Barcoding: the way to patient safetyBarcoding: the way to patient safety

Dr. Nabil YounisDr. Nabil Younis

Senior AdvisorSenior Advisor

The Egyptian Society for Quality in Health CareThe Egyptian Society for Quality in Health Care

ESQuaESQua

Medical ErrorsMedical Errors

Approximately 98,000 Americans die each Approximately 98,000 Americans die each year from medical errors….7.000 of which year from medical errors….7.000 of which

are medication errorsare medication errors

Where Do Medication Errors Where Do Medication Errors Occur?Occur?

Ordering

39%39%

Transcribing

12%12%

Preparing

11%11%

38%38%

Administering

Barcode TechnologyBarcode Technology

• Series of vertical lines and Series of vertical lines and spaces that scanner spaces that scanner converts to electrical signal converts to electrical signal understood by computerunderstood by computer

• Used in grocery stores Used in grocery stores since 1970ssince 1970s

• Can store alpha and Can store alpha and numeric and informationnumeric and information

• Provides accurate, fast, Provides accurate, fast, real-time data collection real-time data collection and entryand entry

• Offers exceptional securityOffers exceptional security• Minimizes errors Minimizes errors

associated with manual associated with manual data entrydata entry

Barcode Medication Barcode Medication Administration TechnologyAdministration Technology

• Nurse barcode scans Nurse barcode scans name tagname tag

• Nurse barcode scans Nurse barcode scans patient identification patient identification braceletbracelet

• Patient MR appears on Patient MR appears on bedside laptop or hand-bedside laptop or hand-held deviceheld device

• Warnings/alerts are Warnings/alerts are issued when indicatedissued when indicated

• Automatic documentation Automatic documentation of administration activitiesof administration activities

Barcoding at the Point-of-Barcoding at the Point-of-CareCare

• Medication Medication AdministrationAdministration

• Transfusion Error Transfusion Error CheckingChecking

• Specimen CollectionSpecimen Collection

• Supply and Supply and Procedure Charge Procedure Charge CaptureCapture

Barcoding at Point of CareBarcoding at Point of CareInformation FlowInformation Flow

Admission

Med. Erros

Pharmacy

Billing

Other Clinical Systems

Bedside Barcode Unit

Reporting & Error Analysis

BPOC System

Levels of PCPOCLevels of PCPOC

Level 3Level 3

Level 2Level 2

Level 1Level 1

Alerts: look-alike/sound-alike; high risk Alerts: look-alike/sound-alike; high risk meds, clinical actions, order reconciliation, meds, clinical actions, order reconciliation,

maximum daily dosemaximum daily dose

Drug reference; formulary Drug reference; formulary commentscomments

5 rights checking; 5 rights checking; eMR; work listseMR; work lists

Level 4Level 4Laboratory specimen labeling; blood Laboratory specimen labeling; blood

product safetyproduct safety

Departments AffectedDepartments Affected

• Departments affected by changes in the Departments affected by changes in the medication processmedication process• Pharmacy• Nursing• Medical Staff• Information Technology• Business Office• Clinical Engineering• Housekeeping• Human Resources• Telecommunications

Technology SolutionTechnology Solution

• Barcode enabled, Barcode enabled, wireless, touch screen wireless, touch screen computercomputer

• Software checks to Software checks to assure 5 rights are metassure 5 rights are met

• Warning screens Warning screens prompt the nurseprompt the nurse

• Online order verificationOnline order verification

• Work sheetWork sheet

• Real time, electronic Real time, electronic documentationdocumentation

Barcoding at the Point-of-CareBarcoding at the Point-of-Care(BPOC)(BPOC)

• Staff scan barcode on Staff scan barcode on name badge, enter name badge, enter secure password secure password

• Scan Barcode on Scan Barcode on patient ID to access patient ID to access patient’s MRpatient’s MR

• Scan Barcode on unit-Scan Barcode on unit-dose medicationdose medication

• Verifies “5 Rights” & Verifies “5 Rights” & provides alertsprovides alerts

Warning Message DefinitionsWarning Message Definitions

Dose Omitted: A prior dose has not been given.

Dose Early: A medication is about to be given

greater than one hour beforeit is due.

Dose Late: A medicationis being given greater thanone hour after it was due.

Duplicate Medication: This medication has alreadybeen selected to be given.

Maximum Daily Dose Exceeded:

The 24-hour maximum safedose will be exceeded.

No Active Orders: The selected medication has

not been ordered for the patient.

Orders Discontinued:The selected

medication has been stoppedby the physician.

Order Expired: The orderfor this medication is no

longer valid.

Route Not Ordered:The order does not specify the

route of administration.

Wrong Dose Range: Themedication entered does

NOT match the prescribed dose.

Future Order:The selected medication

is not currently scheduled.

Alert: Look a like / sound

alike. Medication may have similar name

Warning Message AlgorithmWarning Message Algorithm

Nurse Response

AdministerAdministerWarning MessageWarning Message ContinueContinue

Cancel Cancel Cancel Cancel

Error

Error

Prevente

Prevente

dd

CancelCancel CancelCancel

Error

Error

Prevente

Prevente

dd

PotentialError

PotentialError

Clinical ExampleClinical Example

• A patient had an order for Glyburide (Diabeta) A patient had an order for Glyburide (Diabeta) 5 mg by mouth every day5 mg by mouth every day

• The nurse scanned the barcode on what she The nurse scanned the barcode on what she thought was Glyburidethought was Glyburide

• The following warning appeared:The following warning appeared:

Clinical ExampleClinical Example

• Upon closer inspection Upon closer inspection what she had scanned was what she had scanned was Glipizide (Glucotrol)Glipizide (Glucotrol)

• Pharmacy had dispensed Pharmacy had dispensed Glipizide instead of Glipizide instead of GlyburideGlyburide

• Besides being from the Besides being from the same classification, these same classification, these two generic drugs have two generic drugs have similar sounding names and similar sounding names and nearly identical packaging.nearly identical packaging.

Pre and Post Implementation Pre and Post Implementation ComparisonComparison

Pre-ImplementationPre-Implementation• Incomplete MR verification• Manual MR entries• Inaccurate documentation• Incomplete charting• Limited allergy information• Physician access to

information complicated• Voluntary reporting

Post-Implementation

• Automated MR• Electronic documentation• Real time documentation• Reduced reliance on memory• Legible documentation • Documentation available in

one place• Automated recording of near

misses/errors

Nursing Workflow BenefitsNursing Workflow Benefits

• Automates Automates worksheets, worksheets, documentationdocumentation

• Clarifies ordersClarifies orders

• On-line On-line referencereference

Nurse SatisfactionNurse Satisfaction

• Recruitment & Recruitment & retention toolretention tool

• Positive nursing Positive nursing surveyssurveys

• “Protecting my patients and my license.”

Bar-coding keeps Sponges Out Of Patients & Bar-coding keeps Sponges Out Of Patients & Hospitals Out Of CourtHospitals Out Of Court

How ?How ?

Bar-coding keeps Sponges Out Of Patients & Bar-coding keeps Sponges Out Of Patients & Hospitals Out Of Court…Hospitals Out Of Court…contcont

Safety-Sponge System prevents false correct Safety-Sponge System prevents false correct counts by computerizing all sponge counts in counts by computerizing all sponge counts in an OR. As each individual sponge has a an OR. As each individual sponge has a unique bar code, no one sponge can be unique bar code, no one sponge can be counted twice and inadvertently create a false counted twice and inadvertently create a false correct count. This essentially eliminates the correct count. This essentially eliminates the root cause of retained sponges. root cause of retained sponges.

Address Barcode Needs Address Barcode Needs in Your Organizationin Your Organization

• Identify medications already bar-coded by Identify medications already bar-coded by the manufacturerthe manufacturer

• Determine which medications pharmacy Determine which medications pharmacy produces that are patient specificproduces that are patient specific

• Evaluate the ability of existing pharmacy Evaluate the ability of existing pharmacy system printers to add barcode to labelssystem printers to add barcode to labels

• Establish process to verify medications Establish process to verify medications against your formulary against your formulary

• Create Patient ID bracelets with barcodesCreate Patient ID bracelets with barcodes

• Develop Employee ID badges with barcodesDevelop Employee ID badges with barcodes

Success ElementsSuccess Elements

• Strong management supportStrong management support

• Physicians & Nurses CommittmentPhysicians & Nurses Committment

• Timely response to concerns, questionsTimely response to concerns, questions

• Constant, daily communicationConstant, daily communication

• Identify measurements of success before Identify measurements of success before implementation beginsimplementation begins

• Dedicated IT supportDedicated IT support

Goals and ExpectationsGoals and Expectations(Hospital Wide)(Hospital Wide)

• Automatic recording of errors/near missesAutomatic recording of errors/near misses• Eliminate duplicate chartingEliminate duplicate charting• Simplified/accurate billing processSimplified/accurate billing process• Easier physician access to informationEasier physician access to information• Quick quality check for trendsQuick quality check for trends• Knowledge enhancement with immediate Knowledge enhancement with immediate

feedbackfeedback

Identify Barcode NeedsIdentify Barcode Needs

• Look at internal systems firstLook at internal systems first

• Identify which medications get to the Identify which medications get to the patientpatient

• Can the systems providing those labels support bar-coding?

• Can the systems support a patient-specific barcode, patient account number and order number?

• Can the systems support the bar code?

Address Barcode Needs Address Barcode Needs in Your Organizationin Your Organization

• Identify medications already bar-coded by Identify medications already bar-coded by the manufacturerthe manufacturer

• Determine which medications pharmacy Determine which medications pharmacy produces that are patient specificproduces that are patient specific

• Evaluate the ability of existing pharmacy Evaluate the ability of existing pharmacy system printers to add barcode to labelssystem printers to add barcode to labels

• Establish process to verify medications Establish process to verify medications against your formulary against your formulary

• Create Patient ID bracelets with barcodesCreate Patient ID bracelets with barcodes

• Develop Employee ID badges with barcodesDevelop Employee ID badges with barcodes

Questions?Questions?

The Egyptian Society for Quality in Health CareThe Egyptian Society for Quality in Health CareTelephoneTelephone :227-34-641 227-34-646 www.esqua.org:227-34-641 227-34-646 www.esqua.orgAddress :45/a Ibn Al Nafeis, Al Manteqah as Sadesah, Nasr City, CairoAddress :45/a Ibn Al Nafeis, Al Manteqah as Sadesah, Nasr City, Cairo