One of the paramount concerns of a hospitalized
patient is receiving the wrong medication. Yet
few patients know that they are 100 times more likely
to receive the wrong blood than they are to be exposed
to HIV and hepatitis through a blood transfusion and
that most laboratory specimen errors occur right at
the patient’s bedside.
All clinical processes are subject to human error,
and, where possible, bar coding is being employed to
provide critical double checks for patient safety. This
chapter describes several important clinical bar code
applications.
Medication administration verification
When bar coding technology is used, the nurse
scans his or her name badge and enters a secure password
into a bedside computer (laptop, desktop, or
handheld device). The nurse then scans the patient’s
wristband, which enables the patient’s medication
record, as ordered by the physician and transcribed
by the pharmacist, to appear on the computer screen.
The nurse then scans the bar-coded medication before
giving it to the patient. This medication administration
is recorded electronically, which makes it easily accessible
to physicians and other clinicians.
If the nurse has unintentionally violated one of the
“five rights” of medication delivery, a warning appears
on the computer screen before the patient receives the
medication. Some bar code medication systems provide
clinical alerts, such as reminding the nurse to take the
patient’s pulse before giving a medication or caution
the nurse that a particular drug is easily confused with
a similar-sounding or similar-looking medication. Bar
coding used in medication administration has reduced
medication errors between 71 percent and 86 percent.
Blood transfusion verification
When bar coding technology is used at the bedside,
the nurse again enters the system by scanning his or
her name badge and entering a secure password. The
nurse then scans the patient’s wristband, and through
a series of electronically displayed prompts, scans the
blood product, the blood product type, the patient’s
blood type, the blood unit number, and expiration
date. If all prompts are accurately executed, the nurse
is directed to start the blood transfusion. On the other
hand, if any of the prompts are inaccurately executed
(e.g., the patient’s wristband identification number
does not match the patient identification number on
the blood product bag), an alert is generated. Bedside
bar coding systems used in transfusion have resulted in
100 percent accurate patient identification and are
recommended by industry experts.
Laboratory specimens identification
Some laboratories print labels that identify the patient
and expected test in advance. As the phlebotomist
arrives on a clinical unit and proceeds from patient
to patient, the labels are attached after the sample is
placed in the test tube. It is at this point that most
blood specimen errors occur, as patients are transferred
to other units or discharged, test requests are
modified, and/or specimens are required on an urgent
basis. Using bar coding at the bedside to properly
identify the patient and test results in accurate specimen
labeling can prevent additional testing and
patient discomfort.
Respiratory therapy treatment at the bedside
When bar coding is used, the respiratory therapist scans his
or her name badge and enters a secure password into
a bedside computer (laptop, desktop, or handheld
device). The therapist then scans the patient’s wristband,
which allows the patient’s medication record,
as ordered by the physician and transcribed by the
pharmacist, to appear on the computer screen (e.g.,
Proventil 2.5 mg in 2.5 mL of normal saline every
3 to 4 hours via nebulizer).While nurses may be given
access to all of the patient’s medications, the system
can limit the respiratory therapist’s view to only the
medications and treatments that he or she will be
administering.
The therapist conducts a critical double check by
comparing the order presented on the point-of-care
system with the physician’s original order in the chart.
As the therapist confirms the order, an electronic signature
documents that the verification process was
completed. Next, the therapist scans the Proventil
inhalation solution. The software performs a series of
checks to make sure that the medication is scanned for
the “five rights.” The therapist then completes a final
review of the medication and dose about to be administered.
This step conforms to current standards for
reviewing documentation before an electronic signature
is applied.When the medication has been
administered to the patient, the therapist confirms in
the system that the dose of Proventil was given. As the
medication administration is confirmed, the electronic
medication administration record is updated. In addition,
all charge events can be sent to the billing system
to ensure timely and accurate patient billing and to the
cost accounting system to ensure that the cost of care is
accurately and efficiently captured.
Dietary management
When interfaced with a dietary management system,
a BPOC application using bar coding scanning
can automatically ensure that the right meals get to the
right patient in the right portions. At mealtime, the
caregiver identifies the patient by scanning his or her
bar-coded wristband. This pulls up a patient profile
that includes the latest diet order. A bar-coded meal
ticket on the tray is scanned and cross-checked with
the patient’s diet order. If the ticket and order match,
the tray can safely be delivered.
Gamete tracking in the fertilization process
Throughout
the process, the bar code scanning system is used
to verify the correct union of appropriate components.
The technology stops scientists from fertilizing eggs or
transferring embryos to the patient unless the identification
bar code matches. Likewise, the grown embryos
will be transferred to the patient only after the system
has successfully matched the embryos’ ID with the
parents’ ID.
