Healthcare Today and Tomorrow: Patient Safety and Bar Coding

Healthcare Today and Tomorrow: Patient Safety and Bar Coding August 2010

Presenters Melissa A. Fiutak Senior Product Manager, 2D Handheld Scanners Honeywell Scanning & Mobility Regan Baron, RN, BSN Chief Nursing Officer, RxAware Cerner Corporation

Agenda To Err is Human... Ten Years Later Overview: Patient Safety and Bar Coding Case Studies Implementation Considerations Where to Go for More Information

To Err is Human: Building a Safer Health System Report issued by Institute of Medicine (IOM), released November 1999 Findings 44,000 to 98,000 deaths the result of preventable medical errors Majority of medical errors are the result of basic flaws in the way the health system is organized IOM challenged the medical community to cut the death toll in half within a 5-year period

Ten Years Later...

Ten Years Later... Average Annual Unintentional Injury Deaths Per Year Medical Error Motor Vehicle Accidents Poisoning Falls 0 20,000 40,000 60,000 80,000 100,000 120,000 HIMSS Analytics: EMR Adoption Model Trends TM Closed-loop medication administration 2008 2009 2.5% 3.8% unsummit estimates Closed-loop medication administration 2010 25-30% Death rate from preventable medical errors is still unnecessarily high Slow adoption of emar / barcode scanners Sources: http://www.cdc.gov/nchs/fastats/acc-inj.htm http://www.chron.com/disp/story.mpl/deadbymistake/6555095.html

Why is Bar Coding Important? Causes Look-alike drugs, sound-alike drugs, complex and manual processes Bar Code Scanning Solutions Medication Administration IV Smart Pump Integration Lab & Anatomic Path Specimen Collections Blood Transfusion Administration Breast Milk Matching Mother/Baby Matching Supply/Charge Services Integration Glucometer/EMR integration Vital Signs Integration Other Device Integration Projects Frequency 1 7,000 preventable deaths each year 1 out of every 5 doses given in error 7% of all errors are potentially harmful Medication mishaps are the most common medical error 40 Adverse Drug Events (ADEs) per day in a typical 300 patient facility Expense $3,000 average cost of an Adverse Drug Event (ADE) 2 Up to $5.6 million per hospital 3 Meaningful Use Yet to be fully defined Currently in 2013 requirements Sources: 1Barker, Flynn, Pepper, Bates, Mikeal 2002 2Institute of Medicine (IOM) 1999 3Agency for Health Care Research and Quality 2001 (AHRQ) 4 Federal Register, March 2004

Bar Coding and Error Prevention: Studies & Statistics New England Journal of Medicine, May 6, 2010 Findings Bar code scanning helps prevent 90,000 serious errors each year for Brigham & Women s 41% decrease in administration errors 51% decrease in potential adverse drug events 27% decrease in errors related to wrong time Pediatrics, May 3, 2010 Findings Computerized Physician Order Entry (CPOE) decreased the mortality rate by 20% This adds evidence to the mounting pile that the last piece guaranteeing or verifying medication safety is bar coding. Dr. Christopher Longhurst, CMIO, Lucile Packard Children s Hospital Sources: http://content.nejm.org/cgi/content/short/362/18/1698 http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-3271v1

Client Examples: Does Bar Coding Work? Hospital A Application Evaluation Period Results Part of a Large Midwest IDN Medication Verification at the Point-of-Care 4 month period post go-live (December March) 3 voluntary med error reports citing the incorrect patient Bar code reporting showed 176 incidents of wrong patient scanned in this timeframe Hospital B Application 300 Bed Community Hospital, Midwest Medication Verification at the Point-of-Care Go-Live 1998 Results 50,000 medication errors prevented since go-live (wrong time errors excluded) Have prevented 7-10 fatal medication errors annually since go-live Estimate savings of over $750,000 annually due to bar coding

The Situation Customer Industry Application Memorial Hermann Healthcare Medication Verification at the Point-of-Care The Challenge Top goal was to ensure quality and safety for all patients by eliminating medication errors

The Solution Honeywell Product Host Software 4600h, 4820h, 9900hc Cerner s Millenium POC Implemented a bar coding enabled point-of-care closed loop process with checks and balances from beginning to end to make sure the 5 Rights of patient safety are addressed In FY10, MEDSAFE fired 21,103 patient mismatch warnings Prior to MEDSAFE, many of these potential misadventures were probably caught prior to any meds having been administered A more telling quality MEDSAFE catch might be the 4,094 incompatible dosage form alerts (this equals 11 dosage mismatch warnings each day) These alerts fire when the medication scanned is not appropriate for the route ordered by the physician Without MEDSAFE, these medications might not each precipitate patient harm, however, there are literature examples and historical examples that result

Bar Code Technology - Key To Patient Safety Electronic Records automate the exchange of patient information; Bar code scanners automate the population of Electronic Records RIGHT Patient Bar coded wrist band Scanned to identify & record the patient RIGHT Medication Bar coded pharmaceuticals Scanned to identify & record the medication RIGHT Dosage Scanned to identify & record the dosage RIGHT Route Scanned to identify & record that the medication is being administered in the proper form (e.g. pill, liquid, IV) RIGHT Time Real-time clock in the PC automates the interval check. This can result in a decrease in Medical Errors

Project Considerations Wireless Network Bar-code Readiness-Medications/Repackaging Options Bar-code Readiness-Patient Wristband Clinician ID? Device Selection Smart Pumps and other bedside devices Medication Availability/Impact to Current Nursing & Pharmacy Workflows Project Resources Training

Workflow: Workstation on Wheels (WOW) Mobile workstation assigned to caregiver designed to be rolled into each patient room during rounds Tied into EMR system At a minimum, solution consists of computer, monitor, bar code scanner (corded or cordless) Pros Portable solution allows setup in patient room Perform all Point-of-Care functions from one device Large screen and full keyboard for data entry Cons (Can be) large, bulky, making it difficult to maneuver in small patient rooms Typically requires a battery which needs to be charged Carts are expensive and require preventive mechanical and electrical maintenance

Workflow: Fixed In-Room Workstation One workstation, tied into EMR system, in every patient room; at a minimum, solution consists of Computer Monitor Bar code scanner (corded or cordless) Pros Caregiver does not have to leave the room to care for a patient Cons Small footprint Expensive Patient privacy limits IT access Medications are not within reach Risk of visitors tinkering with the system

Workflow: Portable Data Terminal (PDT) Portable handheld computer with integrated bar code scanner assigned to caregiver, tied into EMR system Pros Compact, lightweight, easily transportable If correctly deployed, can be a costeffective solution for Medication administration Specimen collection Vitals collection Cons Caregivers may complain about having an additional tool to carry with them Small screen makes some applications difficult to see Some applications can only perform a subset of functionality Consumables / medications aren t within easy reach

Implementation Considerations: Bar Code Scanners In General: Choose a solution that can read everything Linear (1D) codes Stacked Linear codes 2D codes Make sure the scanner can be disinfected Avoid scanners that contain lasers With Cordless: Look for solutions that Have built-in, user-configurable wireless interference protection Provide the most secure wireless data transmission of data (FIPS 140-2) Let you access the battery without a tool Contain batteries without memory effect Offer flexible communication methods Let you locate lost scanners with the push of a button Give you an option to scan hands-free Are durable

For More Information Honeywell Healthcare Microsite http://www.honeywellaidc.com/promos/healthcare_aidc/ Healthcare Solutions Brochure http://www.honeywellaidc.com/site.aspx/na/en/resources/publications/other_publications/?subcategory=16 White Papers http://www.honeywellaidc.com/site.aspx/na/en/resources/publications/white_papers/?subcategory=17 Redefining the Patient Wristband Tracking: The Critical Link in Patient Safety Disinfectant-Ready Housing datasheet Bluetooth Wireless Technology Case Studies http://www.honeywellaidc.com/site.aspx/na/en/resources/publications/case_studies/?subcategory=22 Honeywell has deployed 150,000+ scanners into healthcare

Honeywell Scanning & Mobility 800.582.4263 (Option 1) www.honeywellaidc.com Questions? Xenon 1900 Corded 2D Handheld Scanner Xenon 1902 Cordless 2D Handheld Scanner Dolphin 9700 Portable Data Terminal Dolphin 9900 Portable Data Terminal Cerner Corporation http://www.cerner.com/ 1-866-221-8877

Ask the Expert Webinar Series Stay tuned for more details about the next webinar in our Ask the Expert series: Patient Check-In Learn more about how technology can reduce data entry errors and speed up the patient check-in process Scheduled for Tuesday, August 24th @ 1:00pm EDT For a complete listing of all upcoming Ask the Expert webinars: http://www.honeywellaidc.com/promos/0710_ask_the_expert_landing/0710_ ask_expert_landing.html

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