I’ve been thinking about how the work we do today may impact the world we live in tomorrow.

July 23, 2015 | In: I've Been Thinking


This afternoon, I received an e-mail from my friend George Laurer (to my right), the inventor of the UPC bar code—the very same code scanned on the items I purchased this morning at Costco and Trader Joe’s.

It arrived on the anniversary (June 26, 1974) of the first bar-coded product being scanned at a point of sale—a 10-pack of Wrigley’s Juicy Fruit for a grand total of 67 cents—in Troy, Ohio.

This morning, I received an e-mail from George’s pal and colleague back at IBM, Bill Selmeyer (to my left). Bill led the charge that resulted in grocery manufacturers voluntarily and universally printing the UPC bar code on their packaging.

Both e-mails were in response to mine:

Hi, George and Bill,

On this anniversary of the Troy bar-code scanning, I’m thinking of you two and how your work continues to make a difference in our world.

I was in the hospital with my 94-year-old dad the other day, and he was scanned at every point of identification and treatment.

I am happy to report that today more than 90 percent of hospitals are scanning patients and most medications at the point of care.

Grateful, Mark

George’s response:

Hi, Mark, Nice to hear from you. I hope I don’t have to experience hospital scanning firsthand 🙂 Certainly, scanning has saved lives…You have saved lives. Keep in touch, George

Bill’s response:

Mark, You are the complete advocate. This past year I’ve been in hospitals probably more than my entire life previously.  I always check for bar coding, and it has always been there on the patient and what medications the nurses administer.  I let them know that I’ve met you, the person really driving the implementation of barcodes in medicine. Great to hear from you again, Bill

So what’s to learn from these back-and-forths?

1. None of us wants to end up in a hospital, but sooner or later most of us will.

I’m with George, happy to stay out the hospitals as long as possible. But I’m also with Bill, grateful that the facility my dad is in uses bar-code patient safety technology at the point of care.

2. None of us can see far enough into the future to know how the good work we do today will impact our world tomorrow.

George and Bill were just putting in honest days of work, using their good minds and hands to make the grocery checkout process more time-and-cost efficient. Both tell me they had no idea their work was paving the way for a safer point of care.

3. Much of the meaningful work we do today is possible only because of the meaningful work done by those who have gone before us.

Many thanks to the Bills and Georges of our world. May all who come behind us, find us as faithful.

What do you think?

Mark Neuenschwander a.k.a. Noosh

2 Responses to I’ve been thinking about how the work we do today may impact the world we live in tomorrow.


Ray Vrabel, PharmD

April 30th, 2015 at 7:39 am


You have hit the nail right on the head in describing this problem.

The fact is that the majority of hospital pharmacies are making IV admixtures the same way that were over 45 years ago when I was a pharmacy intern working in a laminar air flow hood at St. Joseph Mercy Hospital in Ann Arbor, Michigan. It was one of the first hospitals in the US to implement a hospital-wide, pharmacy-based IV admixture service.

Let me correct that, a couple of things have changed, but not necessarily good things:

(1) Pharmacy technicians have replaced pharmacists and pharmacy interns preparing IV admixtures even though we have NO NATIONAL STANDARDS for the education and training of pharmacy technicians. Not only should we have national standards for all pharmacy technicians, but we should also have specialty certification for pharmacy technicians who are involved in the IV admixture process.

(2) We now have environmental standards for the pharmacy IV rooms (i.e., USP797) that mirror the GMP requirements for a parenteral pharmaceutical manufacturer, even though there was little anecdotal or scientific evidence that hospital pharmacies who were following pre-USP797 ASHP standards represented any significant risk. Granted, pharmacy prepared IV admixtures are probably cleaner than ever before, but has there been any decrease in infections secondary to pharmacy-prepared IV admixtures? For sure, we have made the Pharmacy IV preparation area more complex and that is usually not a good thing.

(3) Pharmacist rarely work inside the IV clean room. This appears to be a consequence of USP797. Pharmacists no longer directly supervise and check the work of pharmacy technicians. The hassle of garbing and un-garbing to move in and out of the IV Room is viewed as inefficient, leaving pharmacists to check the work of technicians after the fact, outside of the IV clean room.
Several years ago, technology was introduced in an attempt to eliminate preparation-related medication errors and to facilitate the remote checking of IV room pharmacy technicians. This technology actually has two components: (1) the barcode checking of the IV admixture ingredients (i.e., patient label, IV bag, medication vials) and (2) photographic images of the various stages of technician work in the IV hood to document what a technician has done and provide a basis for the pharmacist to check the work after the fact. Other vendors have created gravimetric capabilities to help determine if the correct volume of IV additives were added to the final IV admixture.

Too often, because of the additional complexity of introducing this imaging and/or gravimetric technology into the IV room workflow, the use of these technologies is limited to only high-risk IV admixture preparation. The fact is that even lower risk IV admixtures can have fatal outcomes, as evidenced by the lethal error that recently occurred in Bend, Oregon, where a neuromuscular blocking drug (rocuronium) was substituted for a fosphenytoin in a routine IV admixture. Consequently, all IV admixtures should be checked using barcode scanning technology during the medication preparation process (BCMP, bar code medication preparation), similar to how this technology is used at the time of medication administration by the nurse (BCMA, bar code medication administration).

Even though we have many new imaging/gravimetric technologies available for use in the Pharmacy IV room, we should start with the basics. All pharmacy-prepared IV admixtures should be checked utilizing barcode scanning (BCMP) regardless of whether other forms of “process-checking” technology (i.e., imaging and/or gravimetrics) are used. For many years, a hospital with their own pharmacy information system (i.e., Brigham & Women’s Hospital) used barcode scanning in the pharmacy IV room. Fortunately, a couple EHR vendors (e.g., Epic and MEDITECH) introduced BCMP technology for use in the IV room several years ago and two other leading vendors (e.g., Cerner and Allscripts) will have this technology by the end of the year. Likewise, there are other standalone BCMP solutions that could be used.

The bottom line is that ALL hospitals can begin NOW to utilize barcode scanning in the IV room for the preparation of ALL IV admixtures, regardless of whether they implement more advanced (and more complicated) “process checking” automation (i.e., imaging and/or gravimetric technology). This will allow hospitals to prevent the most serious “wrong drug, wrong patient” errors that can occur when barcode scanning technology is not used. Once BCMP is implemented, hospital pharmacies should then focus on how to optimize the use of the newer “process checking” automation technologies. Hospital gift shops have used barcode scanning for years. The time has come for patients to benefit from barcode scanning in the IV room…!!!


mark neuenschwander

May 1st, 2015 at 1:53 pm

Thanks Ray. Insightful and helpful, as usual.

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