Compounding & dispensing errors before and after implementing barcode technology in a nuclear pharmacy

The objective of this study was to determine whether the incidence of compounding and dispensing errors changed significantly in a nuclear pharmacy after the pharmacy adopted a barcode assistance system. Nuclear pharmacy dispensing errors are extremely low compared to that of busy traditional pharmacies, but there is no data available describing the use of bar-coding assistance on the rate of dispensing errors in nuclear pharmacy. A retrospective review of dispensing errors pre-barcode assistance system implementation (2001 through 2004) and post-barcode assistance system implementation (February 2005 through 2009) was conducted using data from a nuclear pharmacy that dispenses approximately 500 prescriptions per day to nuclear medicine clinics and hospitals. Data was obtained from pharmacy error logs filed by the pharmacy as reported by an end user receiving the compounded preparation or the pharmacist having recognized the error before it reached the end user. Dispensing errors were defined as any deviation in the dispensed preparation from the prescribed order. Categories identified as incorrect were: dosage, drug, volume, procedure, patient, and delivery destination. Implementation of the barcode assistance system included installation of computers, software, barcoding devices, and training of personnel. The barcode assistance system provided barcodes for each compounding component, final preparation, syringe label, prescription, and shipping material. The barcode assistant system communicated directly with the dose calibrator, enabling the dose calibrator settings to automatically change according to time of administration and isotope required. The average error rate pre- and post-barcode assistance system was 0.012% and 0.002%, respectively (P<0.0001). Pre-barcode assistance system, two major categories represented 88% of all dispensing errors: wrong dosage (60%) and wrong drug (28%). Post-barcode assistance system, the major category was delivery destination (90%). The results suggest that the barcode assistance system has been instrumental in significantly decreasing compounding errors. The implementation of barcoding during compounding and dispensing has allowed improvement of the processes so much so that it enabled the identification of other sources of routine error.