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Stanford Report, January 15, 2003

Handy new solution seeks to improve patient care


Lucile Packard Children’s Hospital is gearing up to introduce new bar-coded ID wristbands for patients, a technology that shows promise for improving both patient safety and health-care efficiency. Stanford Hospital & Clinics has already begun using the wristbands, which have proved successful.

With this technology, anyone admitted to the hospital will receive a bar-coded wristband containing his or her medical record number. The code is electronically conveyed to various devices, such as glucometers, to link test results directly back to the patient. Upon scanning, data is automatically downloaded to the clinical laboratory, where it is joined to other test results in the patient’s record. The wristband will help eliminate human error in entering medical record numbers and ensure more accurate patient information.

Sandra Trotter shows a glucometer at a docking station in Packard Children’s Hospital. Bar-coded wristbands worn by patients provide a link between the device and the clinical laboratory. PHOTO: NEALE MULLIGAN

The effort began just over a year ago when laboratory glucose meters had been installed in Stanford Hospital but data error rates were high. Lab staff spent up to two hours a day correcting mistakes while nurses spent up to five hours a week fixing problems, said Connie Taylor, patient care policy and procedures coordinator at Stanford Hospital.

"It’s a human error thing," Taylor said. "When people are working fast, it’s like typing with no auto-correct. It’s very difficult. We had to fix the system first."

That fix involved automating how medical record numbers were entered into the test devices, giving rise to the patient ID wristbands. The project to adopt the bar-coded wristbands involved not only the clinical laboratory but also nursing, patient admitting services, medical records, IT and materials management.

As of Oct. 1, all patients in inpatient nursing units, the emergency department, same-day surgery, the ambulatory treatment unit and the cath/angio lab have received the wristbands upon admission.

Nursing staff were trained to use handheld glucose meters with a bar-code scanner and then download the data at a docking station where it was transmitted to the clinical laboratory. Transposition errors that had once occurred when manually entering numbers were eliminated.

"It was a pretty exciting project, one that nurses saw benefit from and they embraced," said Taylor. "It made their jobs easier because it’s a lot less work to scan a bar code than to enter information manually. This change has been perceived as being very positive."

Sandra Trotter, quality manager for the clinical laboratories at Stanford Hospital & Clinics and Lucile Packard Children’s Hospital, said the wristbands also work with a portable device called the i-Stat 1. Designed for use in space by NASA astronauts, the i-Stat 1 analyzes blood chemistry tests.

"For a blood-gas test, you would typically draw blood from an artery, pull it out with a syringe, cap the syringe, label it, put it in a bag of ice, put the order in the computer, take the sample to the lab, mix the sample, warm it a little, put it into a reader and then read it out," said Trotter. "Prior to the i-Stat 1, the time from physician order to result was 30 to 45 minutes. Today, it takes two minutes to decide whether to get a patient up to the ICU or surgery."

Charles Dibble, assistant director of patient services at Stanford Hospital sees the new system as less of a departmental benefit and more of a hospital benefit. "It can be a safety issue for results to be correctly matched to patients. It can also be a financial issue for getting the charge correctly matched to the patient who’s receiving the service," he said.

Dibble also sees tremendous potential for new technology as it becomes widely used. "It’s going to be an expanding process as more departments look at and purchase equipment with bar-code reading capabilities," he said. "Right now, it’s the lab — it can be materials management or it could be the pharmacy, EKG, radiology. It’s almost endless."

Stanford Hospital receives Consumer Choice Award (9/25/02)