Eliminating Costly Medical Errors With Bar Code Scanning

By Cindy Dubin, contributing editor

Children’s Medical Center in Dallas continues to upgrade its handheld scanners used during medication administration.

Ensuring the right medication is being given to the right patient at the right time should be the goal of any hospital. For Children’s Medical Center in Dallas (CMC-Dallas), it has become a core component of the electronic health record. CMC-Dallas has 559 beds spread over two campuses, both of which are using mobile medication administration.

AN EARLY ADOPTER OF BAR CODE MEDICATION SCANNING
Children’s Medical Center was at the forefront of bar code medication administration when it started to evaluate the technology back in 2001 — before the day of the EMR. “We wanted to lower the incidence of giving the wrong medication to the wrong child,” says Debbie Schumann, RN-BC, BSN, MBA, director of clinical informatics at CMC-Dallas. At the time, the technology was so new there was only one scanning device to choose from that met the needs of being portable and wireless. In addition, the first scanners had black and white screens — this was before the day of color screens — which were difficult to see.

And while scanning did lower medication errors from an estimated 120 errors per million doses to less than 40 errors per million doses, the documentation of current medication administrations was located in a standalone system, and that documentation could only be seen by logging into a handheld scanner. (Printouts of the medication administration record were distributed to units nightly for placement in patient charts.) The entire process of giving medications was cumbersome; sometimes labels did not scan, it was difficult to discern the last med administered, and there was a long learning curve relating to upgrading the wireless infrastructure to support the 300 scanners deployed across the hospital.

TYING BARCODING AND EMR TOGETHER
By 2005, CMC was ready for a new scanner and made the move to a new vendor’s unit with a color screen. Also by this point, CMC-Dallas was using an EMR, so the new wireless scanners were integrated with the new system. Now, all clinicians could see the medication administration record (MAR) to know when meds were given and when they were due.

In 2009, Schumann says the hospital did a full-scale conversion from the old EMR and replaced it with the current EHR. Upgraded bar code scanners came with that conversion. “While the staff was involved in the selection of the scanners, there really are not many vendors specific to the healthcare arena,” says Schumann. The same vendor was selected once again. This time it deployed 500 new units, which offered up to 12 hours of battery use. These new devices also were slightly lighter in weight (11 ounces vs. 17 ounces) than the previous scanners. Using the new system, a clinician enters a medication order into the patient’s electronic health record, including dosage, how often to give the medication, and by which route. The physician electronically signs the order, which immediately appears on the MAR in the computer as well as on the handheld computer that the nurse uses.

Before the nurse gives the patient any medication, the caregiver verifies the medication is correct. Upon verification by the pharmacy, a “patient match” message appears on the handheld’s screen confirming the verification and, in essence, giving the nurse the okay to proceed with administering. The nurse retrieves the medication from the medication room, enters the patient’s room, and scans both the medication and the patient’s armband to again confirm that the right patient is getting the right medication at the right time. The nurse then gives the medication and clicks the “accept” button on the handheld screen to complete the documentation process.

A FOURTH UPGRADE UNDERWAY
But technology only lasts so long, so this year another upgrade is in the works. According to Schumann, three applications are being used on the scanner that don’t communicate with each other. An upgrade would address the need to have all three apps integrated.

One of the apps supports the scanning for medication administration. The second app uses positive patient identification to ensure infants receive breast milk that has been pumped by their mothers. The milk is generally stored prior to feeding, so this is how the hospital ensures the right baby gets the right milk. The third app scans to positively identify a patient for specimen collection. “When the nurses draw blood, they scan the bar code label on the blood vial and on the patient’s armband to confirm that the right specimen is attached to the right patient,” Schumann explains.

Two different vendors supply the three apps. The nursing staff is required to log into each app separately. “That means if a nurse is drawing blood and giving medication at the same time, he or she needs to log into each app separately to confirm the match of the patient to the medication or the specimen,” says Schumann. “It also requires the scanner to switch from one app to the other pretty quickly, which doesn’t happen consistently. So, part of our evaluation of devices going forward will be to make sure the scanner can switch based on which app is running on the screen. We think the next-generation scanner will allow the nurses to switch back and forth between apps pretty easily.”

Other decision criteria will be based on the size of the units, as CMC wants units that will fit into a pocket and weigh no more than a few ounces. The other desire is that the devices be multifunctional, for example, including wireless phone technology in addition to scanning. Currently, clinical staff carry wireless phones that get calls from patients, providers, and supervisors and receive monitor alarms. The handhelds are distributed based on the unit; the intensive care units and emergency departments have one handheld per room, and the general care units have about five more than the maximum number of nurses scheduled at any given time. “The more we can combine functionalities to one device, the more efficient nurses can become,” says Schumann. “The goal is to choose a new scanner in the third quarter that meets our clinical needs, and then we will upgrade all 500 scanners.”

MEASURING SCANS AND COSTS
Since moving to mobile medication administration, Schumann has confidence in the hospital’s scanning program. Approximately 96% to 98% of all medications given to patients are scanned.

“The safest way to administer medication to a patient is with bar code scanning,” says Schumann. And while some departments were initially skeptical of using the technology, they quickly accepted its use once they were shown how lives could be saved. “Now, the nurses can’t imagine giving medication without scanning.”

Some friendly competition among the nurses has even emerged to see how many scans they perform during their shifts. Nursing managers hold the staff accountable for their scans and make the scans part of their performance goals and review, ranking them on how well they scan.

“If you consider that one medical error results in significant cost to the organization, you realize that every error avoided actually pays for the bar code scanning solution,” says Schumann. “And a hospital stay could result if a medical error is severe, which can result in thousands of dollars in expenses. But if the error results in death, the cost is immeasurable.”