Challenge
Since 2000, Northeast Medical Center, a 457-bed acute-care hospital in Concord, North Carolina, has been concerned by the need to improve patient safety, a problem dramatically illustrated in reports issued by the Institute of Medicine, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and others, in which medical errors were cited as a central factor in the deaths of between 44,000 to 98,000 U.S. hospital patients annually. Northeast considers itself an early adopter of healthcare technologies, and quickly identified technology as a key element of its renewed commitment to address patient safety.

Larry Hinsdale, Northeast’s CEO, championed an initiative to address patient safety quickly. After considering several alternative solutions, including computerized physician order entry (CPOE) and electronic medical records (EMR), Northeast decided a bar code system would be the most cost effective, manageable patient safety solution, and would yield a collateral benefit to the hospital’s marketing efforts. Northeast began work on a bar code system directed at reducing errors in both phlebotomy specimen collection and in medication administration.

Specimen labels had been printed in batch by printers that were shared and that frequently malfunctioned or produced unreadable bar codes. Batch-printed labels were sometimes applied to the wrong sample. “Each unit had a single printer that was shared between all nurses—a situation that invariably led to errors in labeling,” said Vicki Cooke, Northeast’s expert on nursing information technology systems

Solution
The system went live less than eight months after planning began. The Northeast Medical Center IT department advocated a switch from batch to on-demand printing for specimen collection. Compact Zebra printers are now mounted on a cart along with a laptop. Nurses bring the cart to the patient and produce bar code identification labels when samples are drawn. The labels are applied to the specimen collection tubes, which are color-coded to correspond to the appropriate lab tests. To boost patient safety in medication administration, Northeast now individually packages and bar codes drugs in its pharmacy. Using a laptop mounted on a cart, the nurse scans a bar code on the patient’s identification wristband to pull up the list of drugs to be administered to that patient. The nurse then scans the bar code on the drug to verify that the correct drug is about to be given to the correct patient. The patient’s drug administration record is then electronically updated.

Results
The bar coding system was such an immediate success that all 26 nursing units were equipped with the bar code technology by March 2003.

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Challenge
In 1999, Methodist Medical Center in Peoria, Illinois, recorded an incidence rate of five adverse drug events (ADEs) per 10,000 doses of medications administered. At the same time, the Institute of Medicine released its report “To Err is Human,” which highlighted an alarming rate of patient deaths due to preventable medical errors, thus reinforcing the urgency to implement an automated system to reduce the risk of potential ADEs.

Solution
That same year, Methodist’s new chief executive officer, Michael Bryant, formed an executive IT steering committee to find solutions to the patient safety issue. “The bar coding strategy was selected because it provides the opportunity to close the loop of medication ordering and administration, and offers the added benefit of providing a second check for nurses,” said Tom Rippeto, Methodist’s chief information officer. The bar coding system also offered a more accurate, less subjective method of capturing and reporting medication errors.

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Challenge
A Midwestern distribution center knew that it was losing valuable time in its picking operations. To fill an order, the forklift driver would receive a printed pick list from the shipping office and then drive through the distribution center to pick up the listed pallets. Once he had completed the picking operation, he would return to the shipping office to pick up the required shipping labels based on the number of cartons on each pallet. There had to be an easier way.

Solution
The company now uses bar coding throughout this process to automate the development of the pick list, ensure picking accuracy and prepare items for shipping. Forklift-mounted Zebra® portable printers enable the forklift driver to print on-demand shipping labels— saving the trip back to the shipping office.

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Life in a Global Distribution Centre
Otis’s Gien-based manufacturing plant has been in existence since 1961. The site comprises several operations including cabin system manufacturing; door system manufacturing, for which the Gien site is the world’s leading production center; a research center employing 100 people; and a distribution center. The distribution center presented the greatest problems in terms of depot management. Due to the size and layout of the site and the complexity of procedures that had developed over time it was very difficult for staff to track and follow up incoming and outgoing consignments. Available storage was inadequately utilized, being determined largely by what space was available in the warehouse. On top of that a significant proportion of data entry was done manually. The reliance on paperwork distributed throughout the process increased the number of errors that arose. Paperwork was produced to assist in information sharing between forklift truck operators for storage, and administrators for data entry.

Product Identification
Even though there is a catalog of standard equipment, a lift is almost always manufactured to bespoke requirements. Components from two different orders cannot be switched, even if they are identical, so errors of labeling, handwriting, data entry, reading the order number or storage location could lead to packages being misplaced or overlooked which has a potential knock- on effect for quality and delivery times for the customer.

Until Spring 2000, operators at the end of the production lines at Otis identified packages manually, detailing information on the project number, the number of packages and the weight. The distribution center was organized around a production management and commercial management software package that did not allow for true tracking and tracing, or for storage optimization.

Otis began the search for a solution to give systematic identification, by product line or by supplier, of all packages passing through the depot. Otis called on IDEM, a specialist integrator in the field of automatic identification and data acquisition, to implement the new equipment. They used 3I for the warehouse management software package and Teklogix for the radio frequency component.

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The challenge:
Acquire information from existing barcodes
Print labels easily and on demand

The solution:
Combine the opportunities brought by Zebra’s QL 320 mobile printer and Falcon 320 mobile terminal
Add printing options to Falcon 320 software

The results:
Compliance with labeling regulations Savings on staff time Flexible and time efficient label printing

The challenge
AHOLD Czech Republic’s aim was to improve labeling of pre-packaged meat products in their stores. On receipt of these meat products they only had one label indicating weight. Ahold also used to add an extra price label using a weighing machine.

In order to consolidate information on both these labels, Ahold had to change the way of attaching price labels. The only solution was to scan weight information from the original label and print a new price label based on the original weight.

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Challenge
When the weather heats up, so does the work at Four Seasons, which manufacturers auto- motive air conditioning systems and components sold through thousands of auto parts stores across the United States. Employees at the 400,000-square foot production facility in Lewisville, Texas have to move fast to ship orders on time. But they no longer have to move far to get shipping labels, since Four Seasons began producing labels on demand wherever they’re needed with cart-mounted printers. Migrating from centralized printing has taken a lot of the legwork out of operations and given a boost to labor efficiency.

“When we used stationary bar code printers throughout our facility, workers had to walk to a central print station when they needed a shipping label. More often than not, this meant waiting in line behind two or three other users while their print jobs were being processed,” said Kevin Pentecost, network administrator at the Four Seasons Lewisville facility. “Sometimes they might be 60 feet away from the printer. With some workers needing 200 labels a day, you can just imagine the amount of time that was wasted just walking back and forth.”

Four Seasons wanted to find a process to cut the wasted time without requiring an undue amount of work or effort to change business processes, rewrite label printing applications, or make modifications to its homegrown warehouse management system (WMS) and JD Edwards enterprise resource planning applications (ERP) that resided on an IBM AS/400.

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Airlines know that one of the most proven ways to increase business is to improve service. On-time arrivals, helpful employees, and faster check-ins-especially during these security-conscious times-translate quickly to the bottom line through satisfied customers who become repeat travelers.

Challenge
At American Airlines, curbside check-in requires users to present their luggage and ID to a skycap at curbside, along with their ticket (both traditional and e-tickets are accepted). In return, they receive a boarding pass with their seat assignment and bag tag receipts. Because the ticket is surrendered and matched with luggage, the system is considered more secure than processing luggage and people separately. Boarding pass in hand, passengers are able to bypass busy ticket counters at the front of the terminal and check in stands at the gate, stopping only to present the boarding pass and identification to the gate agent for scanning before settling into their seats.

Achieving fast check in at curbside was made possible by a system design meticulously built around the needs of its users, the skycap These are hard workers who make their living and feed their families on the tips they make-one bag at a time. Any new process that cuts into a skycap’s ability to process passengers quickly dies on the curbside.

While the system may reinvent the passenger check-in process, it streamlined the job of the skycap, who doesn’t have to do anything differently. The clever system enables skycaps to check in passengers and generate a boarding pass using only one more keystroke than it takes to check-in baggage.

“We want our skycaps to focus on passengers.We don’t want them to have to deal with anything else,” says an American Airlines spokesperson.

After receiving a passenger’s ticket, skycaps call up the flight number and enter the first letter of the passenger’s surname on a touch-screen computer built into the curbside check-in kiosk. The data is transmitted over a wireless network from the kiosk to a host computer inside, which then transmits flight details and a partial passenger list to the kiosk. The skycap verifies that the passenger in front of him has a reservation and hits another key to create bar coded baggage tags and a bar coded boarding pass, generated by separate printers within the kiosk.

To enable fast transaction times, skycaps are not able to change seat assignments, check in international passengers, sell tickets, or make itinerary changes.

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Challenge
Beloit Memorial Hospital, a 175-bed community hospital in Beloit, Wisconsin decided to make patient safety a strategic priority after recent reports indicated that medical errors were increasing costs nationwide. The Institute of Medicine concluded that medical errors were a serious problem in the industry, and a study from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) found that each incident involving an adverse drug event (ADE) costs hospitals an average of $2,000. About 40 percent of errors in prescribing medication are caught by the pharmacist or nurse before reaching the patient, but the hospital had no such “second check” for bedside administration of medication.

Solution
Beloit Memorial wanted to see if introducing technology tools at the point of care would reduce the risk for error. One possibility for streamlining the process for prescribing medication was computerized physician order entry (CPOE). But Beloit conducted demonstrations of CPOE products, and determined the technology did not meet the hospital’s needs: it wasn’t easy to use, and in fact added complexity to the process.

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Challenge: Reduce adverse drug events
In the wake of the 1999 Institute of Medicine study, “To Err Is Human,” Aurora Health Care wanted to consider the local implications. So management at the not-for-profit integrated delivery network, which is based in Milwaukee and includes 12 acute care hospitals, extrapolated the findings. To their surprise, they learned that medical errors were taking as many as 3.5 lives on an average day in Wisconsin.

So Aurora took action. Leadership began exploring how to further Aurora’s use of integrated electronic medical records across facilities in eastern Wisconsin to promote quality and protect patients. A core component of that initiative was to use bar coding to prevent and detect medication errors.

“Bar coding is part of a larger patient safety effort, but it’s a multi-stage project on its own,” says Robert Raschke, manager of electronic health record systems and information services at Aurora. “With bar coding and, eventually, CPOE [computerized physician order entry] in mind, we envisioned a closed-loop, integrated point-of-care medication administration system.”

Solution: Part One – Labeling Pharmacy Medications
As the first phase toward realizing this vision, Aurora determined that the value of any bar coding effort would be directly proportional to the percentage of medications properly labeled. In fact, their goal is to label 100 percent of medications. This objective called for on-demand bar code printing in a wide variety of settings.While some smaller Aurora facilities might demand an average of 6,000 to 25,000 bar code labels per month, larger sites may need to print more than 50,000. Aurora needed printers that were appropriate to the volume demands of their varying sized hospitals. They also placed a priority on finding printers that would integrate smoothly with an existing pharmacy information system from Cerner.

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Barcelona City Police have adopted a new solution to speed up the bureaucratic processing of traffic fines. The benefits of implementing this new technology solution have been faster processing of traffic fines which can now be paid immediately via credit card. In addition data and information management has improved which has subsequently helped to reduce the amount of errors being made.

Barcelona City Council continues incorporating new technology to provide its local police force with more modern and efficient systems. In a recent project, the local police have started using a total of 330 PDAs and 150 Zebra RW 420 mobile printers.

The RW 420 mobile printer is connected to the PDA via Bluetooth® for printing fines and violations. The printer also contains a built in magnetic card and smart card reader which allows the user to log into the system using their identification card whilst also accepting credit card payments.

User friendly system
This new mobile technology solution allows more accurate data and information management by users, as the PDAs enable fast data entry and access to various tools and information. Users no longer have to carry bulky forms for fines and street maps. An added benefit is that the PDA software reduces the risk of errors in issuing fines as items such as street names are selected from drop-down menus, preventing the user from mis-typing or mis-spelling details

The new system also complies with new local legislation which came into effect in July 2006. It allows additional information to be added to the fine such as the loss of license or penalty points

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