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KSR Publishing, Inc.
Copyright © 2016
 
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         Clinical intelligence for supply chain leadership

INSIDE THE CURRENT ISSUE

June 2007

Products & Services

New Technology

DuPont elastic technology offers stretch capability in nonwoven fabric

DuPont announces the introduction of Engineered Elastic Nonwoven Technology, a new offering that enables designers to provide unique elastic functionality and deliver soft-stretch comfort. Available now, this innovative technology is latex-free and contains no elastomeric polymers or chemical additives, resulting in a versatile fabric that can meet a variety of industry needs. Fabrics produced from DuPont Engineered Elastic Nonwoven Technology can be high stretch or high stretch with varying degrees of elastic recovery power, depending on end user needs.

Potential applications and benefits include: wound dressings that are soft and have comfortable stretch; knit-like stretchable gown sleeves and cuffs for use in protective and clean room apparel; hygiene side panels for diapers and adult incontinence garments that are less irritating and fit better; elastic bandages and low power wound care sleeves that may be less irritating than conventional materials; elastic protective covers that fit better, reducing the number of sizes needed; elastic interlinings that are resistant to deformation; and elastic composites that are versatile and stretchable. Those interested in fabric samples or additional information may contact DuPont by calling 1888-476-6827 or by e-mail to zelasticnonwovens@ dupont.com

Once-a-year drug reduces fractures from osteoporosis

A treatment for osteoporosis delivered once a year is as effective as current monthly or weekly osteoporosis regimens at reducing the incidence of bone fractures, according to a new study led by a UCSF research team. Results from a three-year, international study of 7,736 postmenopausal women with osteoporosis are reported in the May 3, 2007 issue of the New England Journal of Medicine. The study showed that treatment with zoledronic acid (marketed as Reclast) was very effective in reducing the incidence of all types of fractures in women with postmenopausal osteoporosis, the researchers said. Impact included a 70 percent reduction in the risk of spinal fractures and a 40 percent reduction in the risk of hip fractures. The effect was sustained over three years.

Reclast is an investigational drug in the bisphosphonate drug category that is being developed by Novartis Pharmaceuticals Corp., a U.S. affiliate of the Swiss-based Novartis AG. It is the only once-yearly bisphosphonate treatment being studied for osteoporosis and is still in the approval process through the FDA.

Bars and stripes forever

Despite RFID’s premise and promise, healthcare’s high-touch nature keeps bar coding in plain sight

by Rick Dana Barlow

Zebra printer produces a patient wristband
with Aztec Code

Even though newer electronic tracking techniques, such as radiofrequency identification (RFID) and real-time location systems (RTLS) may be riding a wave of popularity, bar coding remains a more realistic option, particularly for those healthcare facilities that have yet to take the plunge.

In fact, in an industry enamored by chips and tags, bar coding shows few – if any – signs of being replaced by RFID or RTLS. Supporters contend that the technologies will be complementary or synergistic at least, thanks in part to RFID’s current higher cost profile, but also to some limitation that bar coding doesn’t experience. One of the current advantages that bar coding touts over its perceived next-generation siblings is each/unit dose applications where item-level identification may require line-of-sight visualization. Because bar coding is – and has been – widely available and in active use for years, which contributes to its cost favorability, reports of its demise may be considered premature at best.

Moreover, advancements in bar coding capabilities and functionality seem to indicate that bar coding won’t go away without a fight as purveyors also promote it as a precursor in the migration to RFID or RTLS.

Success tied to 2-D, better printers

If you wanted to pinpoint some of the more recent noteworthy improvements in bar coding technology you would look no further than two-dimensional functionality and improvements to printer capabilities, sources told Healthcare Purchasing News.

"While 2-D Aztec Code has been around for several years, it is now making inroads in the hospital market," said Debbie Murphy, global practice leader, healthcare, Zebra Technologies Inc. "The growing use of Aztec Code is noteworthy because it allows users to store a larger amount of data than a linear code. It also does not require white space, which means that it can be printed repeatedly around a wristband. This results in higher read rates for nurses scanning the bands."

Echoed Mike Poldino, vice president of advanced data capture for the enterprise mobility business, Motorola Networks & Enterprise: "We have seen more and more healthcare organizations implementing 2-D bar codes into their environments. A 2-D bar code can be read omni-directionally using a digital imager scanner. This means that when the bar code is placed in multiple locations on a patient wristband the patient needn’t be disturbed for the code to be read. The bar code isn’t linear and does not need to be aligned with the laser scan line as a regular 1D code would need to be."

Two-dimensional codes allow more information to be collected from a smaller bar code, according to Keith Lohkamp, product strategist, supply chain management, Lawson Software Inc. "This has opened up the possibility to scan items that do not have adequate surface area for a traditional 1-D barcode, such as surgical instruments," he said. "New bar code and reader capabilities allow for more detailed information to be easily captured in a small bar code. For instance, a product part number, lot number, and expiration date can be captured in a single scan. This drives additional process efficiency and enables richer information... [which] can lead to hard dollar cost savings. For instance, by knowing which lot numbers an organization has in stock, these items can be actively managed to avoid outdating or facilitating returns in a recall scenario."

Ken Woodruff, industry director of healthcare, Lexmark International Inc., cited specific ways of how 2-D bar codes, such as Aztec or PDF 417 high density, make a difference. For example, Aztec code allows for up to 3,750 numeric digits with a 25 percent error correction in a small square shape that can be placed around the perimeter of patient wristbands for easier scanning, he noted. "Also, Aztec does not require a ‘quiet zone’ so it can be placed next to other printed areas on wristbands which are tight on space," he added.

Hand Held Products 7900 Dolphin
mobile computer reads Aztec Codes

PDF 417 high density code allows for more than 2,700 characters in one bar code and up to nine levels of error correction. "[It] can be used to encode critical patient information on printed forms and documents or ID cards for automated downstream processing," he said.

Beyond the bar codes, printer technology and the labels themselves have improved, "producing much higher quality direct thermal bar codes that are easily scanned and produce higher read rates," said Ralph Moher, vice president of marketing at General Data Corp. "General Data has been one of the leading developers of bar code labels for the last several years, and the technology for label making has jumped light years allowing hospitals to print more durable labels for everything from patient wristbands to tissue slides," he added.

The emergence of small, lightweight, mobile printers also are making bar code technology more useful in hospitals, according to Murphy. "These printers offer superior print quality as well as an extended battery life, helping to bring more applications to the bedside," she said. "One of the fastest applications for mobile printers in healthcare is specimen collection. By labeling specimens at the point of care, clinicians can eliminate the delay between taking the sample and labeling the vial. As a result, the chances of human error are minimized."

As a result, bar coding promotes patient safety, which is becoming more the rallying cry for clinical applications than its traditional place as a business function within supply management. In fact, clinical patient safety applications represent some of the key growth areas for bar coding, Murphy emphasized, including unit-dose labeling in the pharmacy, bedside medication administration and blood administration, as well as specimen collection. The technology also has been shown to reduce errors in the laboratory and generate efficiencies by, among other applications, interfacing with electronic medical records.

"Patient identification is also a growing area, as statistics show that very few hospitals are using bar coding to its full potential," Moher added.

ROI challenges

While some healthcare facilities might delay implementing bar code technology for a variety of reasons, more often than not those reasons center on the return-on-investment. It’s a hang-up that can have potentially dangerous consequences on both the clinical and financial levels.

Motorola handheld, Bluetooth-enabled digital image scanner

Woodruff called the use of bar coding for medication administration a "no-brainer," citing the results of several studies that showed it reduces various point-of-care errors between 62 percent and 93 percent. In fact, he added that the cost of one adverse drug event ranges from $2,000, excluding malpractice, to $5,000.

Murphy concurred. "The FDA estimates it costs $1,799 per bed to implement a bar code point-of-care (BPOC) system for medication administration and another $1,000 for annual maintenance," she said. "However, each adverse drug event (ADE) costs hospitals an average of $2,257, so a single ADE prevention practically offsets the BPOC investment cost for the bed. When you consider the average jury award for medication error cases exceeds $600,000, BPOC systems appear very cost effective."

An innocent mistake can be deadly, Poldino argued, but it’s easy to show how implementing a bar coding system and related applications can save lives. "It’s important to take the discussion down to the basic financial level and look at the hard, cold reality of what happens to a healthcare organization who makes that deadly error," he noted. "If the patient is critically injured or dies as a result of human error on the part of a hospital employee, the hospital may face severe legal costs associated with malpractice that can run into hundred of thousands if not millions of dollars."

Certainly error reduction and overall patient safety are necessary accomplishments, but cost efficiencies also are noteworthy.

"It is also important not to overlook the productivity gains that result from implementing a bar code system," Murphy noted. "With the nursing shortage, many clinical departments are understaffed. Introducing time-saving technology like bar coding can help to streamline processes while also reducing costs."

Two benefits include bar coding forms and documents to automate scanning into EMRs and print-on-demand forms, according to Woodruff. "Pre-printed forms are costly when taking into account administrative costs and waste," he said. Implementing post-discharge scanning of patient charts can streamline review and patient billing and eliminate physical storage of charts, leading to faster turnaround time and fewer full-time equivalents in the medical records department, for example.

One ROI challenge may be healthcare facilities’ failure to take full advantage of what bar coding offers. In fact, some facilities may not realize the financial and operational power bar coding offers because they don’t implement the technology to the fullest extent possible – whether that involves equipment, people or products.

Dave Stewart, healthcare team director at Hand Held Products, urges facilities to focus on measurable ROI factors. "Pharmacy has a measurable return, including the ability to locate recalls and identify expired medications," he said. Furthermore, with positive patient identification, caregivers can take advantage of pharmacy’s work at the point of care.

Consumables billing offers another benefit. "Today, accountability for the billing of consumables for patients is very inconsistent and has no back up system if challenged by the patient," he added. "Hospitals absorb a great deal of costs for consumables." Bar coding also helps facilities track their assets better, including maintenance, recalls and improved management of capital investments, he noted.

Start small, smart

Certainly, administration, equipment tracking, shipping and receiving are fundamental applications for bar coding, as is patient identification, which some observers emphasize may be a smart place for healthcare facilities to start with minimal disruption before rolling out to other areas. However, supply management continues to offer the most obvious benefits, largely because it’s been in use in the manufacturing and distribution supply chains for decades.

"One of the benefits of bar coding is that healthcare organizations can start small — with a stand-alone application in the pharmacy, lab or admissions — and then expand their strategy from there," Murphy said. "After completing a successful implementation in one area of the facility, it is easy to take advantage of additional applications that use bar codes, such as automated medication administration and specimen collection at the bedside, blood administration, asset management for supplies, instruments and equipment, and employee identification."

Lexmark Clinical Assistant

But healthcare facilities must create detailed implementation plans up front, Murphy advised.

"To maximize the value of their investments, hospitals must take steps to lower the total cost of ownership and develop a migration path for cost-effectively evolving and expanding applications," she continued. "These steps include using standardized bar code symbologies and data formats, following technology and process best practices whenever possible, and selecting products that support organizational IT standards for networking, connectivity, and security."

Because bar code implementation requires changes in processes to be effective, physicians, nurses, pharmacists and other end users must buy into the project, she added.

"Bar coding efforts should be focused on business processes with a high volume of data entry and where accuracy is of utmost importance," Lohkamp said. "Bar coding par supply shelves that are counted several times per week will drive ROI in a short time, whereas bar coding shelves for supplies that are less frequently ordered will be harder to justify. When low [unit-of-measure] bar codes are available for a critical mass of products, utilization of bar codes for reordering will have a more compelling ROI."

Detailed planning that pinpoints targeted problems is the most effective strategy, according to Jeffrey Schou, director of healthcare solutions for the enterprise mobility business, Motorola Networks & Enterprise. "The most important factor for the successful implementation of all these applications is a well-planned, phased implementation schedule that takes in to account where the hospitals biggest pain points are, the cost of solutions to address those pain points and the training required of the staff to insure full utilization," he said.

"There is a lot of noise in the marketplace about bar coding technology and competitive or complementary technology," Moher noted. "Bar coding is still the most proven and affordable solution on the market for healthcare organizations, whether for equipment tracking or patient identification. Healthcare is still a high-touch industry, so the interaction between patient and caregiver is not going to change. If there is too much manual compliance or intervention, then the overall system was not designed correctly. It takes more than just a printed bar code. Hospitals need a well-designed system of labels, printers, software, scanners and programming that is designed for their specific needs and the users of the technology. The sooner we can get the system in place, the faster we can enhance clinician productivity, reduce errors and increase patient safety."     

 


www.hpnonline.com

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HOME
KSR Publishing, Inc.
Copyright © 2016
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         Clinical intelligence for supply chain leadership