Key Considerations for Bar Coded Infant Wristbands

Posted March 23, 2012

Make the Switch from Vinyl with Confidence

Medical centers worldwide are switching to bar coded wristbands to improve the safety and quality of care while meeting industry mandates. However, nurses in maternity wards are concerned that the switch from vinyl to new materials may not be suitable for infants. Tried and tested for decades, vinyl is non-abrasive, hypoallergenic, and does not damage the delicate skin of babies and premature infants. In fact, infants are the hardest patients to create wristbands for, and few adequate solutions exist that support this need.

Fortunately, bar coded wristband solutions now offer soft nylon material that is perfect for the delicate skin of a tiny infant. Even with the right material, the information provided on the wristband must afford easy readability, and deliver the right information in the right way. Due to the small size of an infant’s wrist, little room exists on the wristband to contain all the information required for effective bar coding.

The purpose of this white paper is to provide maternity ward staff the information they need to make the right decisions when it comes to bar coded infant wristbands. Durable, supple wristbands that deliver the full benefits of bar coding make it easier for nurses to perform infant care tasks, and help eliminate workarounds. The result is improved efficiency and quality of care. Medical staff is more productive, there are fewer chances for errors, and nurses can provide more focused attention to infants in their care.

Introduction—Infant Wristbands Fulfill Key Mandates

Bar code wristbands are not just for adults—infants need them too. Imagine a mother’s shock to find out that a maternity nurse gave her newborn to another mother for the infant’s first feeding. Although this may seem like a simple, non-threatening mix-up, the risks become acute when considering that many diseases like HIV and hepatitis can pass to a baby through breast milk. While reports of these incidents continue to grow, no one knows how often breast-feeding mix-ups occur. This is because few states require hospitals to report the incidents.

One well-reported case occurred at a Brooklyn hospital, where nurses confused two mothers that had the same first initial “S” and last name “Brown.” In this event, one of their children ended up with the wrong mother for his first feeding. At least eight other incidents received attention, including two at Washington area hospitals where nurse aides gave babies to the wrong mothers at checkout. These errors highlight the major challenge of accurate patient identification, which is a well-documented cause of health-care errors that goes beyond just the maternity ward.

In each of the incidents above, bar coded wristbands could have prevented each infant mix-up. Bar coded wristbands form the foundation for positive patient identification and help prevent serious medical errors, or infants leaving the maternity ward with the wrong mother. When The Joint Commission first introduced its National Patient Safety Goals (NPSG) in 2003, improving the accuracy of patient identification topped the list, a position it has held with each successive year. Of course, this mandate extends to all patients, regardless of age.

Medical centers are deploying patient IDs for older children and adults at an increasing rate. In most cases, providing the same information for infants tends to be an afterthought. While the industry struggles to find a solution, maternity nurses are worried about babies being injured by the new wristbands, and that they are too small to contain the required information. Now, as the American Recovery and Reinvestment Act (ARRA) spurs the widespread adoption of electronic health record (EHR) systems at hospitals nationwide, maternity wards need to move forward with the new mandates. To support this effort, bar code-based systems can improve the accuracy of patient records, minimize errors, and enhance the overall safety of maternity care. For infants, the new medical records created upon birth automatically link to their mothers, and carry forward as the child grows.

For babies, bar code-based wristbands allow maternity staff to identify patients and document the associated treatments. They also provide a more accurate way to ensure babies only come into contact with their mothers, and no one else.

Meet Requirements for Even the Tiniest of Patients

Bar coded wristbands for infants and their mothers provide a convenient way to comply with the National Patient Safety Goal (NPSG) to “Improve the accuracy of patient identification,” which The Joint Commission has included in its goals annually since 2003. Compliance with the patient ID goal requires that healthcare centers use at least two patient identifiers whenever taking blood samples and administering medications or blood products. A bar coded wristband can provide two forms of identification in one easy-to-access place by encoding the patient name and identification number. The Joint Commission recognized the value of this approach in an FAQ item on its Web site that explains the safety goal:

“The two identifiers may be in the same location, such as a wristband…. Acceptable identifiers may be the individual’s name, an assigned identification number, telephone number, or other person-specific identifier. Electronic identification technology coding, such as bar coding or RFID, that includes two or more person-specific identifiers (not room number) will comply with this requirement.”

Once wristbands contain bar codes to provide basic patient identification, medical IT staff can add numerous other identification, tracking, and data collection applications to take advantage of bar code data entry.

Considerations for Infant Wristbands—Soft, Sizable, and Safe

Nurses in maternity wards may be resistant to moving over to bar coded wristbands because they are concerned that soft materials are not available. Solutions exist today that easily and safely enable bar coding for mature babies down to the smallest of preemies. The considerations that follow show how to properly choose infant wristbands so the maternity ward can achieve its goals of meeting patient identification standards.

Soft—Will Not Injure an Infant’s Skin

A baby’s skin is as thin as paper, and premature infants are even more delicate. The wristband must be the softest material available so it will not injure a baby’s skin. Hypoallergenic bar code wristbands exist that use very thin, nonabrasive, soft nylon material that is much more supple than conventional thermal patient wristbands. Antimicrobial coating that protects the wristband is another consideration. Be sure to take into account the material’s flexibility—it must afford efficient, smudge-free printing.

Sizable—For the Tiniest of Wrists

Wristbanding infants is a sensitive issue. While hospitals go to great lengths to identify infants properly, staff members are also concerned with the flexibility and durability of the bands. The size of an infant’s wrist can range widely depending on her birth weight, and the age of prematurity. Given these variables, bar code designs must be adjustable to fit the smallest of patients

Scannable—Accessible and Easy to Read Data

Adult wristbands contain enough surface area to present all the data required to meet positive patient ID standards. Infant wristbands are simply too small to afford easy scanning of the linear bar code. If nurses find it difficult to scan, the maternity ward will not use it, and the whole transition to bar coding fails. The best solution contains a flat surface print area with enough room to contain both 2-D and linear bar codes. The flat tab allows easy, safe bar code scanning from all angles, without having to disturb the infant or move his arm.

Formatting—The Right Information Presented in the Right Way

Instead of using pre-numbered vinyl wristbands, maternity wards can use thermal bar code wristbands in soft nylon material to identify and associate the mother and father with the baby. When a nurse prints the baby’s patient ID wristband, she can also print parent wristbands with the baby’s financial identification number (FIN). The software that encodes data for healthcare wristbands typically supports standard defaults including the patient’s date of birth, age, and sex.

Infant wristbands should use linear bar codes as part of the basic design, which includes at least one, but preferably two, linear bar codes on the wristband to support glucometer readings. This is important because with two bar codes, the first meets the positive patient identification requirement mandated by the Joint Commission, while the second enables glucometer scans.

Beyond the actual bar code, the infant’s and/or mother’s last name and first name should be printed on the band with human-readable text so that clinicians can easily read it. Doing so fulfills the second part of the Joint Commission Mandate to identify the patient in two different ways—one is with the bar code, the second is with the human-readable name on the band.

Check Codes—Safety for Infants and Mothers

Another consideration is to include a check code so that when the baby matches up with the parent, the nurse can easily verify the match. Check codes should be consecutive, and attached to the patient records. Check codes link to the mother’s registration, and are included on both the mother and father’s wristbands. In addition to being visible to the nurse, the check code needs to be part of the bar code format so that the nurse’s bar code scanner will read it.

Efficiency—Use Thermal Print-on-Demand Printers

Bar coded wristbands are the foundation for positive patient identification and the prevention of serious medical errors. Thermal printers produce crisp, clear print quality on all wristbands, so bar codes scan quickly and reliably. Thermal printing’s performance and total cost of ownership advantages more than offset the perceived convenience of using an office laser printer for creating wristbands. Thermal is the dominant bar code printing technology used throughout industry for mission-critical operations.

Healthcare quality requirements and usage environments demand the excellent bar code symbol quality that thermal printers provide. Scanners decode the information from bar codes by measuring the differences between narrow and wide elements, and the contrast between dark bars and light spaces. If the ratios or contrast deviates slightly, the bar code may be difficult or impossible to read. A nurse’s time is too valuable to waste by repeatedly trying to read poor-quality bar codes, and rushed, manual data entry by a frustrated nurse carries too high of a risk for errors. Printing the bar codes in vertical, or ladder, orientation, enables faster, easier scanning than when the printer lays out symbols in a horizontal, or picket fence, orientation.

Thermal printers can produce patient wristbands on demand, one at a time. Laser printers, by contrast, often need to print an entire sheet, which typically includes one wristband and many labels—creating waste and unnecessary expense. Laser printers can be prone to jamming when used to print wristbands because of adhesive buildup, which is not a problem for thermal printers, which are specifically designed to print wristbands and labels, not documents. The differences in printing and media give thermal printers a total cost of ownership advantage over lasers for bar coding in healthcare.


Your medical center is moving to 100 percent bar coding for patient identification—but you are worried that the maternity ward cannot achieve these goals. Making the switch to thermal bar coded wristbands for infants is not as difficult as you think. With over 200 million wristbands sold globally, Zebra has already laid the groundwork for your success. Zebra delivers wristband solutions so you can easily make the switch from vinyl to bar-coded wristbands. Gain the peace of mind that the wristband will not scratch or damage an infant’s delicate skin, is adjustable, is the right format, and is easily scannable. Now, medical centers can realize improved efficiency, better safety, and higher quality at the point of care—for even the tiniest of patients.

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