WLAN, Bar Code-Based Asset Tracking Improve Patient Safety

The Institute of Medicine estimates that preventable medical errors kill up to 100,000 patients a year and cause up to $29 billion in costs, mostly in lost labor and expensive hospital stays. The word “preventable” is key here — many of the errors are mistakes, such as dispensing medicine incorrectly. Luckily, technology solutions such as bar code and RFID (radio frequency identification) tracking can help prevent these mistakes. One hospital realized this benefit by implementing a bar code-based asset tracking solution.

St. Luke’s Hospital in St. Louis has 493 beds, 3,000 employees, and more than 1,100 physicians. It is one of 77 Benchmark Hospitals in the nation, and for 6 of the past 10 years was named a “Top 100 Hospital” by Solucient, a healthcare information product provider. St. Luke’s attributes this recognition largely to technology innovation. Not immune to preventable medical errors, St. Luke’s decided to implement an electronic medication administration and reporting system, which is known in the healthcare industry as an eMAR system. The bar code-based system has enabled St. Luke’s to significantly reduce medication administration errors.

At the start of the project, before any planning had begun, St. Luke’s realized it needed input from several departments and created a dedicated team with representatives from IT, nursing, and pharmacy. The team reported its recommendations to the hospital steering committee. The team determined that instead of computer carts, the best solution included laptops in all the patient rooms and wireless bar code readers for all of the caregivers. “The software component of the solution needed to seamlessly integrate with our existing medical software applications, and we decided we would only implement eMAR in inpatient areas,” says Glen Schodroski, information services site manager.

With these stipulations in mind, the team chose the solution components: Bridge Medication Administration, a software solution from Cerner; Code Reader 2.0, a bar code reader with Bluetooth connectivity supported by Brady Corp.; Dell laptop PCs; and a Cisco 802.11b WLAN (wireless LAN). To implement the system, St. Luke’s installed the wireless network and integrated the Bridge Medication Administration system with its clinical applications, then prepared to add the bar code scanning element. “That’s when we faced our biggest challenge,” says Schodroski. “Not all medications at the hospital pharmacy had bar codes.” In fact, 80% of the inventory was without bar codes, so the hospital purchased a repackager for its drug containers that placed bar code labels on all dispensed and dosed medication.

ASSET TRACKING REQUIRES USER TRAINING
Because the solution was so dependent on a PC, St. Luke’s wanted to make sure all users were able to properly operate the PC, so the hospital’s education department provided training to improve computer literacy before the eMAR system was implemented. Also, caregivers were required to attend a four-hour training class on the Bridge Medication Administration system and were invited to take the class as often as needed until they felt comfortable with the system. As with most new technology devices, user-adoption issues regarding the bar code readers arose fairly quickly in the rollout as well. Some caregivers had trouble using the bar code readers properly and weren’t getting good reads of the bar code labels, so the hospital identified “super users” who used the bar code readers well. The super users provided one-on-one training as needed and helped develop training materials for other users.

With the eMAR solution, a caregiver enters a patient room and establishes the Bluetooth connection between the bar code reader and the laptop. Caregivers log in to the system by scanning their ID badges and entering in their PINs. Then, they scan the patient’s bar-coded wristband and the medication to be dispensed. The software on the PC displays the patient information specific to the medication and reviews the information according to the “five rights”: right patient, right medication, right dose, right time, right method. Based on the review of the “five rights,” the caregiver decides if the medication is appropriate and administers it if needed. “The fact that the caregiver still retains decision-making responsibilities was important to us,” says Schodroski. All actions taken by caregivers are stored in real time in the patient’s medication administration record. The eMAR system has helped St. Luke’s reduce its medication administration errors and overall costs of care, as well as increase patient safety and accurate reporting.