Barcoding: the way to patient safety

1. Barcoding: the way to patient safety Dr. Nabil Younis Senior Advisor The Egyptian Society for Quality in Health Care ESQua

2. Medical Errors Approximately 98,000 Americans die each year from medical errors….7.000 of which are medication errors

3. Transcribing Ordering Preparing Administering Where Do Medication Errors Occur? 12% 39% 11% 38%

4. Barcode Technology • Series of vertical lines and spaces that scanner converts to electrical signal understood by computer • Used in grocery stores since 1970s • Can store alpha and numeric and information • Provides accurate, fast, real-time data collection and entry • Offers exceptional security • Minimizes errors associated with manual data entry

5. Barcode Medication Administration Technology • Nurse barcode scans name tag • Nurse barcode scans patient identification bracelet • Patient MR appears on bedside laptop or hand-held device • Warnings/alerts are issued when indicated • Automatic documentation of administration activities

6. Barcoding at the Point-of-Care • Medication Administration • Transfusion Error Checking • Specimen Collection • Supply and Procedure Charge Capture

7. Barcoding at Point of CareInformation Flow Admission Med. Erros BPOC System Bedside Barcode Unit Pharmacy Reporting & Error Analysis Billing Other Clinical Systems

8. Laboratory specimen labeling; blood product safety Level 4 Alerts: look-alike/sound-alike; high risk meds, clinical actions, order reconciliation, maximum daily dose Level 3 Drug reference; formulary comments Level 2 5 rights checking; eMR; work lists Level 1 Levels of PCPOC

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

10. Technology Solution • Barcode enabled, wireless, touch screen computer • Software checks to assure 5 rights are met • Warning screens prompt the nurse • Online order verification • Work sheet • Real time, electronic documentation

11. Barcoding at the Point-of-Care(BPOC) • Staff scan barcode on name badge, enter secure password • Scan Barcode on patient ID to access patient’s MR • Scan Barcode on unit-dose medication • Verifies “5 Rights” & provides alerts

12. Warning Message Definitions Dose Omitted: A prior dose has not been given. Maximum Daily Dose Exceeded: The 24-hour maximum safe dose will be exceeded. Route Not Ordered: The order does not specify the route of administration. Dose Early: A medication is about to be given greater than one hour before it is due. No Active Orders: The selected medication has not been ordered for the patient. Wrong Dose Range: The medication entered does NOT match the prescribed dose. Dose Late: A medication is being given greater than one hour after it was due. Orders Discontinued: The selected medication has been stopped by the physician. Duplicate Medication: This medication has already been selected to be given. Order Expired: The order for this medication is no longer valid. Future Order: The selected medication is not currently scheduled. Alert: Look a like / sound alike. Medication may have similar name

13. Warning Message Continue Administer Cancel Cancel Potential Error Error Prevented Error Prevented Warning Message Algorithm Nurse Response

14. Clinical Example • A patient had an order for Glyburide (Diabeta) 5 mg by mouth every day • The nurse scanned the barcode on what she thought was Glyburide • The following warning appeared:

15. Clinical Example • Upon closer inspection what she had scanned was Glipizide (Glucotrol) • Pharmacy had dispensed Glipizide instead of Glyburide • Besides being from the same classification, these two generic drugs have similar sounding names and nearly identical packaging.

16. Pre and Post Implementation Comparison Pre-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

17. Nursing Workflow Benefits • Automates worksheets, documentation • Clarifies orders • On-line reference

18. Nurse Satisfaction • Recruitment & retention tool • Positive nursing surveys • “Protectingmy patients and my license.”

20. Bar-coding keeps Sponges Out Of Patients & Hospitals Out Of Court How ?

21. Bar-coding keeps Sponges Out Of Patients & Hospitals Out Of Court…cont Safety-Sponge System prevents false correct counts by computerizing all sponge counts in an OR. As each individual sponge has a unique bar code, no one sponge can be counted twice and inadvertently create a false correct count. This essentially eliminates the root cause of retained sponges.

22. Address Barcode Needs in Your Organization • Identify medications already bar-coded by the manufacturer • Determine which medications pharmacy produces that are patient specific • Evaluate the ability of existing pharmacy system printers to add barcode to labels • Establish process to verify medications against your formulary • Create Patient ID bracelets with barcodes • Develop Employee ID badges with barcodes

23. Success Elements • Strong management support • Physicians & Nurses Committment • Timely response to concerns, questions • Constant, daily communication • Identify measurements of success before implementation begins • Dedicated IT support

24. Goals and Expectations(Hospital Wide) • Automatic recording of errors/near misses • Eliminate duplicate charting • Simplified/accurate billing process • Easier physician access to information • Quick quality check for trends • Knowledge enhancement with immediate feedback

25. Identify Barcode Needs • Look at internal systems first • Identify which medications get to the patient • 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?

26. Address Barcode Needs in Your Organization • Identify medications already bar-coded by the manufacturer • Determine which medications pharmacy produces that are patient specific • Evaluate the ability of existing pharmacy system printers to add barcode to labels • Establish process to verify medications against your formulary • Create Patient ID bracelets with barcodes • Develop Employee ID badges with barcodes

27. Questions?

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