order.

Resume
Prescription drugs are delivered in a patient drawer after reading the barcode of:

  • the patient
  • the drugs needed for that patient

Also here the hospital pharmacy has an absolute check for identification by means of barcodes according to the EHIBC rules.

by Han Harmsen, Central Hospital Pharmacy of Meppel-Hoogeveen