St. Clair Hospital’s barcode journey began in 1992, when the Pittsburgh-based community hospital served as a development site for a pharmacy robot. The robot used barcodes to identify medications it picked off a supply rack. By scanning the barcode, the robot knew which medication it had chosen before putting it into the hospital’s distribution chain. The high-tech system, later acquired by San Francisco-based McKesson Corp., is still used today.
But for years, the automation stopped there. A decade passed before St. Clair incorporated barcoding at the bedside—the critical administration point where medical errors often occur. Not only were readers unreliable, but the hospital also lacked adequate software to interpret the data elements needed to ensure proper administration. But bedside barcoding has finally paid off, as the hospital staff now can electronically verify the “five rights” of medication administration: drug, dose, time, route and patient.Better together
Spurred by a substantial drop in medical errors, St. Clair is expanding its wireless technology. To identify patients and caregivers, it is now implementing radio frequency identification technology, which supplements the barcode system used to identify medications. The two technologies—which are merged into one handheld device used by nurses—work well together, St. Clair’s executives say. More important, the hybrid approach serves patients better because nurses can identify patients without disturbing them. Rather than passing a barcode scanner over the patient’s wristband, nurses activate an RFID reader in the scanner, passing it near—but without touching—the patient’s wrist. The wrist band emits a signal when activated by the handheld scanning device. That signal wirelessly transmits information to the nurse’s device, which connects to the hospital’s medication administration software. The software matches the patient with the current drug orders, assuring the nurse that the correct pieces are in place before medications are dispensed.
St. Clair demonstrates how error-free medication administration involves synchronizing many moving parts and harmonizing related applications. When St. Clair first wanted to expand the use of barcodes beyond its robot, it had difficulty finding an appropriate vendor partner to tackle medication verification, recalls Tom Ague, chief operating officer at the 331-staffed-bed hospital. “The bids were astronomical,” he recalls.
So in early 2003, Chief Information Officer Rich Schaeffer turned to Sculptor Developmental Technologies. Sculptor, an offshoot of the hospital’s information systems department, had become a St. Clair subsidiary in 1993. It took Sculptor nearly two years to develop “Veriscan,” the software that adjudicates information from the hospital’s pharmacy and medication orders systems and matches it with the patient’s ID. Prior to implementing barcoded medication administration, many errors simply went unnoticed, says Ague. “We see the handheld device as the hub of many initiatives for patient safety.”Prevention is key
Despite the potential for error reduction, some nurses at St. Clair’s resisted using the handheld devices, says Lori McAninch, R.N., a project manager in St. Clair’s information systems department. The devices are outfitted with barcode/RFID readers from Newark, Calif.-based Socket Communications Inc.—tools that nurses were unaccustomed to using. “The average age of our nurses is the mid-40s, and they have their routines,” she says. “But the younger staff were willing to run with it.”
Ironically, it was a near miss on a medication error by a younger nurse that made the entire staff take notice of the new technology, McAninch says. Walking out of a patient room in the med-surg unit where the readers were first deployed, the shaken nurse made a startling confession to her colleagues. “She was about to give the medication at the wrong time, but the system stopped her,” McAninch recalls. “She said, ‘I can’t believe it. I almost made an error.’”
After the Veriscan system’s implementation in March 2004, St. Clair prevented about 5,300 medication errors annually, based on an extrapolation of data obtained the following September, Ague says. The number of errors caught by the system has fluctuated in subsequent studies, but the data captured by the electronic system is far more reliable, Ague says. Prior to the installation, the hospital reported some 600 such errors annually, through a self-reporting system. “Many errors were missed, or just unknown,” Ague says. That caregivers were missing so many errors, Ague concedes, “was inconceivable to us.”The road ahead
St. Clair is exploring using RFID as an asset-tracking tool. The hospital maintains a limited inventory of some equipment, such as wheelchairs designed for obese patients. An RFID-based tracking system could enable staff to quickly locate the wheelchairs, he says. But the RFID tags cost about $1 each, which prohibits using them to identify the 1.3 million doses of medication that the hospital dispenses annually, Ague says.
Nevertheless, the hospital is testing the use of RFID tags on intravenous solutions. Because the solutions pouches do not offer a flat, rigid surface, scanning barcode labels affixed to them is difficult, Schaeffer explains. “It is tough to aim a barcode scanner at a bag hanging in the air,” he says. “To make the barcode scanner work, you have got to have a good line of sight.”
An Ultra-Hip Tracking System
When it comes to patient and asset tracking, radio frequency identification technology usually leads the debate. But researchers at Boston’s Brigham and Women’s Hospital are testing an alternative.
In a pilot set to finish this fall, the hospital is trying out an ultrasound indoor-positioning system in its emergency department. Rather than sending a signal across a radio frequency, the system donated by Oslo, Norway-based Sonitor Technologies uses ultrasound waves to sense where patients are. “We were concerned about using radio frequency, which can interfere with the monitors we use,” says Tom Stair, M.D., research director.
In the pilot, patients will wear waist packs that include a small chip. If the patient moves, the chip activates, sending out an ultrasound signal to one of 10 ceiling detectors positioned around the waiting area. That information is fed to a central computer, which translates the patient’s location to a graphic display of the waiting area. In addition, the waist pack is collecting the patient’s EKG and pulse data, which are routed via electrodes into a PDA. That information is dispatched wirelessly, as well, to the central monitoring station, Stair explains.
The wireless tracking system is funded by a $3 million grant from the National Library of Medicine, which is exploring how information technology could be used in disaster settings. “In the emergency department, we have mini-disasters every day,” Stair says. “It is easy to lose track of patients.” Gary Baldwin is technology editor of
HealthLeaders. He can be reached at firstname.lastname@example.org.