At the University of Wisconsin (UW) Hospital and Clinics in Madison, patients' identification bracelets bear much more their name and date of birth. Each bracelet features a tiny bar code that, when scanned, retrieves a comprehensive record detailing every medication the patient has been prescribed and every time that medication has been administered in the hospital, a 400-bed medical center that provides more than 3 million medications each year.

The bar code, similar to the UPC codes long used in grocery stores, is key to a system designed to prevent the estimated 34% of adverse medication events caused by errors in administration.

After implementing the system, the hospital saw its medication error rates plummet 87% ­ a rate similar to that experienced by Veterans Administration hospitals and others that have adopted the technology. Yet, despite bar coding's potential for reducing medication errors, UW Hospital and Clinics is one of only about 150 hospitals that installed the scanning systems throughout their facilities.

The reason for this sluggish adoption rate: with only about 35% of pharmaceuticals imprinted with a barcode, hospitals were reluctant to invest in scanning technology.

But that's expected to change as a result of the Food and Drug Administration's (FDA) Feb. 25 rule requiring pharmaceutical companies to apply FDA-approved, machine-readable bar codes on most human drugs and biological products, such as blood for transfusions. Each bar code must include the drug's 10-digit, three-segment National Drug Code number, at a minimum, and also may contain product expiration dates and a lot number. The rule requires new medications to feature a bar code within 60 days of their approval, and existing drugs and blood products to comply within two years.

The FDA projects the rule will prevent nearly 500,000 adverse medication events and transfusion errors and save $93 billion in health care costs, pain and suffering, and lost work time over 20 years.

The new FDA requirement already has given a major boost to bar-coding systems, said Scott Wallace, president and CEO of the National Alliance for Health Information Technology. The alliance was co-founded by the AHA and includes more than 100 health care providers, suppliers and technology organizations that are working to harness the power of information technology (IT) to enhance patient safety and improve hospital and health care operating efficiencies. "The rate of adoption has skyrocketed in the past several months alone in anticipation of the rule," said Wallace. "We'll see a dramatic shift, and bar-coding systems will become a standard of care."

Still, with a hefty price tag of $500,000 to more than $1 million, the systems remain beyond the reach of many hospitals, already stretched due to dwindling reimbursements, workforce shortages and other IT demands. Wallace emphasizes that, beyond the initial investment required, hospitals implementing bar-code systems also will incur significant employee training and system maintenance expenses.

But Wallace said hospitals can expect a considerable return on their investment due to improvements not just in patient safety but also in efficiency. Nurses will be able to print out complete medication administration reports at the end of their shifts, instead of manually logging the information ­ shaving time off of every shift. And that information will be reported in real-time, meaning hospitals can bill for medications more quickly. It also means better charge recapture, as the system automatically records every medication administered. Wallace said hospitals also should look to insurers to "step up to the plate and reward their investment in these systems" by cutting liability costs.

Mary Beth Navarra, director of medication safety for McKesson Corporation, maker of bar-coding systems and other health information technology, said the potential for patient safety improvement lies not only in the technology itself but in the process required for implementation: "It really is a process change," said Navarra, who is a member of the alliance's barcoding committee. "It requires nursing and pharmacy to take a step back and evaluate how they deliver care, and then implement technology to improve those processes. And ultimately, it brings multiple parts of the hospital together under the same system."

The system is "remarkably simple," said Steve Rough, pharmacy director at UW Hospital and Clinics. Before administering a medication, the nurse scans the patient's unique barcode and a barcode on the drug label using a wireless, hand-held device. The portable device instantly displays the patient's medication administration history and warns the nurse of an error ­ such as a wrong medication, wrong time or wrong dose ­ before it can occur. Rough said a warning or alarm is generated 3.2% of the time a medication is scanned.

He agrees with Wallace that the bar-code system "pays for itself many times over each year in reducing error." He added that the technology also has great potential as a nurse recruitment and retention tool: The hospital has seen nurses' satisfaction rates jump 42% due to the bar-coding systems.

"It gives nurses a sense of security," said Betty Nichols, director of information systems at Eisenhower Medical Center in Rancho Mirage, CA, which made the decision to implement a bar-code system about a year-and-a-half ago. "It's a second check to verify that the right drug is being administered at the right time, in the right dose, to the right patient."

The alliance's Wallace expects widespread adoption of the systems to take three to four years because of the considerable capital and time ­ about 18 months ­ required to implement them. "But we now have good models of how it works," he said. "It's not a bleeding-edge technology any more."