Circulation 36,825 • Volume 18, No. 4 • Winter 2003   Issue PDF

Bar Coding May Reduce Drug Errors

Charles H. McLeskey, MD

Medication errors continue to be one of the many patient safety issues facing the health care industry today. The 1999 landmark study by the Institute of Medicine found that medication errors may contribute to more than 7,000 deaths a year in the United States.1

Solutions to date have focused on enhancements of drug labeling, separation of storage facilities, and efforts to train staff on proper safety procedures. While these efforts may help, they have not gone far enough to minimize the risk of errors. The United States Pharmacopeia, which establishes quality standards for medicines, announced that most medication errors result from incorrect medication delivery techniques, including dispensing the wrong drug or administering an improper dose. These errors can sometimes produce patient injuries resulting in longer hospital stays and additional treatments, all of which increase costs to the health care system.2 Clearly, more can, and should, be done to mitigate this problem.

Bar coding pharmaceutical products has emerged as a promising solution. In fact, the U.S. Food and Drug Administration (FDA) has proposed a rule requiring the pharmaceutical industry to apply bar codes to their products at the unit-of-use or single-dose level.3

Bar coding is not a new idea. The technology, which has been used on consumer retail products since the early 1970s, already is commonly used in retail pharmacy and over-the-counter drugs. However, it is not yet widely used in the inpatient setting, where some of the most critical and most easily confused medications are administered. With this technology, clinicians can scan a patient’s wristband ID, and the bar coded drug, and then match them against a computerized list. By cross-checking, the “five rights” can be made more certain. These five rights are the right patient, the right drug, the right dose, the right route of administration, and the right time. Hospitals that have adopted this technology have seen dramatic results. A study conducted by the Veterans Affairs San Diego Health System saw inpatient medication errors drop 50%.4 Concord Hospital in New Hampshire reduced medication errors by 80%.5

If bar coding offers such promise, why hasn’t its adoption by the pharmaceutical industry been more widespread? The answer to this question is technology. Until recently, the technology required to shrink bar codes down to the unit-of-use level has not existed. As a result, manufacturers could not place bar codes on smaller or odd-shaped containers. The Uniform Code Council (UCC) has been working to develop standards and applications for space-constrained products for 4 years. In 2001, the UCC partnered with Abbott Laboratories to test Reduced Space Symbology® (RSS)–a new technology that allows for a bar code to be applied to single-use containers as small as a pen cap. The test showed that RSS bar codes can be commercially printed, applied, and read, even on small products that previously could not be bar coded.
Subsequently, Abbott has completed an initiative to affix bar codes to all of its hospital injectable pharmaceuticals and IV solutions. This effort is particularly important because, in hospitals, the majority of medications are administered via infusion or injection. Of the more than 1,000 products that Abbott has bar coded, more than 25% use this revolutionary RSS technology.

Bar coding also allows for other advances in medication management, such as improvements in patient-controlled analgesia (PCA) devices. PCA devices, introduced by Abbott almost 20 years ago, have become an important pain management tool. Although these devices have simplified the administration of opioids and other potent pain medications, they have not eliminated the risks associated with the administration of these types of medications. In fact, analgesics remain the drug class most frequently associated with adverse drug events, accounting for 30% of such events.6

As part of its ongoing effort to reduce medication errors and enhance patient safety in hospitals, Abbott Laboratories recently introduced an advanced PCA device. The LifeCare® PCA3 Infusion System is the first PCA pump to incorporate a built-in bar code reader, allowing the pump to automatically identify and verify the specific drug and drug concentration to be administered. This advance will further enhance the safety profile of these important devices.

Bar coding has the ability to enhance the safety of drug administration, particularly in the hospital setting. Current technological advances made by Abbott Laboratories and others in the pharmaceutical industry, coupled with pending FDA guidance, will help open the door for widespread adoption of this technology. Bar coding is just the beginning, however. Health care providers, manufacturers, and others in the industry must continue to work together to develop additional effective medication management solutions that further ensure the safety of patients and health care workers.

Dr. McLeskey is Global Medical Director/Global Marketing Director, Acute Care, Abbott Laboratories– Global Pharmaceutical Research and Development, Abbott Park, IL.


1. To Err is Human: Building a Safer Health System. Institute of Medicine of the National Academies. November 1999. Available on the web at: books/0309068371/html/

2. USP Releases New Study on Medication Errors at U.S. Hospitals. U.S. Pharmacopeia Press Release. December 4, 2002. Available on the web at:{dfad5295-0ec2-4e20-a56d-268ca3a46cf2}/FY0315MedMarx2001-Trade.pdf

3. Secretary Thompson Announces Steps to Reduce Medication Errors. United States Department of Health & Human Services News Release. March 13, 2003. Available on the web at:

4. Webb M. VA statistics show computer program cuts drug error rate: pharmaceuticals urged to adopt bar code system. San Diego Business Journal 2002;23(3):13, 15.

5. Bates D. Using information technology to reduce rates of medication errors in hospitals. BMJ 2000;320:788-91.

6. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995;274:29-34.