Polk Hospitals Using Bar Codes To Improve Safety

More and more hospital patients are being treated like loaves of bread. That’s a good thing, nurses and hospital administrators say.Like the scanner that reads bar codes in the grocery, Polk County hospitals are bringing bar-code technology to the bedside, all in the name of patient safety.

Medication errors harm at least 1.5 million people every year, with a conservative estimate of 400,000 preventable drug-related injuries in hospitals each year, the Institute of Medicine of the National Academies reported in 2006.

For patients, having bar codes on their armbands is one of the more visible signs of safety initiatives that have multiplied since the Institute of Medicine issued its watershed 1999 report, To Err is Human. That report said 44,000 to 98,000 people a year died from preventable medical errors that occur in hospitals.

“One of our biggest problems in health care is medication errors,” said Mike Kosor, chief executive officer at Bartow Regional Medical Center. “There are a lot of needless, accidental deaths as a result.”

Winter Haven Hospital is the latest hospital making the technological leap.

Its nurses, who now visually check the name on patient armbands when dispensing medication, recently trained to use a combination of bar-code technology and computers. As the system goes live during the next couple of weeks, they’ll routinely scan a bar code on each armband in addition to reading the patient’s name.

Bartow Regional Medical Center and Heart of Florida Regional Medical Center already have patient bar-code scanning, often called bar coding at the point of care. Lake Wales Medical Center plans to start implementing it next month.

Lakeland Regional Medical Center expects to start using bedside bar-code scanning on emergency department and operating room patients next year as it implements a comprehensive electronic health record system in the emergency and surgery departments.

Many patient-safety experts recommend bar coding and electronic medical records, leading to an almost paperless hospital, as ways to reduce errors.

About one fourth of hospitals now do bar coding at the point of care. That number is far too low, according to Mark Neuenschwander, co-founder of the group that organized unSUMMIT for Bedside Barcoding.

“The most serious errors happen at the point of care, not earlier,” he said.

What Bar Coding Means for Nurses, Patients

Having bar codes on medications and increasingly on patients’ arm bands doesn’t relieve nurses of the obligation to follow other precautions called the “five rights of medicine administration:” the right medicine to the right patient, in the right dosage, by the right method and at the right time.

But it will automate the checks and balances nurses normally go through before administering medicine, said Winter Haven Hospital’s Kathy Edinger, registered nurse and a senior clinical systems analyst.

And it will alert them if the codes on the medication or the patient’s arm band don’t match the information in the patient’s medical file.

“No alert is ever going to jump out of a paper folder,” Edinger said. “With this system, you know right away if something is not what it should be. … Visually, it will highlight the alert.”

This is one time, it appears, when patients may benefit from being treated like a loaf of bread.

“I worked a lot of years without something like this,” said Sherri Shepherd, registered nurse and education coordinator at Bartow Regional. “It is wonderful.”

BRMC started using bedside bar coding in December 2007. Heart of Florida, owned by the same company, has had it for about a year, said Beth Dewey, nursing director on the surgical-orthopedic floor.

“I’ve used electronic medication administration at other places,” Dewey said. “It makes you feel safer as a nurse giving medication.”

The software used in bar coding systems has different levels of sophistication and added features. SafeScan, the system used by Bartow Regional and Heart of Florida Regional, can record what medicine was administered, who gave it and who got it. It also reminds nurses of other tasks to do along with giving a particular medicine, such as saying to review the level of a patient’s pain 30 minutes after the patient gets pain medicine.

With SafeScan and with the AdminRx program starting at Winter Haven, nurses use a handheld scanning device. They scan the bar code on the patient’s arm band and scan the bar code on the medication to make sure they are in sync.

In learning to use the bar-code scanning, Winter Haven’s nurses also were trained in using a new computer system with mobile computers that provide a full-screen view of a patient’s medication profile, vital signs and other medical details.

LRMC officials support having bar-code scanning at the bedside. The delay in implementing it is due to their decision to go an extra step by implementing the electronic health record at the same time, said Dr. Jennifer Strickland, LRMC’s pharmacy director.

“It allows us to have additional patient safety measures,” she said, adding, “We chose to do it the right way.”

In addition to starting electronic documentation in the emergency department and operating room next year, doctors and nurses in those departments will enter all orders by computer. When the new system is implemented throughout the hospital, all hospital records would be electronic, said Mary Ford, LRMC’s vice president of information systems.

She said the whole system will be complete and the hospital paperless by 2012.

For Winter Haven Hospital, going fully paperless with a complete electronic health record also is a couple of years away, Edinger said. Bedside bar coding is part of a three year-plan to automate everything in the hospital.

Essential in Hospital Pharmacies

Nurses became increasingly familiar with bar codes since the Food and Drug Administration issued a rule in 2004 that set 2006 as a deadline for requiring bar codes be put on most medications dispensed in hospitals. The FDA said the new system was to help reduce medication errors.

If the hospital gets medications in large, bar-coded bottles, then dispenses them in individual-dose packets, each packet needs a bar code. At Lakeland Regional, that’s a lot of packages to be bar coded.

“We dispense more than 5 million doses a year,” Strickland said. “Thank goodness we have technology to support us.”

The Talyst system used in LRMC’s pharmacy has built-in provisions to reduce the risk of errors occurring in the pharmacy, such as the wrong medication being put in a packet. As bar code labels come out of a printer, pharmacy staffers scan each label. An electronic signal is sent to one of two large, rotating carousels that contain about 2,000 different medicines.

The carousels look like rows of bins against one wall. The signal directs the carousel to rotate until the proper row, containing the desired medicine, is in a position where the drug can be removed. Lighted messages direct pharmacy technicians to the right bin.

Pharmacy technicians and pharmacists know they can’t rely solely on the bar codes, Strickland said, adding “You still have to use your brain.”

Nurses also use bar code scanning when they remove medications from automated machines in about 80 MedSelect dispensing units throughout LRMC.

Winter Haven’s pharmacy dispenses about 1.5 million doses a year. WHH nurses get most medications, which are bar coded, through Pyxis automated dispensing machines on the various floors.

“The nurses have more confidence when they go into the machine,” said Dr. Keith Hamm, assistant pharmacy director. Having bar codes on patients’ arm bands will enhance the process, said Dr. Glenn Wysock, Winter Haven’s pharmacy director, who has been “a proponent of bedside bar codes for quite a few years.”

[ Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558. Read her blog at robinsrx.blogs.theledger.com. ]