Southwestern Vermont Medical Center Turns to 2-D Bar Codes at Bedside

Posted October 13, 2010

An early adopter of healthcare IT, Southwestern Vermont Medical Center (SVMC) began implementing bar coding for bedside medication verification in 2007 as part of its organization-wide initiative to enhance patient safety.

SVMC—which operates a 99-bed flagship facility along with rehabilitation, long-term care, hospice and home care, advanced cancer treatment, and primary care services—received funding support for this initiative through the Agency for Healthcare Research and Quality (AHRQ). Even though the incidence of errors was rare at SVMC, the project aims to decrease the potential for medication transcription and administration mistakes through the use of bar coding and e-MAR technologies.

According to Charles Still, senior systems analyst at SVMC, the key to a successful implementation lies in helping nurses and clinicians verify patient identification and medications with the greatest possible ease and reliability. “We reviewed both bar code symbologies and print technologies thoroughly in light of the needs of our patients, clinicians and the hospital mission,” says Still. “Each symbology has its own pros and cons.
The same is true for standard laser printers and thermal printers.We knew our decisions in each of these areas could affect ease of use and reliability of both patient identification and medication scanning at the bedside.”

For patient identification and medication labeling, SVMC opted for two-dimensional (2-D) bar codes over linear bar codes. Two-dimensional bar codes—in SVMC’s case, the Data Matrix format—provide more flexibility than linear codes. Still offers three primary reasons for the decision.

First, ease of use is crucial because a cumbersome scanning process can lead to workarounds that jeopardize patient care. Linear symbologies are larger, and therefore harder to scan on a curved wristband. Because smaller 2-D symbols are readable from any angle and can be repeated around the length of the wristband, there’s often no need to disturb a sleeping patient just to get a positive scan. “If a nurse is administering an IV drug late at night, he or she can scan any spot on the wristband, from any angle, and get a positive patient identification,” says Still.

Second, error rates for 2-D symbologies are 10 to 20 times lower than for linear codes. Perhaps more importantly, 2-D images can withstand more wrinkling and damage and still remain readable.

Finally, though some hospitals must invest in newer scanners with CCD sensors to read 2-D symbols, the cost for these scanners continues to decrease. “Fortunately,” says Still, “reliable 2-D barcode scanners are available for several hundred dollars.”

SVMC’s next priority was ensuring that the printed bar code labels would be durable and reliable enough to produce the consistently high scan rates necessary for ongoing patient identification and medication verification.

Previously, SVMC had been using laser printers to output adhesive-backed bar code labels, which they then attached to wristbands. These wristbands were inadequate for a hospital environment because they were easily damaged and fell apart quickly.

Still and his colleagues selected Zebra Technologies’ LP 2844 direct thermal printers to produce their patient identification wristbands. “Thermal printers are designed specifically for bar coding and produce lasting, durable bar codes that can be easily scanned at the point of care,” explains Still. “Also, when compared to laser printers, there is not a significant cost difference.”

In addition to the printers at admission, SVMC located five direct thermal printers on the nursing floors, so staff can now print replacement wristbands on demand. Unlike laser or ink jet printers, these machines do not use ink, toner or ribbons. They can also generate single labels on demand, avoiding the waste associated with laser printers, which typically must output at least a half sheet of media at one time. Because loading media is a simple process and the printers require minimal maintenance, they are ideal for networked use anywhere in the organization.

Still also notes the relative ease of printing 2-D codes. “Generating 2-D bar codes is not any more difficult than generating linear codes,” he says, “because the intelligence for creating the 2-D images resides in the printer, not the application software.” In its pharmacy and medical offices, SVMC is also using this embedded capability to print 2-D bar codes directly from its Meditech hospital information system using Zebra’s LP 2844 printers.

By February 2008, bedside medication verification was live in the ICU and in both the east and west wings of the medical center.

“The system is certainly preventing errors,” concludes Still. “Our clinicians now systematically verify the five rights—patient, drug, dose, route and time—before administering medication.” SVMC’s more advanced symbology and durable bar codes are making it easier for caregivers to do their jobs efficiently and effectively.

“In the first two weeks, we administered 10,000 medications with a 93 percent scan rate,” says Still, who was pleased to see that nurses were able to scan medications early in the implementation with minimal challenges. “That figure is a conservative estimate; factoring in patient transfers, the real rate is probably higher.”

Soon, SVMC will be exploring bar code-based systems for specimen collection and blood transfusion management. As SVMC’s experience demonstrates, choice of symbology and print technology can directly impact productivity, the risk of workarounds and medical error rates.With the right solutions, hospitals can generate bar codes easily and reliably, resulting in fewer errors and enhanced safety across the organization.

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