September 16, 2005
New wristbands pave way for patient safety initiative
The new (top) and old wristbands. Bar codes on the new wristbands appear on the side not shown above.
Beginning this month on Dana 11, patients will receive new wristbands when they check in, paving the way for a broader patient safety initiative. Unlike the old wristbands with embossed text, the new wristbands have computer-generated text that is easier to read. They also contain bar codes that will eventually link to a patient's medications, electronic medical record, and blood products, enhancing coordination of care and decreasing the chance of a medication error.
Following a pilot period, the bracelets will be rolled out in other patient-care areas. Patients will still need their blue cards at check-in and will receive a new wristband during each day of treatment.
Updated wristbands are only the beginning of changes designed to make it easier and safer to identify patients and administer medications. While the new bar codes will not be scanned during this phase of the project, in a future phase nurses will use handheld scanners linked to portable computers, and scan both the wristband and medicine containers prior to drug administration, ensuring a positive match between the two. "If we bar code both the patient's band and the drugs, we can make sure the right drugs are getting to the right patients," says Saul Weingart, MD, PhD, vice president for patient safety and executive sponsor of the initiative.
The scanners will beep if a mismatch has occurred, and the handheld computers will also alert nurses about unsafe drug doses or combinations. As the project moves forward, the computers will also use information from a patient's electronic medical record to notify nurses if a patient is overdue for a medication, or has a drug allergy. "The bar coding initiative will demonstrate the organization's commitment to safe care through the use of the best available technology," says Weingart.
Bar-coding encouraged by safety experts
The Institute of Medicine's Nov. 1999 report To Err Is Human cited bar codes as a valuable technology for improving patient safety, and hospitals that use them have seen medication errors fall dramatically. One Veterans Affairs hospital documented a 24 percent decrease in medication-administration errors after implementing bar codes, and a recent New England Journal of Medicine article reported that bar coding prevents approximately 20 adverse drug events per day in pilot units at Brigham and Women's Hospital.
However, despite the benefits, only five percent of U.S. hospitals currently use bar coding. "There is a lot of national interest in bar coding, but this technology is relatively new to healthcare," says Weingart. "This is a cutting edge, medication practice."
Dana-Farber's medication error rate is already low, reflecting an 11-year campaign to become a national leader in patient safety. For every 10,000 medications dispensed at Dana-Farber, only one to two errors will reach a patient. "We have a very safe system, and we can demonstrate that, but are still many opportunities to improve," notes Weingart.
According to Sarah Cohen, project specialist for clinical applications, oncology care may be particularly well-suited for the new technology. "Here at Dana-Farber, we are pioneering the way with an effort focused on outpatient care. In other places, medication administration systems are geared for inpatients."
Changes in the Dana-Farber pharmacy, such as separating drugs that look alike or have similar names, have already reduced dispensing errors, and computerized medication orders have reduced mistakes caused by hard-to-read physician handwriting. But fewer systems are in place to prevent administration errors; a clinician can still reach for the wrong medication
"Medication use has four steps. First, a physician prescribes a medication. Second, a pharmacist dispenses it. Third, a nurse administers it. And finally, a clinician monitors the patient and follows up on its effects," says Weingart. "Clinicians at later stages in the process can prevent mistakes that happen in earlier stages. When errors occur at administration, there are few safeguards. That's where the bar codes come in."
Pharmacist Barbara Jones Finley says that the process for making sure medications are correct in dosage, dispensing, and administration is largely visual, and this will not change. "I still read the doctor's orders, make sure the dose is in the normal range, take the medication from the shelf, create a label, and give it to a nurse to administer," she says. "The bar code will make sure the right patient is getting the correct drug, but will not change the process that takes place beforehand. It's an extra check."
In addition to reducing errors, the bar codes will provide valuable data about the medication administration process and ways to further improve patient safety. "We need to track what happens each time the machine says 'beep,'" notes Weingart. By building a database of "near misses," clinicians and hospital administrators will be able to better understand the chain of events that leads to an error, and make appropriate changes.
