Taking Barcoding to the Next Level


Vol. 12 •Issue 4 • Page 60
Taking Barcoding to the Next Level

Hospitals are utilizing barcoding at the point of care for enhanced safety and productivity.

Barcode systems have begun to take on new importance in the hospital setting as they expand into clinical territory. Beyond its primary historical uses in materials management and medical records applications, barcoding is accelerating its reach into pharmacies and laboratories, and moving to the patient bedside.

As barcodes move into the clinical realm, adoption of applications is growing steadily in areas such as positive patient identification, automated medication administration and bedside specimen collection at the point of care. Recent research indicates that one out of every eight hospitals has a point-of-care barcoding system in place. But that figure is projected to increase. CIOs report that technologies aimed at reducing medical errors and increasing safety rank as a top priority, with barcoding for patient safety being the top implementation priority for 2008, according to the 2007 HIMSS Leadership Survey.

The activities of a variety of national and global agencies, such as the U.S. Food and Drug Administration, the Joint Commission, the International Council for Commonality in Blood Banking Automation, the American Society of Health-System Pharmacists and the Leapfrog Group, have furthered the cause of patient safety in general and barcoding in particular.

But beyond this spate of recent regulations, standards and guidelines, a number of other factors have begun to encourage adoption.

Three major trends are at work. Enhanced, two-dimensional (2-D) symbologies make barcode scanning more practical for the clinicians who must use the equipment on a daily basis. At the same time, the objective of a closed-loop medication administration system, long considered an ideal, is becoming an urgent goal for many hospitals and health systems. And, thanks to the proliferation of wireless networks, hospital infrastructures are more readily accommodating mobile computing and mobile peripherals, including portable barcode printers and scanners.

Breaking the codes

Though the symbologies — the actual barcode symbols themselves — may seem to be a straightforward consideration, there are many types available to suit many different auto-identification needs. The widespread adoption of 2-D codes is one key factor contributing to recent growth in implementation of barcoding systems. These kinds of symbologies, such as Aztec Code, Data Matrix and PDF417, can significantly improve the day-to-day experience for nurses and patients alike.

Aztec Code, for example, can be encoded with much more information than traditional linear barcodes. The largest type of Aztec Code symbol can represent more than 3,000 characters – a generous amount of patient-specific data that can serve as a portable record. This storage capacity makes 2-D barcodes a popular choice for patient wristbands as well as unit-dose labeling in the pharmacy.

In addition, Aztec Code doesn’t require white space between symbols, so the barcode can be repeated around the length of a patient wristband. To identify a patient, nurses simply apply the barcode reader to any point on the band without having to reposition it.

These advantages prompted Wisconsin-based Aurora Health Care, a not-for-profit integrated delivery network that includes 12 acute care hospitals, to select Aztec Code for its patient wristbands. As a part of the selection and implementation process, Aurora first selected thermal printers to produce the wristbands because they provided the best combination of image resolution and durability. The output not only survives the rigors of hospital life, but also ensures ease of scanning. In addition, thermal printers allow Aurora personnel to create wristbands one at a time, while laser printers require users to produce an entire sheet of labels at once, causing unnecessary waste and expense.

With the organization’s commitment to maximizing patient comfort, the Aurora team also wanted to minimize any disruption or complication at the point of care. Since poorly constructed, difficult-to-scan wristbands cause frustration for caregivers and patients, Aurora chose to standardize on the Aztec Code symbology because of its data capacity and because scanners read it well on curved surfaces.

Beyond the patient experience, enhanced read rates impact every function that depends on point-of-care data capture, such as bedside medication administration.

For added flexibility, Aurora also incorporated one-dimensional or linear barcodes on patients’ wristbands. These simpler codes allow clinicians to use existing scanners that already support glucose readings, specimen collection and other types of point-of-care testing.

Closing the loop

Barcodes play a prominent role at registration for patient wristband printing, in the pharmacy with unit-dose labeling, and at the patient bedside for verifying the five rights of medication administration (right patient, medication, dose, time and route). The results of this comprehensive effort include significantly reduced potential for medication error, a more comprehensive patient record, more accurate tracking and complete data capture for a variety of clinical analyses.

The Holy Grail of medication management is closed-loop medication administration. Every step in the process is automated and integrated for maximum efficiency and efficacy: order verification and submission via e-prescribing or computerized physician order entry (CPOE) system; order evaluation and dispensing in the pharmacy; order verification and administration at the bedside; and documentation in the electronic medical record (EMR) system or hospital information system.

Several years ago, after considering the local implications of the landmark Institute of Medicine (IOM) report “To Err is Human”, Aurora began to chart a course toward closed-loop medication management. An extrapolation of the IOM findings to the entire state of Wisconsin suggested that medical errors were taking as many as three lives on an average day.

Aurora began to further its use of integrated EMRs across facilities. As a related, core component of that effort, Aurora began implementing barcoding at the point of care (BPOC). Because the impact of BPOC is in large part determined by the percentage of medications properly labeled, Aurora placed early emphasis on 100 percent labeling of its medications. Considering the size and scope of the Aurora system, this goal called for a high volume of on-demand barcode printing in a wide variety of clinical settings.

At its major hospitals, Aurora estimates that about 75 percent of inpatient medications are barcoded at the unit-dose level. This figure represents medications pre-labeled at the unit-dose level by the manufacturer as well as those labeled by pharmacies in-house, prepared by a robot on-site, and delivered from one of two locations using a repackager. To help achieve the ultimate goal of labeling 100 percent of medications, Aurora is centralizing its repackaging, which helps keep costs down and increases the number of barcoded medications.

With medication labeling and patient wristbanding capabilities established, Aurora has begun to implement bedside barcode medication administration. Because 34 percent of all medication errors occur at the point of administration — and few are intercepted using traditional, manual approaches — this phase of the initiative will generate its own clinical benefits for the heath care orginization.

But it will also provide a firm basis for CPOE and the ultimate long-term goal: an integrated, closed-loop medication administration system that continuously improves clinical outcomes at Aurora.

Going mobile

Hospital networks are increasingly going wireless, and that infrastructure for mobility is enhancing the business case for a range of barcoding applications. With wireless scanners, hospitals can offer more options to match the needs and preferences of their nursing staff. The ability to access software wirelessly streamlines the process of identifying the clinician, confirming the five rights during medication administration or viewing lab orders at the point of care.

Many hospitals are leveraging their investments in wireless and barcode technology by deploying mobile barcode printers to generate labels while collecting specimens. The process of labeling blood and other samples at the time they are collected helps to prevent errors, including many of the estimated 160,900 adverse events that occur in U.S. hospitals annually because of sample misidentification.

At Hamilton Medical Center, a 282-bed hospital based in Dalton, Ga., the opportunity to enhance patient safety encouraged the medical center to deploy barcoding in the phlebotomy area. Hamilton also sought to eliminate much of the inefficiency related to manually printing, sorting and organizing labels in the laboratory before starting rounds.

The medical center had a head start on its initiative thanks to its established barcode system for medication administration. Hamilton added two more mobile components to support its phlebotomists’ work at the point of care.

The first, a hand-held computer or PDA now provides real-time access to draw orders. It also allows phlebotomists to document collection activity in the patient record. The hand-held device’s built-in scanner also scans the barcode on the patient wristband and confirms the patient’s identity.

Second, Hamilton acquired mobile, thermal printers for use at the bedside. Thermal printing was developed specifically to produce barcodes; the printers’ compact, highly durable output can easily accommodate small vials or sample containers. The thermal label media is also durable enough to survive the rigors of the testing and storage process. To ensure that phlebotomists are truly mobile, the lightweight printers can attach to a belt or strap for easy handling.

Today, Hamilton’s phlebotomists are generating patient-specific labels at the bedside. Patient identity, collection time and user credentials are all captured on the label while the procedure is documented in the software application to create an audit trail. The specimen-labeling project also fulfills one of the Joint Commission’s patient safety goals, an important consideration for all U.S. hospitals. On average, Hamilton reports the system saves staff 45 minutes per day. At the same time, turnaround has accelerated and staff members perform fewer re-draws.

In addition, the medical center recently expanded its use of barcoding so that clinicians can verify that the correct patient receives the correct blood product during transfusions — another positive step toward improving safety and minimizing the opportunity for error.

Looking forward

The future of auto-identification technology is likely to continue the move toward integration. Medical devices may present one avenue of opportunity. Smart pumps, for example, can read barcode labels on IV bags to ensure the proper medication and dose.

In addition, as radio-frequency identification (RFID) continues to evolve, there will be opportunities to leverage the technology in combination with barcoding. While barcoding will remain a simpler, more cost-effective alternative for many health care uses, emerging applications utilize barcoding alongside RFID.

As information systems continue to mature, health care organizations will discover new and innovative ways to take advantage of this multi-use technology in the clinical setting.

Ms. De Martini is health care global practice leader at Zebra Technologies. She is a member of the HIMSS Auto ID Task Force.

Wristband Technologies Ensure Patient Safety

We recently asked health care IT vendors to supply real-world cases of how their products help ensure patient safety in hospital or medical practice environments. Consider the following three examples:

  • According to Bob Chadwick, president of EndurID Inc., his company’s wristbands have been part of a number of highly successful patient safety initiatives. “While a wristband cannot solve a patient-safety issue alone, it provides a solid and consistent foundation for safety programs,” noted Chadwick.

    Wristbands must perform in a hostile environment, be comfortable to wear, waterproof, secure, easy to produce and support easily scanned barcodes. Endur ID’s wristbands provide additional tools for use at the bedside, such as color-coding and alerts.

    “Projects we have been involved in have contributed to a 55 percent reduction in medication errors at a New England hospital and have contributed to a 99 percent medication administration accuracy rate at a federal health care system,” said Chadwick.

  • The Memorial Hospital at Easton, a Shore Health System hospital, uses FormFast’s forms automation technology to ensure proper patient identification during patient encounters such as point-of-care testing. Barcoded wristbands are automatically printed as part of the admissions packet generated by FormFast’s FastPrint software.

    With FastPrint, every form related to a patient is imprinted with a pair of barcodes that identify the patient and the form. Those barcodes ensure that all forms are ready for scanning into the hospital’s EMR system and placed in the proper patient’s medical record.

    In addition to point-of-care testing, the hospital is introducing a bedside medication verification system to further ensure patient safety. This new system uses the barcodes on the patient’s wristband, the medication, and the nurse’s badge to verify and log medication administration.

    According to Senior Systems Integration Analyst Jason Youngbar, the automated system from FormFast has increased accuracy, efficiency and patient safety. He stated, “Barcoding with FormFast removes many opportunities for human error. The patient information is always legible, the barcodes are always right and there is no risk of using obsolete forms that could pose a threat to patient safety.”

  • Springhill Medical Center (SMC), located in Mobile, Ala., is a 252-bed acute care hospital accredited by The Joint Commission and includes the hospital, a comprehensive heart center, senior residence, sleep center, athletic club and orthopaedic surgery center.

    SMC has implemented a barcode and labeling system provided by PHG Technologies that allows for enhanced patient safety and prevention of potential adverse events. The technology enables assignment of a unique barcode for each patient containing patient-specific data, which in turn provides more accurate identification of the patient. Identifiers include patient name, medical record and account number, and date of birth. The barcode and information prints on a patient armband, which is placed on the patient’s wrist for accurate patient identification when drawing blood, administering medications or rendering other treatment. SMC also prints labels to correspond with the armbands; the labels are affixed to the patient’s medical record for cross-reference. The patients’ armbands are scanned before treatment or tests for modalities such as point-of-care lab and respiratory services.

Contest to Honor Patient Safety Initiatives

Precision Dynamics Corporation (PDC) is teaming with Patient Safety & Quality Healthcare magazine to reward hospitals that are taking innovative measures to better protect patients. Through its “Partner in Patient Safety Campaign,” PDC will award $10,000 in free wristband products to the hospital that submits the best patient safety success story, as chosen by a judging committee. Three additional honorees will be awarded $1,000 each in products.

The contest began March 2 and ends Aug. 4.

With recent studies revealing that one in 10 U.S. patients is injured and nearly 100,000 die every year from preventable medical errors, PDC is focused on how it can help hospitals improve patient safety outcomes. “There’s no denying the amount of discouraging news lately on medical errors and their immediate effect on human lives,” said PDC President and CEO Gary Hutchinson. “Traditionally, hospitals were quick to place blame on the individual caregiver who made the mistake. But now, through a more advanced approach, we’re focusing on systematic changes and using automated technologies to prevent medical errors. Our campaign is geared toward recognizing these hospitals, and helping other facilities learn from them to better maximize safety and improve patient outcomes.”

Hospitals and health care facilities can participate in the contest by visiting a special Patient Safety section on PDC’s Web site (www.pdcorp.com/patientsafety). The section features a selection of resources on how hospitals and health care facilities can better protect patients; hospital success stories using PDC wristband systems; and articles on patient safety and medical error prevention. PDC will launch new interactive features and accompanying events throughout the year on the site.

In selecting the winning success story, the judging committee will place emphasis on ways that clinicians use innovative products and effective processes to prevent medical errors and improve patient safety.