The effectiveness of these systems can be undermined, however, if the bar codes can’t be read reliably. That’s what Jane Phillips Medical Center (JPMC) in Bartlesville, Okla., discovered during the implementation of a new medication safety solution. By deploying a new patient

 wristband printing system, JPMC was able to ensure its bedside scanning initiative would run smoothly.

JPMC is a fully accredited, 150-bed healthcare facility serving northeastern Oklahoma and southeastern Kansas. The tech-savvy facility already had an electronic health record system and used bar coded wristbands for glucometer readings. Plans were underway to implement a new bar code-based medication safety solution, but there was a snag: The existing patient wristbands were not reliable enough for the new bedside scanning requirements. The old paper labels were difficult to scan because of curvature issues, and could be easily damaged when exposed to moisture. Nurses at JPMC developed workarounds for the scanning problems, but these procedures would not have worked with the medication safety system.

"We discovered staff would create a ‘cheat sheet’ with the bar code labels on it, then scan that label rather than scanning the wristband," says Susan Herron, nursing director at JPMC. "We were in the process of implementing a solution for bedside medication administration. We wanted a unique patient bar code appearing only on the wristband that couldn’t be duplicated easily, to guarantee that our patients were scanned at bedside for medication administration and glucometer scanning."

JPMC’s primary requirements were that the bar code be unique, that the solution could integrate with the new IntelliDOT™ Corp. CAREt™ medication tracking solution and existing electronic health record system, and that wristband printing could be centrally controlled.

The medical center found a solution to its scanning problems with SATO America’s Positive Patient ID system and DuraMark™ thermal wristbands. With SATO’s CT410MD thermal printers and Label Gallery HC™ software, staff at JPMC can print unique bar codes for each patient during registration. The durable wristbands can withstand the wear and tear of the hospital environment, which means the nursing staff is confident they will always get a good read at the bedside.

"Part of this implementation was to force the attendant to go to the bedside, which required a unique bar code," says Jamie Stallings, product manager for healthcare at SATO America. "All of the printing is centrally controlled. The nurse does not have the ability to reprint the bar code."

"We realized we needed to do something to improve scannability. The system also provided control over who could generate a wristband," says Marc Rafferty, pharmacy manager at JPMC. "We wanted to avoid workarounds."

When patients are admitted to the facility, the registration clerk prints a unique Code 128 bar code on the wristband and places it on the patient prior to taking them to the nursing unit. During medication administration, nurses first scan their ID badge using the wireless IntelliDOT scanners, then scan the patient wristband and the bar code on the medication (all unit-of-use dosages are bar coded). The wristbands are also scanned for glucometer readings.

"If the medication has been profiled by the pharmacist for that patient, they get a positive sign," says Rafferty. "If it’s the incorrect patient or incorrect medication, there is an audible and visual alarm."

If the wristband has to be cut off for any reason during treaent, the person who cuts it off has to request a duplicate. The duplicate is then printed by registration clerks. "No one else has that computer authority," says Herron.

All of the medication and patient data associated with the wristband scanning is also integrated with the information in the Cerner Corp. PowerWorks electronic medical record system at JPMC.

The latex-free DuraMark wristbands are more durable than the previous label-based solution, and incorporate SATO’s Failsafe Fastener™ to ensure they cannot be removed and transferred to another patient. The Label Gallery software is designed to integrate easily with patient information management platforms.

SATO worked closely with IntelliDOT to make sure the printing solution would work seamlessly with CAREt. For its part, JPMC scheduled a two-hour training session for all licensed nurses, on their respective units, the week before the "go live" date. When the system was installed, an additional nurse was added to each unit for the first 96 hours of the transition to decrease the nurse-to-patient ratio and to allow the nurses more time to acclimate to the new system.

The SATO solution, which had to be installed before the IntelliDOT system, was up and
running in one day. All seven inpatient units should be live with the CAREt system by the
end of September 2006.

According to Herron, the safety benefits of the new system were emphasized during
deployment, which helped ensure that everyone at the hospital would embrace the system. "The staff is just amazing," says Herron. "I consider our nurses pretty techno-hip because we’ve been doing computerized charting since 2001. This is a very progressive organization, and we have actively pursued many wireless options over the last three years. The nurses came up very quickly and efficiently. I give them all the credit."

Herron added that readability has improved tremendously because the new wristbands
don’t react to moisture, and are more comfortable for the patients. With more reliable scanning, the medication safety initiative has gone without a hitch.

And there may be more innovations on the way. The printing system is designed so that patient photographs can be added to the wristband, a function Herron says the hospital is considering for the future.