1. A Bar Code Case Study
Steve Braun

2. Today’s Presentation Why Hospira Implemented Bar Coding
Program Management
Customer Communications
From Bar Codes to RFID
Keys to Success
Lessons Learned

3. Hospira Advancing Wellness Through Innovation
Plum® Infusion System with positive valving
PCA Infusion System
Omni-Flow® IV Medication Management System
ADD-Vantage® System
FirstChoice® Premix solutions
LifeShield® needle protection systems introduced
Plum® Infusion System added RS232 dataport
Oximetrix® 3 Monitoring System
Continuing education courses for MD, RPh, RN
National Hospital Pharmacy Quality Awards
LifeShield® CLAVE® Connector
Q2™ Monitoring System
SAFESET™ Blood Sampling System
Label enhancements
Nutritional containers bar-coded
Carpuject® syringe technology acquired
Remote communication
ASHP medication error reduction grants
Ansyr® syringe
Q2™ Plus Monitor
Plum A+® Infusion System
Bar-coded IV and injectable products introduced
Needlestick Prevention Systems web site launched
All unit-of-use injectables and IV solutions bar-coded
LifeCare® PCA3 Medication Management System Introduced with bar code ID of drug concentration
Plum A+® Infusion System with enhanced safety portfolio
1980s
1990s
TODAY

4. The Need to Improve Hospital Patient Safety
7,000 deaths per year1
Potential ADEs 5.5%
ADEs 6.5%
1.8% are preventable2
Patients Not Exposed
12% of Patients Exposed to an Adverse Drug Event (ADE) or Potential ADE2
1. Phillips et al, Lancet Bates et al. JAMA

5. Medication Errors in the Hospital
51% of hospital errors occur during administration1
Leading Administration Errors2
Adverse Drug Events by Drug Class3
Error Type
Incidence
Drug Class
ADEs
Wrong Dose
27%
Analgesics (Narcotics)
30%
Wrong Drug
12%
Antibiotics
24%
Missed Dose 8%
Sedatives
Wrong Time 7%
Antineoplastic
Known Allergy 6%
Cardiovascular 4%
Wrong Choice
Anticoagulants 3%
Wrong Frequency 2%
Adapted from a system analysis of a prospective cohort study of medication error reports on admissions from 11 medical and surgical units in two tertiary care hospitals over a 6-month period (N=4,031 nonobstetrical adult admissions).
Results from a prospective cohort study of medication error reports on admissions from 11 medical and surgical units in two tertiary care hospitals over a 6-month period (N=4,031 nonobstetrical adult admissions).
1. Leape LL, et al. JAMA Leape LL, et al. JAMA Bates DW, et al. JAMA

6. The Promise of Bar Codes
Bar code-enabled systems have been shown to reduce medication errors
by 64.5% (at VA facility)1
by 71% (at North Colorado Medical Center)2
1. Malcolm et al Annual HIMSS Conference Pucket F. Am J Health-Syst Pharm

7. Customer Direction Group purchasing organizations
Contractual commitments
Wholesalers/distributors
Leading providers
St. Alexius
VA Hospital Systems

8. Formed the Bar Code Team
Technical Operations
Engineering
Label Control
Graphic Studio
Manufacturing Plants
Regulatory Affairs
Materials Management
Quality Assurance
Marketing
Hospira Bar Code Implementation Team 10

9. Program Plan Over 5,800 packages: 1,200+ drugs
Committed to a standard; UCC.EAN-128
Began with corrugate
Low technical hurdles
Prioritized based on customer needs
Incorporated with any other label changes
5 manufacturing plants
No financial justification

10. Challenges Linear bar codes too large
300 items too small for UCC.EAN-128
Including some of the most critical drugs
What standard would industry adopt?
Price increases unacceptable to customers
Unexpected issues (RSS)
Verifiers
Software
Packaging levels

11. RSS Technology UCC owned technology
Hospira is the first health care company to use Reduced-Space Symbology (RSS) to bar-code injectables and I.V. solution products
RSS allows all information to fit in an area as small as a pen cap
Trial run made in 2001 at St. Alexius proved readability
Expands opportunity for additional information

12. Hospira Bar Code Initiative
All injectables and I.V. solutions labeled with bar codes at the unit of use
Ten-Unit Pack
Five-Unit Pack
Single Unit

13. Hospira Bar Code Initiative
Encompasses more than 1,200 drug and I.V. products
Critical mass for POC Medication Management System
Outstanding customer support and appreciation
Initiative
announced
July 2002
FDA proposed regulation announced March 13, 2003
Hospira initiative completed March 27, 2003

14. Manufacturing With Bar Codes

15. Moving Beyond Manufacturing
How do you know if a product has a bar code on the label?
Where is the database of UPN numbers and corresponding NDC numbers maintained? Is this a validated system?
What product identifier does your customer use to order product?
How are they linking the product identifier for ordering with the UPN?
How do you make all product identifiers known to customers? How do you update them on changes?

16. Electronic Catalog
Accessible from the corporate web site

17. Product Identification
Updated daily
May be downloaded into spread sheet

18. Radio Frequency Identification (RFID)
Track and trace technology vs. simple identification
Opportunity for:
Patient identification
Pump or other equipment locator
Drug or other expensive supply locator
Narcotics pose challenge to track and trace (control) today
Host System
RFID Reader

19. From Bar Codes to RFID Supply channel value initial goal
Customer and the FDA will define implementation timeline
Will have need for both technologies
EPC implementation required
Similar project approach
Shared/accessible electronic files required

20. Keys to Success Champion(s) Team approach Executive management support
FDA engaged
Network of knowledgeable experts
Listen to customers
Frequent reviews

21. Lessons Learned Education is important Risk versus reward
Work with standards organization
Voice equals change
Build alliances
RSS software (new technology) may delay
Understand the market
Leadership brings rewards

22. Hospira Advancing Wellness…
Through the right people and the right products