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Transforming medication safety with barcode technology

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The pharmacy team at Markham Stouffville Hospital remembers the first patient whose identification bracelet included a barcode.

That barcode enabled the BoxPicker, a state of the art automated medication storage and retrieval system, to find the medication that was ordered for that patient.

“Our first patient was so excited. Our team was so excited,” says Karen McFarlane, pharmacist. “It’s great to see our patients aware of safety and the role that technology plays at the bedside in delivering medication.”

The innovative technology was built into the new pharmacy as part of the hospital’s expansion and renovation project.

“When the new pharmacy space was being designed, we were able to build this technology in – right from the beginning. This is a great advantage to the team. You can design your process and your workflow in your new space, knowing that technology like the BoxPicker will be there to support your work,” says Barbara Steed, Executive Vice President, Clinical Programs and Chief Nursing Executive at Markham Stouffville Hospital.

The Swisslog BoxPicker has robotic arm that moves up and down the aisles in a secured space where more than 1,000 medications are stored in white boxes, in proper doses, each with its own barcode. The mechanical arm slides up and down and back and forth along a track picking medications that pharmacy staff have asked it to find.

With this new state-of-the-art technology, patients receive medications that have been verified using barcodes to enhance patient safety and reduce medication errors.

The barcode technology model of medication management requires a few different steps in order to get the right dose of the right medication to the right patient at the right time, including:


Requesting and selecting medication

MSH 2When a physician orders a medication for a patient, the order is scanned to the pharmacy. The pharmacist will then review the order for appropriateness, right dose, frequency, drug interactions, and allergies. The order is then sent to the BoxPicker which boasts 100 per cent accuracy.

Confirming medication

A pharmacy technician confirms the picked drug is correct using a barcode scanner which lets you know that the barcode matches the order. Following this step of confirmation, the medication is sent without delay to the nursing unit using the pneumatic tube system which connects the pharmacy to all the patient care areas.

Administering medication

On admission to the hospital, each patient is given an armband that contains a unique barcode specific to that patient. This barcode is then verified by the nurses or technologists each time a medication is given, or a treatment or test is done.

Once the armband is verified, the nurse can then use the patients’ eMAR (electronic medication record) to scan the medication and the patient armband prior to giving the medication to the patient.  If the nurse scans the wrong medication or a medication that is not ordered for the patient, the eMAR will alert the nurse of the incorrect medication and thus prevents an error from occurring. Since medications may need to be administered after hours when the pharmacy is closed, the pharmacy has technology called automated dispensing units (ADUs) to dispense urgent medications for patients. This technology utilizes fingerprint verification to access the machine and retrieve the right medication for the patients based on what was ordered for the patient. Nurses really appreciate this system since it allows easier access to medication after hours.


“The technology is a big step to enhance patient safety,” says Steed “The pharmacy team, our nurses and our physicians benefit from this technology as it reduces human error and they are able to make certain the right medication is being administered to the right patient. Ultimately, it’s all about our patients, their safety and the quality of care we are providing them.”

By using barcodes on medications and having a standard multi-step medication verification process, the hospital is able to maintain a process that is fast, accurate and reduces human error.

“As a nurse who uses this system every day, it makes my job easier and makes my patients safer,” says Maria Dimacuha, surgical nurse.  “I am able to work together with the technology right next to my patient and make sure they are getting the medication they need to help them get better.  This brings caring and technology together in a really great way.”

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