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David Crist,  President, Brother Mobile Solutions

Here’s a statistic that will stop you in your tracks: There has been virtually no improvement in patient safety over the past 15 years, according to testimony by health experts at a U.S. Senate subcommittee hearing last summer.

In fact, patient safety may have gotten worse – or, at the very least, our tracking capability has gotten more accurate. A Journal of Patient Safety study published in 2013 estimated that hospital medical errors lead to more than 400,000 patient deaths annually, more than four times the number of preventable deaths estimated in the Institute of Medicine’s (IOM) landmark report in 1999. The new study calculated serious harm to be 10 to 20 times more common than lethal harm.

Clearly there are no easy remedies, given the amount of time, energy, and money already invested in patient safety initiatives during the past decade and a half. One logical, cost-effective way to begin tackling this stubbornly high rate of preventable adverse events is by expanding the adoption of barcoding technology across the healthcare enterprise.In fact, patient safety may have gotten worse – or, at the very least, our tracking capability has gotten more accurate. A Journal of Patient Safety study published in 2013 estimated that hospital medical errors lead to more than 400,000 patient deaths annually, more than four times the number of preventable deaths estimated in the Institute of Medicine’s (IOM) landmark report in 1999. The new study calculated serious harm to be 10 to 20 times more common than lethal harm.

Unrealized potential

While it’s true that most hospitals have implemented a barcode system to use for patient identification and medication administration, few systems are using the technology to its fullest potential. Many healthcare systems have been slow to recognize that the latest technology advances make it easier to integrate barcoding seamlessly into clinician workflow. This helps enhance patient safety and improve efficiency – both of which are critical to succeeding in today’s value-based healthcare environment.

Next-gen barcoding technology includes innovative ID printers with wireless functionality, specifically engineered to support patient monitoring and safety. Healthcare CIOs, IT directors, lab managers, and nurses have expressed the need for this type of versatile on-demand printing, ideal for needs ranging from admissions wristbands to labels for medication, laboratory, trauma, and surgery, to bedside identification of patients and specimens.

Even the 1999 IOM report prophetically suggested that barcoding may prevent many medical errors. In the years since, the introduction of the barcode medication administration (BCMA) system and subsequent evidence supporting its efficacy has proven tremendously significant to the industry and the patient. For example:

  •  A 2006 study at the University of Iowa Children’s Hospital found that BCMA reduced preventable adverse drug events (ADEs) in a neonatal intensive care unit by 47 percent.
  •  A study in the Journal of Nursing Administration in 2008 reported that the time nurses spent providing direct patient care increased after implementation of BCMA.
  • A study published in The New England Journal of Medicine in 2010 reported that using BCMA technology to scan patients and drugs led to a 41 percent reduction in medication errors and decreased potential adverse drug events by more than half. It also reduced documentation errors – in other words, diagnostic errors – by a whopping 80 percent.
  •  Research published by the Society for Academic Emergency Medicine in 2013 associated BCMA implementation in the emergency department with reducing medication administration errors by nearly 67 percent and wrong-dose errors by 90 percent.

Despite barcoding’s promise, adoption of the technology has lagged in healthcare compared to other industries. In retail, product barcodes became ubiquitous within years of first appearing on a 10-pack of chewing gum in 1974. But barcodes didn’t start showing up on medications until 1991, and it wasn’t until 2006 that the Food and Drug Administration required manufacturers to include them on all medications.

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Supporting the five patient rights

Today, nearly two-thirds of U.S. hospitals scan most medications at the point of administration, up from around 3 percent in 2001. From a safety perspective, there’s no question that BCMA should be used to verify the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time. Also, hospitals seeking to qualify for federal incentives by meeting Stage 2 Meaningful Use objectives must automatically track medications from order to administration using “assistive technologies” in conjunction with an electronic administration record (eMAR). BCMA can be used to document compliance because it qualifies as eMAR technology.

However, to make serious progress with patient safety, hospitals need to expand barcoding technology beyond medication administration into all areas of the hospital, from the patient room to the lab to the pharmacy. After all, even a state-of-the-art bedside scanning system can’t alert nurses to medication preparation or dispensing errors. Therefore, any time providers perform an action on or for a patient, safety best practices dictate scanning the barcode labels with accurate drug, test, and patient-specific information, then generating a data record entered directly into the patient’s EHR.

Since errors can occur at any point in the care delivery process between admission and discharge, proper identification is critical whether patients are being admitted or operated on, receiving medication or meals, or having something collected from them. For example, incorrectly labeled items such as mother’s milk, blood, stem cells, bone marrow, specimens, and biopsies can result in misdiagnosis and improper – even life-threatening – treatment, as in the case of blood transfusion errors.However, to make serious progress with patient safety, hospitals need to expand barcoding technology beyond medication administration into all areas of the hospital, from the patient room to the lab to the pharmacy. After all, even a state-of-the-art bedside scanning system can’t alert nurses to medication preparation or dispensing errors. Therefore, any time providers perform an action on or for a patient, safety best practices dictate scanning the barcode labels with accurate drug, test, and patient-specific information, then generating a data record entered directly into the patient’s EHR.

In labs, barcoding streamlines sample management and tracking, improving safety and saving time by eliminating the need for substantial manual data entry. In the pharmacy, scanning enables pharmacists to record that medication has been dispensed, and validates the medication and dosage against the prescription order. Additionally, 2D barcode labels can be printed with infusion parameters for automatic reading by smart infusion pumps, increasing administration accuracy.

Moving from BCMA to BPOC

Mark Neuenschwander, a leading expert in the field of medication dispensing automation and barcode point-of-care systems, encourages hospitals to embrace a more holistic view of barcoding and patient monitoring. He prefers to use the term BPOC (barcoding at the point of care) rather than BCMA.

Neuenschwander believes that safe labeling practices provide an essential foundation for the success of any barcoding system and should include:

  • Proximity. On-demand printing of barcoded labels and wristbands at the point of care ensures that the labels don’t get lost, left behind in rooms after patients are discharged, or attached to the wrong items. It also reduces the risk of safety-compromising clinician error resulting from distractions, interruptions, and heavy workload.
  • Readability. Clinicians need to be able to quickly, easily and accurately scan and print barcodes the first time.
  • Durability. Barcoded identification labels must be readable throughout a patient’s hospital stay, even after repeated scanning. For patients, that requires antimicrobial wristbands that can survive exposure to soaps, solvents, blood, and other elements. For medications, label media must also be able to withstand moisture, refrigeration, and freezing.

It is important to note that the ability to print labels and wristbands close to or at the point of care does not automatically promote patient safety. The key is to seamlessly integrate workstation and cart-based printing solutions into workflow, encouraging clinicians to view them as tools for providing safer, more efficient, higher-quality care versus an additional administrative burden they need to work around.

Best-in-class mobile ID printing solutions offer features valued by clinicians, IT leaders, and the C-suite, including:

  • Multi-functionality. Clinicians can take advantage of smart media technology to load and automatically print adult, pediatric, and infant wristbands and labels using a single printer, without any special setup or calibration.
  • Ease of use. Plug-and-play functionality ensures the printers are up and running right out of the box.
  • Speed and reliability. Wi-Fi, Bluetooth, and USB connectivity support fast, accurate barcode printing that enables clinicians to minimize interaction with technology and maximize face time with patients.
  • Transportability. Compact form factors are ideal for workstations and carts where space is at a premium. Optional batteries add versatility.
  • HIPAA compliance. Thermal print technology eliminates the need to make an imprint of protected patient information, safeguarding privacy and supporting compliance.
  • Streamlined integration. Solutions integrate easily with the hospital’s existing admission, lab information, and EHR systems.
  • Scalability. Solutions have the ability to meet patient ID and barcoding needs well into the future.

Faced with competing technology priorities and growing pressure to improve patient safety and clinician efficiency, forward-thinking hospitals are investing in barcoding 2.0 and next-gen advances such as ID printing solutions in mobile formats. With technology and utilization both maturing, it appears increasingly likely that barcoding will finally live up to – or even exceed – expectations for improving safety, workflow, and quality of care.


Resources

James, John T., “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care,” Journal of Patient Safety.

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