Bridge-Medical

One of the latest entries into the patient identification arena is a radio frequency identification (RFID) tag that is affixed like a bandage to a patient’s surgery site to help prevent errors. Developed by orthopedic surgeon Dr. Bruce Waxman, the SurgiChip is the first surgical marking device approved by the Food and Drug Administration to use RFID. Surgeons scan the chip that has both printed and encoded patient data, prior to surgery to help prevent wrong-site, wrong-procedure, wrong-patient surgeries.

General Data Personal ID with printer

Also new in patient identification is the use of biometric technology with fingerprint scans. The Advanced Ambulatory Surgical Center in Chicago is having success using a biometric identity management solution from Ultra-Scan Corporation (Buffalo, NY). Upon arrival, the patient’s index finger is scanned using high frequency sound waves that provide a more accurate read then traditional fingerprint-scanning methods. The fingerprint scan is then tied to the patient’s medical records. One of the advantages of this high-tech solution is that it provides a virtually tamper-proof identification method; the patient in effect becomes his own ID. The result has been increased patient privacy, a streamlined registration process and improved overall quality of care.

PHG Technologies EasyID

These are just a few of the innovative patient identification technologies to emerge in 2004. The year ahead will surely bring even more solutions to the challenge of achieving positive patient identification throughout the hospital.

A survey1 published at the end of 2004 showed that five years after the 1999 Institute of Medicine report, "To Err is Human: Building a Safer Health System", Americans are still concerned about the safety of the U.S. health system and they do not believe that the nation’s quality of care has improved. One in three surveyed said they or someone they knew had experienced a medical error in their lifetime.

SurgiChip

These and other patient safety-related news events and initiatives only serve as a reminder to hospitals that automated identification systems (auto ID) are a necessary investment. This article will look at some of the available options, all of which will satisfy goal one of the 2005 National Patient Safety Goals released by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO): to improve the accuracy of patient identification through the use of at least two patient identifiers whenever administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures.

Bd.id System

Bar coded wristbands
As an added interpretative guideline to Requirement 1A above, JCAHO adds, "It is the person-specific information that is the "identifier", not the medium on which the information resides. Acceptable identifiers may be the individual’s name, an assigned identification number, telephone number, photograph or other person-specific identifier. Bar coding that includes two or more person-specific identifiers (not room number) will comply with this requirement."

Olympus OsYris

Because of their accessibility, familiarity and relatively low cost, bar coded wristbands have become popular forms of auto patient ID.

General Data Company (Cincinnati, OH) has been involved in bar coding and auto ID for over 20 years, specializing in labels and wristbands that are designed to stand up to a variety of harsh environments.

The company’s highly durable PersonalID patient identification wristbands have been lab-tested for extended resistance to water, baths, showers, etc. And because the wristbands are thermal-printed, the printed image can’t be rubbed off, even with alcohol.

As an added identifier, patient photographs can be scanned from a driver’s license or taken with a web camera and printed onto the wristbands.

The PersonalID wristbands use a non-adhesive snap closure, which is a feature that infection control professionals especially appreciate, said Ralph Moher, director of corporate communications, General Data Company. "Infection control likes them because adhesives can be a magnet for dirt."

Alaris IV-Right Application

Moher cautions that when it comes to implementing an automated patient identification system, "a label is not just a label. If the wristband cannot withstand the hospital’s processes and procedures, and the bar code identifier is somehow damaged and can’t be scanned, an expensive patient ID system can be wasted."

He notes that last year’s FDA medication bar code ruling is "an open door for hospitals to implement a bar code patient ID system. "Bar coding is proven to work in other environments, and now hospitals are looking to implement the technology to their benefit," he adds.

PHG Technologies (Brentwood, TN) is a company that provides a combination patient identification and document management solution that operates using standard laser printing and forms designed using Microsoft Word. PHG provides bar coded wristbands in eight different colors that can include a patient photo and can accommodate both vertical and horizontal bar codes for easier scanning. Labels are laser-printed on 8 ½ x 11" or smaller sheets, then applied to the wristbands which have a built-in clear protective overlay. Soft, fabric-like Tyvek options are also available for use on infants or in critical care situations. In this case, waterproof vinyl labels are laser-printed and applied to the Tyvek wristband. PHG claims that the labels have been tested for wear as long as two weeks.

Ultra-Scan

PHG’s EasyID document management solution merges live patient data and bar codes with the appropriate admissions forms which can then be printed, stored, emailed, or faxed on demand complete with the patient’s bar coded data.

The company’s EasySIGN option is a digital clipboard that captures patient signatures and allows the admissions manager to view documents on the screen as the patient fills them out. EasyTAG is a solution that allows patient verification and printing of bar coded labels at the bedside.

According to Jennifer Smith, marketing manager, PHG Technologies, the entire system can be implemented in as little as six weeks with PHG spending a week on-site in training. She describes the system as easy to use, easy to implement and easy to interface, even with the difficult demands of military hospital systems.

The company’s Easy DownTime solution allows for patient admissions even when the hospital network is compromised.

More traditional laser-printed stock labels are available from vendors such as the St. John Companies and United Ad Label.

The Conf-ID-ent Patient Identification Wristband from St. John Companies is a one-part, self-laminating, moisture-resistant, low-cost solution. The company has a White Paper available on its web site, www.stjohninc.com, "Meeting the New Patient Identification Safety Goals: How Barcoded Wristbands Can Improve Your Patient ID System".

United Ad Label provides a variety of convenient label/wristband options. According to Mark Lombardo, national sales manager, United Ad Label, the advantage of the company’s stock label and wristband solution is not only the attractive cost but the ability to buy one case or 50, shipped in 24 hours.

Whichever type of wristbands you choose, you’ll want to consider features such as ease of printing, durability, readability and scanning accuracy, patient comfort, tamper-resistance, etc. You might even want to conduct a wear-trial to validate company claims.

Medication administration
Positive patient identifications may center around the wristband, but that’s just the beginning of the patient identification loop.

The Institute of Medicine report emphasizes that drug-related adverse events are a major component of medical errors that cost lives, injuries and wasted healthcare resources. In an attempt to curb medication errors, the Food and Drug Administration ruled in February 2004 that bar codes be required on most prescription drugs as well as machine-readable information on container labels of blood and blood components intended for transfusion.

This ruling provides a further springboard for the use of auto patient ID in conjunction with medication administration.

Bridge Medical, an AmerisourceBergen company, was a pioneer in commercial point-of-care bar coded medication administration systems. The company’s MedPoint solution is a comprehensive system proven to reduce the risk of medication errors, specimen collection and transfusion errors.

Though highly advanced, MedPoint can be installed in as little as four months or less, said Denean Rivera, president, Bridge Medical. She attributes this to the highly consultative nature of the Bridge approach. "We walk hospitals through the entire process, starting with designing the team that takes the project forward," said Rivera. "It’s a very detailed methodology and we receive very high customer satisfaction ratings for this approach. It greatly minimizes risk," she adds.

In addition, she notes, the system is very intuitive for nurses and clinicians who can usually be trained in as little as two hours.

Bridge Medical was recently named the top bar code point of care vendor for the KLAS Enterprises "Medication Administration - Bedside Study". The Bridge MedPoint solution scored highest in 32 out of 40 categories including "product and technology", "service indicators", "success indicators" and "business indicators," as judged through interviews with CIOs and department directors using the system. One of the requirements of the KLAS award is that the system be live in at least 15 different organizations; with more than 34 live sites, MedPoint was a clear contender.

A clear advantage of the MedPoint system lies in its clinical safety parameters. "We go beyond the five rights," states Rivera referring to the patient’s right to be administered the right medication, at the right time, in the right dose, through the correct route. With embedded ISMP alerts, the MedPoint system also checks for allergies, weight-based dosing parameters, maximum daily dose limits, and look-alike, sound-alike rules, among other things.

As a side effect of automated medication administration, work-flow processes are also improved. Real-time order documentation and clarification helps break the disconnect between pharmacy and nursing. "We never preach that the system is a time saver, we focus on the safety benefits," said Rivera. "But because it does everything real time and you don’t need to print out the MARs and do the reconciliations required in a paper process, hospitals find that it does save a lot of time, as much as an hour per shift."

Data collection is a critical component of MedPoint, which has available anywhere from 30 to 40 different reports. "The system has a very sophisticated reporting engine that allows you to analyze your data so you can really look at process improvements through the whole cycle," notes Rivera.

And because the system records every nurse transaction, it will show if a nurse was stopped from making an error. Rivera notes that voluntary reporting numbers for mistakes are extremely low compared to what hospitals typically see when the system goes live. "They don’t really know what they don’t know until they go online and it’s all automated for them," she explained. 

According to Rivera a critical factor in the success of any point of care automation system is that the technology should work with the hospital’s established processes, not against them. "You should enable and enhance the care process with the technology, not try to totally change it."

She confirms that bar code patient identification systems are quickly gaining momentum nationwide. "Previously it was the clinical thought leaders who were implementing bar code patient identification systems. We’ve seen a dramatic shift from facilities asking, ‘should we do bar coding, to how do we get started with bar coding?’"

In addition, through AmerisourceBergen, Bridge Medical provides pharmacy automation that allows facilities to save money by buying medications in bulk and then unit dose packaging and bar coding themselves.

The MedPoint system also includes transfusion and specimen collection point of care models. Rivera notes that MedPoint is designed with standard interfaces to work in any system set-up, from pharmacy to lab to ADT.

The Pyxis Veri5 medication verification software application from Cardinal Health integrates with Cardinal’s Pyxis system to provide an automated double-check of medications administered at the point of care while providing real-time documentation to Pyxis MAR or a facility’s electronic chart.

The Veri5 can be used on a hand held device or in conjunction with the Pyxis PatientStation, for a unique in-room point of care technology system that not only provides clinicians with bedside access to clinical applications, but also serves as a bedside communication, education and entertainment tool for patients, even providing them with access to medication information.

Chris Buckley, director of marketing, Cardinal Health, Pyxis products, notes the rise in patient confidence levels with the increase in the use of bar coded systems and wristbands. "Hospitals are reporting that patients are automatically raising their wrists when a nurse walks into the room to administer treatment."

Buckley says that the Pyxis system is designed to help make the workflow more efficient, reduces mistakes and reports on near-misses. Features such as a larger font screen size and touch screen applications are designed to be easy-to-use and intuitive for nurses. He notes that Cardinal is also looking at additional ways to improve medication administration safety and work flow. Buckley urges buyers to consider a vendors’ support network and stability when comparing systems.

Infusion safety
In addition to point of care medication safety, ensuring positive identification at the point of infusion is just as important, if not more. According to Dr. David Bates, Brigham & Women’s Hospital, Boston, 60% of serious and life threatening medication errors are IV-related. Or as Dr. S. Gerald Sandler, director of transfusion services for MedStar-Georgetown University Hospital, puts it, "There aren’t as many transfusions as there are pills dispensed, but errors in transfusion medicine can have much more serious consequences than in the size of the dose of a pill."

Current bar code systems do not address programming of IV pumps, a known source of many medication errors. Unlike the administration of a pill which is a single "event", the initial setup of an IV fluid may represent only 5-10 % of the overall programming of the infusion. Combining a point of care bar code system with Smart infusion pumps improves the safety of IV medications which represent a "process", notes Tim Vanderveen, PharmD, Executive Clinical Director of the Cardinal Health Center for Medication Safety and Clinical Improvement. Alaris Products, which was acquired by Cardinal Health last year, provides a sophisticated solution to a previously missing link in the medication use system.

 The Alaris IV-Right application works with the Alaris smart pump system and a PDA to provide a high-degree of infusion safety over a wireless network. The system provides intuitive guidance for nurses allowing them to choose from among pre-programmed options. Not only does it serve to help eliminate programming steps in a complicated procedure, but is also an excellent continuous quality improvement tool.

An additional advantage of the Alaris system is that the pharmacy now has a window to the bedside, according to Vanderveen. "Pharmacy can view infusion status to better plan the IV room workload." With a real-time window to the bedside, the pharmacist knows when a patient’s infusion medication is about to run out, for example.

Specimen collection
Ensuring that specimens are collected from the right patient at the right time, placed in the right container, subjected to the right test and that test results are linked back to the right patient is equally as critical as safe medication delivery and can have a multitude of effects.

Michael Mutter, M.S., R.Ph, and his colleagues at The Valley Hospital (Ridgewood, NJ), were directly involved in the development and research of the Bd.id Patient Identification System for specimen management. About seven years ago, following a change in blood collection processes and in the personnel making the collections, the hospital saw a dramatic rise in phlebotomy errors.

"We went from a small group (centralized by the lab) to a large group of people (decentralized by nursing unit) collecting blood. When we started tracking, we saw errors such as mislabeled samples and the use of wrong specimen collection tube — critical errors that necessitated redraws," said Mutter.  

Fortunately for Valley, the hospital is located near BD headquarters in New Jersey. The company became aware of Valley’s specimen collection issues and stepped in to help. "We had started looking for technology right at the point of care to help us avoid errors," recalls Mutter. "But at the time, we were not able to find a suitable product. BD was right next door, and they came to us and said, ‘we’re thinking about technology for specimen collection error reduction.’"

It was a natural union, with Valley sharing its error data with BD, and BD providing a customized solution to a costly problem.

From that point, Valley served as one of the development sites for the BD.id System, with Mutter’s team utilizing the specimen collection system on a few pilot floors. Right away, they noticed a reduction in incorrect tube errors, as well as mislabeling, and specimen collection errors, recalls Mutter. He notes that there are just two areas of the hospital left, ED and Critical Care, before the system is used house-wide. Valley is currently reporting a reduction of 99.95% in errors related to incorrect labels and reductions of 100% in errors related to both misidentifying patients and using an incorrect specimen container.

Even the implementation process for the Bd.id System is highly standardized. Mutter allows two hours for training new staff on the system, but it usually only takes 90 minutes to an hour, he said.

The Bd.id System involves a software application that works on PDAs, along with a portable printer for bar coded labels. The system’s data capture and reporting capabilities will not only allow hospitals to identify root causes of adverse events, but also provides for streamlined specimen collection.

Mutter notes that Valley will soon be installing a wireless system to help further eliminate any potential human factor errors associated with uploading data to the PDA. "With radio frequency, nothing should stand in our way."

A wise warning from someone who’s been there: "Know your process first. If you don’t know the problems that you have, or if you’re inconsistent in your processes, you will have problems with the implementation," Mutter suggests. 

DiLauri confirms that BD is developing a wireless system. The company recently released Version 6.0 of the BD.id System, which includes enhanced reporting capabilities and other system upgrades.  

Following successful implementations in hospitals throughout the U.K., Olympus America is now bringing its Olympus osYris patient identification system to the U.S.

The osYris system uses a two-dimensional bar coded wristband that is scanned with a wireless PDA to gain positive patient identification. Components of the modular patient safety system include: Bedside Drug Order Management, Request Order Management, and the Auto PPI bar coded wristband and patient ID system. "First and foremost, the caregiver must positively ID the patient," notes Terry Giacomo, Director, New Business Development for Olympus Diagnostics Systems Group. The system allows the caregiver to electronically verify four key identifiers with just one scan, she notes.

Using Olympus osYris, caregivers can order tests at the patient’s bedside using a profile checklist, then draw blood samples and print sample tube labels all at the bedside. Once samples have been collected, the PDA sends a message, via wireless LAN, to notify the laboratory of their pending arrival. Once the samples arrive at the lab, the bar coded sample label is scanned, and receipt is confirmed. With information about the requested tests already on the lab information system, no further data entry is required and analysis can start right away. This reduces turnaround time from sample collection to results arrival. Because software development is Olympus osYris’ core competency, a customized solution is developed to meet each hospital’s unique needs. Each facility is assigned its own Olympus osYris consultant to lead the implementation and conduct on-site training of the patient ID system and patient safety solution modules.

"We provide a complete observation, process mapping and needs analysis that allows us to provide true process innovation, said

Giacomo. "Then, after implementation, we perform post audits and document the efficiencies that are gained as well as the resources that are saved."

Giacomo notes that implementation of an automated bar code ID system is an interdisciplinary decision. "Successfully implementing an enterprise-wide patient safety solution depends on consensus among all key areas in the hospital such as Nursing, Admitting, Pharmacy, Laboratory, Radiology and IT."

In order to make the system a more affordable acquisition for facilities, Olympus provides alternate financial solutions including one based on cost per admission. Similar to the company’s cost per procedure program for endoscopy this solution helps the hospital avoid large capital outlays. Giacomo adds that Olympus is positioning itself towards an RFID application.

ID in the lab
A final link in the closed loop auto ID system is the laboratory. The American Society of Cytopathology has recommended the use of bar code identification technology from patient registration through the lab process.

General Data recently introduced a tissue and specimen slide identification system designed to withstand repeated and extended exposure to harsh chemicals and solvents. StainerShield is a patent-pending solution that allows lab technicians to print patient-specific bar code labels on-demand and apply them to the slides before they’re exposed to chemicals, solvents or stains. They can label slides pre-stainer plus reap the benefits of using bar code technology to track slides and confirm that the right slide is matched to the right patient for the right test. The system can help improve lab workflow – slides are labeled and ready to go at the cutting stations – and help reduce the need to redraw samples and repeat tests.

The company says its StainerShield starter kits which include a printer, software and labels, starts at under $3,000. General Data also offers its CryoDentity labels for vials, test tubes and bottles that are designed to withstand extreme cold environments or immersion in liquid nitrogen. Even radiology labs are getting into the picture. The University of Texas M.D. Anderson Cancer Center is using bar coded picture wristbands with DICOM modality worklist capabilities to positively ID patients prior to imaging procedures. HPN

RFID opens the door for wireless tracking and more
If bar code solutions can help close the loop on patient safety, then RFID has even greater potential to not only improve patient identification, but facilitate process improvements throughout the hospital.