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Designing drug packages to support correct barcode scanning and closed loop medication

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European Statement

Selection, Procurement and Distribution

Author(s)

Helge Ovesen

Why was it done?

In November 2022 St Olav’s hospital, a large university hospital, introduced electronic prescribing and closed loop medication for more than 700 beds. Oral medications are predominantly available as unit doses, other medications as barcoded packages. After go-live with the bedside scanning, data showed that a large part of the administrations and preparations did not happen with barcode scanning. The hospital needed to understand the reason for this in more detail.

What was done?

A team of pharmacists, nurses and IT personnel have analysed technical reasons why medications are not scanned at the patient’s bedside during administration or when doing preparation in the wards’ medicine room.

How was it done?

The group collected data on all scans that had failed and analyzed the input to the barcode scanner. In addition, the nursing staff lead was consulted to provide more information of the problems with the physical packages for the medication and how that affected the work process of achieving closed loop medication. Products that did not have a printed barcode at all were not included in the analysis.

What has been achieved?

Six different areas were identified when trying to describe the problems with closed loop medication and scanning of medicine:
1. Barcode printed on package but missing product code/GTIN in the system/national drug registry.
2. Barcode printed on package but with wrong implementation of ISO/GS1 encoding.
3. Barcode printed on package but hidden for the user on the package label.
4. Barcode only printed on the outer package that was removed when stored in the medicine room.
5. QR codes with links to training materials or other barcodes confused the nurse and the wrong code was scanned.
6. Barcode printed on package but contrast for the barcode scanning was not good enough (ex. dark vials with black barcodes).
The problems have been shared with drug manufacturers and competent authorities to raise awareness of how drug package design and correct/incorrect use of barcode printing affect implementation of closed loop medication.

What next?

Work together with national drug registries in Norway and drug manufacturers to create a national best practice for barcode printing on drug packages. The work should be coordinated with work on a European level.

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