www.hpnonline.com

Search our website

Self Study Series
White Papers
Webinar Series
Special Reports
Resources & Agency Listings
Show Calendar
HPN Hall of Fame
HPN Buyers Guides
HPN ProductLink
Issue Archives
Advertise
About Us
Contact Us
Subscribe

Receive our

HOME
KSR Publishing, Inc.
Copyright © 2016
 
Header
 

         Clinical intelligence for supply chain leadership

 
 

INSIDE THE CURRENT ISSUE

August 2009

Products & Services


 

New Technology

METIman cries, bleeds, talks, but he’s no ordinary man

Medical Education Technologies Inc., or METI, produces simulators, or mannequins, that are remarkably human-like. These new teaching tools cost less than competing simulators and will benefit those that may one day save your life.

Listening to a heartbeat...checking for a pulse...his eyes blink and pupils react to light. This dummy is anything but dumb. In fact it is more advanced than you can imagine. He is called METIman, and his creators say he is the first of his kind wireless patient simulator.

The first four units were shipped to Saskatchewan Institute of Applied Science and Technology (SIAST) in Saskatchewan, Canada, and will be used for healthcare education at each of their four campuses. SIAST already utilizes a number of other METI simulators at their Simulation Center on their main campus in Regina.

METI already has orders and will be delivering METIman to teaching and healthcare institutions throughout the world, including one to Lakeland College in Alberta, Canada, who were the first to place an order for METIman in March.

"METIman is without a doubt the right simulator at the right time," said Jeff Dustow, manager of capital projects at Lakeland College. "It gives us the ability to provide the best educational tools available to our students on a scale that we couldn’t have afforded in the past."

METIman’s state-of-the-art technology operates wirelessly, via a laptop computer and web-based software, but what the nurses and medics who developed him like best is his price. At only $27,000 each, METIman is the lowest priced simulator available today. Most simulators start at about $45,000.

METIman is available in two models, one built specifically for nursing education and one for pre-hospital training.

The first generation wasn’t wireless like the new METIman who is self-contained and even more technologically advanced. METIman engineers say times have changed. The life-saving tools currently used out in the field will work on METIman, making it more realistic to students...and more affordable.

In the future, the company hopes to make infant and children-size simulators with the same technology as METIman. www.meti.com

Bar codes
earning their stripes

Providers, suppliers put their support behind bars for people, products

by Rick Dana Barlow

Ubiquitous in retail and manufacturing but far more uncommon in healthcare, bar coding may slide into a renaissance, courtesy of a floundering economy and a marketplace dogged by rampant administrative inefficiencies.

Renewed vigor around supply chain standards, as well as vibrant and visceral interest in linking product purchasing to consumption to charging and ultimately to optimal patient care is casting bar code use in a new light. In the face of bloated budgets, bleeding bottom lines and reimbursement restrictions, the block of aligned black stripes may turn out to be just what the fiscal doctor ordered even as chips and tags try to usurp some of the limelight.

Whether it’s regarded as an interim step to radiofrequency identification or real-time location systems or merely the end game for traditional pen, paper and sticky notes, bar coding continues to deliver enough results to keep it relevant and viable.

But how long will this endure? Healthcare Purchasing News wanted to explore bar coding’s role in supply chain process improvement and highlight the merits of bar code adoption and implementation. HPN tapped six experts for their takes on where healthcare facilities can generate easy wins with bar coding, where they probably should bypass and what categories make the most sense for bar coding technology.

Dennis Black, BD

Easy wins

Whether at the dock, in the storeroom, in the warehouse, at the bedside or at a product’s point of use, bar code applications can notch some no-brainer, surefire success stories if done right.

"Scanning bar codes on the delivery dock seems like the ultimate easy win," said Dennis Black, director, e-Business, BD, Franklin Lakes, NJ. "Hospitals could verify they are receiving the correct products and the correct quantity with relative ease. Furthermore, expiration dates, lot numbers and serial numbers – when applicable – could also be scanned and recorded for product tracking."

In fact, Black indicated that all of the valuable information included in many bar codes could be used to improve the accuracy and speed of receiving product, including using the information to rotate inventory and track lot numbers. "Imagine how easy recalls and other surveillance activities would be for hospitals if they simply tracked the data most suppliers already include in their bar codes," he added.

Black also recommended using GS1 Healthcare US’ Global Trade Identification Number (GTIN) for tracking storeroom inventory. "Shelf packs can be scanned when inventory is delivered to the room, high-value items can be scanned when issued to a patient and empty or near empty shelf packs can be scanned to trigger reordering," he noted.

Lana Makhanik, vice president, business development, at Seattle-based VUEMED Inc., emphasized the importance of medical product and device management in terms of clinical and financial effectiveness. "These consumables and perishable products are vital for patient care and can be very expensive, so it is important to be able to track them for availability, expiration and recall status," she said. "Nearly all products come with bar codes already printed on them, and the information typically includes a unique reference number, the expiration date and the lot number."

Using bar codes for intravenous pump programming for pharmacy-prepared drugs may eliminate a considerable percentage of medication errors, according to Gale White, vice president, infusion systems, B. Braun Medical Inc., Bethlehem, PA.

Lana Makhanik, VUEMED Inc.

White argued that nearly 30 percent of medication errors can be linked to IV pump usage and that most of those estimated
errors can be traced to improper programming. "These errors are caused by selecting the wrong drug from the pump’s on-board drug library, or misplacing a decimal point while programming the pump’s delivery rate, or administering the drug to a patient for whom it was not intended," he said. "Studies document that these errors and other pump programming transcription errors could be virtually eliminated with the use of IV pump bar coding."

Pharmacists affix labels to the drugs they prepare that include the patient’s name, the drug name and the IV pump delivery data. "This label could be easily formatted with bar code symbols so the pump could be programmed through a hand held or pump-based scanner that would positively program the pump with the correct patient’s ID, the drug information and the pump delivery information," White insisted. "This data would then be checked and verified automatically by the pump’s dose error reduction system and, after confirmation by the care provider, the IV drug delivery could be initiated with assurance that the right patient is getting the right drug at the right rate."

On the flip side of a full-blown bar-coded medication verification solution that may be viewed as a "huge task," according to Vivian Funkhouser, principal, Global Healthcare Solutions, Motorola Enterprise Mobility Solutions, Holtsville, NY, is the simple patient wristband, which can be deployed and used "relatively easy and quickly."

Such a safety net, Funkhouser continued, can provide "greater patient care, improved patient and staff satisfaction and a peace of mind for family members who know that there is an objective, methodical manner to confirm patient identity." Plus, the bar code on the wristband, can be embedded with valuable information like patient allergies, she added, which extends error reduction to the point of care.

Bar-coded labels at the point of care for specimen collection applications offer a compelling and related return on investment, urged Donna Lee, Alliances Specialist, Healthcare, Honeywell Scanning & Mobility, Blackwood, NJ.

"A complete LIS [laboratory information system] that utilizes ‘rights’ similar to the ‘5 rights’ used in medication administration could result in easily measured cost savings by ensuring that the right specimen is being collected from the right patient and that the right tests are being run," Lee noted. "The use of bar-coded labels in specimen collection eliminates ‘do overs’ that cause pain to the patient, costly lab tests re-runs and potential misdiagnosis from mislabeled specimens." Another bonus is that bar codes can streamline a phlebotomist’s workflow, she added.

Donna Lee,
Honeywell Scanning & Mobility

The typical ROI for such a system can be less than a year for an average-sized hospital, Lee indicated.

Cristina DeMartini, market development leader, Zebra Technologies Corp., Lincolnshire, IL, acknowledged that pharmaceutical
labeling, patient identification or wristbanding and laboratory labeling are sound clinical application areas for bar coding. But she prefers bar coding laboratory specimen containers at the point of care as a "great opportunity" for reducing errors and increasing patient safety.

Point-of-care specimen labeling generally works like this, according to DeMartini: Clinicians apply a bar-coded label to a specimen container after the specimen has been collected from a patient at the patient’s bedside or at the point for which the patient is being cared. Traditionally, labels for bedside specimen labeling are preprinted by a lab for all of the patients that will be seen that day by all clinicians. Then the labels are manually sorted to be placed in order of the collection rounds for each clinician.

"Often, more than 200 labels are printed per day and sorted for the collection rounds," DeMartini noted. "At each patient’s room, clinicians must find and match the right label with the right patient before affixing it to the specimen. By using this method, there’s a possibility of placing the wrong patient label on the specimen. Being able to print the right label at the patient’s bedside by first scanning the bar code on the patient’s identification wristband and then automatically printing a bar- coded specimen label on a mobile printer for that patient eliminates the possibility of placing a different patient’s label on the specimen." Using the bar-coded specimen label throughout the laboratory testing process further reduces the chance of the patient receiving someone else’s lab results down the road, she added.

Cristina DeMartini, Zebra Technologies Corp.

DeMartini also noted that point-of-care laboratory labeling can save process time.

"Providing a clinician with real-time draw orders via a mobile computer reduces the amount of time that the clinician spends walking to and from the lab or nurses’ station to receive updated orders," she said. "By scanning a patient’s wristband, a clinician can retrieve the draw order for a patient at the patient’s bedside and can collect specimens and print labels for those specimens even if the order was just added."

But Marga Ortigas-Wedekind, vice president, marketing, Omnicell Inc., Mountain View, CA, emphasized that bar coding is "almost essential in tissue tracking.

"Hospitals are under increasing pressure to establish effective, electronic tracking and compliance procedures for tissue," Ortigas-Wedekind noted. "Joint Commission standards and AORN require hospitals to upgrade their tissue storage and issuance processes." Such standards are designed with patient safety in mind to help reduce infections in tissue and implant recipients.

"In addition to tracking the tissue specimen itself, essential information such as expiration dates can be easily scanned in to hospital supply chain management systems from bar codes and goes a long way in reducing errors," she added.

Gale White, B. Braun Medical Inc.

Hard sells

Just as healthcare administrators and clinicians can notch key wins with bar coding applications, they also can run head-first into roadblocks that may erupt into anger, disappointment, skepticism, cynicism and ultimately, rejection.

For B. Braun Medical’s White, BD’s Black and VUEMED’s Makhanik, a key hurdle is bar-code gluttony.

Bar coding too much information can be frustrating, according to White. "A hospital had hoped to maintain a data log of all transactions performed on their equipment by each specific user," he said. "To accomplish this task, it was necessary to have the users scan their badges at various stages of the equipment’s operation. This caused a significant inefficiency in the equipment’s utilization and frustrated the users to such a degree that they found several creative workarounds to the bar-code system."

Black admitted that "printing, scanning, recording and analyzing GTINs, lot numbers and expiration dates on each and every medical device directly at the point of care would provide thorough tracking of consumed products, but it also would be a significant cost to the healthcare supply chain.

"Scanning and capturing all of this information and storing it for each patient would require significant investments and tremendous process changes for the entire industry," Black continued. "Many healthcare providers have stated that some high-volume, low-risk products should not be scanned at the point of care due to the labor expense and the fact that these products can be tracked via an ASN, scanned at the case level and scanned at the shelf pack level before they even reach the point of care."

Marga Ortigas-Wedekind,
Omnicell Inc.

In fact, for some commonly used, low-cost products, such as needles, tip-caps, cotton balls and gauze, the cost of additional packaging/bar code printing or adding bar codes directly to the product could equal or exceed the current cost of the device, Black noted.

BD affixes data-laden bar codes, including GTIN, on virtually all of its products, which providers easily can access and use, according to Black. But he cautioned against a "one-size-fits-all" approach that requires the same level of bar code detail for all products at all packaging levels. He also expressed confidence that the industry – providers and suppliers together – will accept and develop workable solutions and standards.

Makhanik recalled the glee of one of VUEMED’s earliest customers. "They loved their new bar-coding system so much that they tried to use it for everything," she remembered. "They literally tried to track every single [Johnson & Johnson brand] Band-Aid. But they quickly realized that it wasn’t an efficient use of their time. Band-Aids almost never expire, they don’t get recalled, they’re not expensive and you don’t need to know exactly how many you have in stock. You just order more from central supply when you need them. 

"Inventory tracking systems in general should only be used for items that rise above some critical level of importance, and Band-Aids don’t quite cut it," she added.

With the emergence of real-time location tracking through such media as radiofrequency identification (RFID), bar coding may not be as efficient for tracking patients, staff and assets, according to Zebra’s DeMartini.

"Typically, RFID is a better source for real-time location tracking," she said. "Because bar coding requires line of site, it should be expected that a staff member might forget to scan a patient’s wristband if you were to use bar coding to track patient workflow within the operating room, for example. A better alternative would be to use active RFID technology where clinicians can find a patient’s location without relying on a human to physically scan the patient."

Hospitals can generate considerable efficiencies when they use bar codes for high-value products in the operating room and specialty areas, such as the cath lab, according to Omnicell’s Ortigas-Wedekind. "So arguments are often made that it doesn’t make much sense to make use of bar codes on items such as sponges and Band-Aids," she indicated. "However, you can also realize significant efficiencies when you are dealing with lower-cost inventory items due to the economies of scale in dealing with such large volumes. Bar coding simply makes sense across a wide range of products."

Vivian Funkhouser, Motorola Enterprise Mobility Solutions

Motorola’s Funkhouser and Honeywell’s Lee offered a much broader perspective in higher-risk scenarios.

For example, Funkhouser questioned the timeliness of patient care should the bar-code scan "slow down or impede the expediency required in an acute emergency situation." Such situations may include the scene of an accident, in the emergency room or in care associated with the deployment of a crash cart.

"In these acute emergency care situations, caregivers may bypass the bar-code scan of medications and assets used in the care of the patient at the time of use," she indicated. "Their protocol may be to scan the bar codes after the emergency has passed and the patient is stabilized or moved to further care." As a result, caregivers may rely on a combination of bar codes and human readable information.

But Funkhouser noted that bar coding definitely has merit post-crisis to improve administrative processes. This includes scanning the supplies and medications which helps to populate and document the electronic medical record (EMR) for the patient so that future caregivers can track the patient’s care as well as facilitating the billing cycle by capturing charges of the assets used. 

Lee deflected concern about clinical applications of bar coding and instead insisted that the "approach and sequence of events" when implementing bar coding can create horror stories.

"For example, trying to implement bedside bar code administration before the entire pharmacy has implemented bar codes on all medications is a recipe for disaster and confusion," Lee said. "Another disaster scenario is inadequate training of clinicians. The timing of when to train clinicians on how to utilize bar codes in their clinical application is very important to their acceptance of bar-code hardware as a tool and not an enemy."


www.hpnonline.com

Search our website

Self Study Series
White Papers
Webinar Series
Special Reports
Resources & Agency Listings
Show Calendar
HPN Hall of Fame
HPN Buyers Guides
HPN ProductLink
Issue Archives
Advertise
About Us
Contact Us
Subscribe

Receive our

HOME
KSR Publishing, Inc.
Copyright © 2016
Header
 

         Clinical intelligence for supply chain leadership