Preparing for EHR Downtime and System Failures
Health care providers are increasingly moving from paper medical records to electronic medical records/health records in an effort to boost efficiency, reduce costs and improve record accuracy and care coordination. However, while electronic health systems (EHRs) have many advantages over paper, when the system fails, it can paralyze an organization. System outages may be planned or result from an unplanned problem, such as a power outage. Organizations need to have protocols and systems in place to move quickly to an alternate method, in many cases a paper-based system, when these outages occur to prevent care delays and hassles for patients.
Organizations must ensure data security under the federal HIPAA Security Rule in the event of a system failure, but they should also create policies and procedures focusing on how staff members should respond to EHR system failures, protocols for bringing the system back online, and how to add information collected during an EHR system outage, back into the system.
They should also have procedures in place to ensure staff members are notified quickly of an outage and have proper training and hands-on practice in using a back-up paper system. It’s also important for organizations to prepare paper systems for staff members to use in these instances. A tool kit of written reference materials and labels can help staff members provide timely care to patients in the event of an outage.
Organizations should also consider running routine practice drills simulating a system outage to ensure that staff members know how to respond and to detect additional planning gaps that require additional thought or training.
Maintenance and Compliance for Life-Safety Equipment
Hospitals are responsible for maintenance and status documentation of all types of equipment used in patient care. Hospital safety is a multifaceted concern that involves everything from evaluating computer data and systems entry to monitoring life-safety equipment. Federal and state regulations require that records attest to careful adherence to manufacturer’s guidelines with respect to preventive, predictive, reactive and reliability forms of maintenance. Equipment that is critical to patient life support and recovery must meet even more stringent maintenance guidelines that mandate frequency of monitoring. The use of labels is an effective way of meeting compliance regulations set forth by the U.S. Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). Labeling lifesaving pieces of equipment provides immediate and up-to-date access to maintenance records available to technicians and clinical personnel. Hospital labels are subject to degradation due to cleaning agents, alcohol and blood. Preservation of mandated maintenance data is of utmost importance to provide necessary information regarding the needs for all forms of maintenance, equipment readiness and reliability to perform at peak efficiency. There are several types of lamination that form a protective barrier over paper and synthetic labels and preserve critical information. Labels used in the hospital setting should meet the International Organization for Standardization (ISO) requirements and be an integrated part of the hospital’s quality assurance program.
Central Sterile Processing White Paper
In hospitals around the country, successful surgical outcomes are accomplished with the help of color coding, asset tags and bar codes. Communication between Biomedical and Central Sterile departments is essential for the successful procurement, inventorying, tracking, and delivery of supplies and instruments. Without proper coordination, surgeons can arrive in the operating room only to find that necessary equipment and/or instruments are missing. From a risk-management perspective, this means that time and financial resources are wasted. More important, patient care can be compromised.
The use of bar codes, color coding, and asset tags is a quick and efficient way to track medical supplies and instruments as they move from one department to another, whether from inventoried stock all the way to the operating room or back to Central Sterile to be washed, wrapped, and autoclaved for re-sterilization. Using appropriate labels, a surgical nurse or medical technician anywhere in the hospital can locate a missing instrument tray or find a smaller piece of medical equipment by inputting the assigned barcode into the station's computer.
Although labels may be one of the smallest items used in the daily operation of the Biomedical and Central Sterile departments in a hospital, they are of primary importance. Hospital management seeking to improve patient care, mitigate risk factors, and better coordinate activities between departments should consider implementing color coding, asset tags, and bar codes.
Direct Thermal Labels White Paper
Labeling is a necessary part of the medical and healthcare industries. Labels are used for wristbands for patient identification, containers of specimens and samples collected for diagnostics, and medication directions and dosages for bedside therapies and treatments. These labeling systems have been the target of advancements to reduce medical errors and increase administrative efficiency and appropriate patient identification. Bedside bar-code technology has reduced scanning errors by more than 80 percent in hospitals that have implemented the technology, and expected increases in efficiency and satisfaction have been realized.
Direct thermal printing uses heat-sensitive material to print an image on the label when it comes into contact with the pins of a thermal print head. This printing technology has been implemented in many institutions to reduce medical errors at the bedside, increasing staff job satisfaction and patient satisfaction in the process. However, the heat-sensitive coating on the paper used in direct thermal printing systems is susceptible to fading and discoloration when it comes into contact with alcohol, potentially increasing the time and effort needed to ensure proper labeling. This is an unfortunate disadvantage with the increased use of alcohol-based hand sanitizers in healthcare facilities. Hand sanitizers and gels containing high concentrations of alcohol have been promoted in an attempt to alleviate concerns regarding nosocomial infections and to promote good hygiene practices. Expanding upon the technology with better, alcohol-resistant printing materials that can be used in current direct thermal printing equipment and bar code systems will solve the problems caused by hand sanitizer use. The use of this product would further reduce errors in patient and specimen identification and medication administration, but it would not compromise hygiene practices and patient safety.
Infection Control White Paper
In an effort to contain costs, Medicare, Medicaid and many private insurers will no longer cover the costs associated with many hospital-acquired infections. According to a recent article in Urologic Nursing, urinary tract infections are one of the most common infections in hospitalized patients. Of these infections, approximately 80% are caused by indwelling urinary catheters. The total annual cost of treating a catheter-associated urinary tract infection (CAUTI) is approximately $424 million. The policy change will make hospitals financially responsible for failure to prevent 10 specific hospital-acquired conditions (Blodgett, 2009).
The Centers for Disease Control and Prevention (CDC) estimates that there are 2 million healthcare-associated infections in hospitals each year in the United States, including CAUTIs (CDC, 2005). These infections result in longer hospital stays, and higher treatment costs and can potentially be fatal. Of hospital patients who develop a hospital-acquired infection, 90,000 die each year, more than die from diabetes. The cost of these preventable infections is between $4 billion and $5 billion annually. Even more alarming, about 70% of these infections are resistant to at least one drug (Wyeth, 2010). Given that the development of just one new drug costs millions of dollars and requires years of clinical studies and trials, the potential exists for the mutation of so-called "superbugs," which would be impervious to any medication regimen currently available. Such a mutation would have devastating consequences on morbidity and mortality rates.The purpose of this white paper is to examine how infection control policies and procedures are developed, why procedures are sometimes not followed, and take a look at how signs, labels and other communication devices can help increase awareness and compliance with infection prevention and control standards. The problem of controlling and reducing the spread of infection is complex; while there are no easy solutions there are steps, such as hand hygiene, that are easy to implement. Signs can help prompt hand hygiene by bringing awareness to how serious some infections may be.
Patient ID Wristband White Paper
In 2003, the United States Joint Commission highlighted the need for improved safety practices in the healthcare setting, citing too many historical instances of patient harm due to negligent medical practices.
Since that time, combined presidential administrations have contributed to the goal of creating an electronic medical record (EMR) for every American by the year 2014. While it is believed that a scannable healthcare record will decrease the risk of medical error due to human negligence, it is impossible to maximize the effectiveness of an EMR without the use of bar-coded wristbands to ensure correct patient identification. Scannable wristbands are the missing link between patient and the appropriate delivery of medical services based upon physician orders.
The Joint Commission's primary safety goal is best met by ensuring that at least two pieces of identification are standardized and scanned onto a patient's wristband by means of bar-coding. This will allow for each patient's wristband to be read and his identity to be verified prior to receiving services.
Although patient ID wristbands have been used in the hospital setting for several decades, their efficacy has been limited by human error due to lack of a standardized protocol that is universally recognized. New state regulations are increasingly adopting a three-color standard to identify patient risk and end-of-life directives.
The addition of bar-coding can be the next step in minimizing patient harm while maximizing the best possible outpatient and inpatient healthcare outcomes. Bar-coded wristbands are available in a variety of materials to accommodate hospital needs as well as patient comfort. They are tamper proof and resistant to damage due to moisture, alcohol, or rubbing associated with patient movement. Accurate patient identification is essential to ensure that medications and services are administered correctly. Barcode technology promises to significantly decrease errors in the healthcare setting while improving the quality of medical care.
Pharmacy Unit Dosing Labels White Paper
Findings such as those released by the Institute of Medicine in 1999 have highlighted the need for improved quality assurance measures in pharmaceutical management in the inpatient setting. With as many as 7,000 deaths per year attributable to medication error, there is an emergent need to address a system of checks and balances that will significantly decrease permanent injury and death related to improper dosing at the patient's bedside.
According to the Federal Food and Drug Administration, the use of bar codes on unit-dose medication has been responsible for reducing hospital error by as much as 85% in some settings. Government-regulated unit dosing provides for a standard of care that ensures that proper patient identification occurs prior to the administration of bedside medication.
Pharmacy unit dosing is moving toward a standardized level of care that will include the use of bar-coded labeling on inpatient wristbands that will contain vital information that can be cross-checked against patient records to ensure accuracy in medication administration. New FDA guidelines provide for a number of specific pieces of information to be included on each unit dose of medication as an additional quality assurance measure to ensure patient safety.
While unit dosing and bar-coded labels can be applied inside the hospital at the time that bulk medications are repackaged, not every inpatient pharmacy has onsite access to the kinds of equipment needed to complete this process. Both repackaging and labeling can be accomplished by outsourcing to companies that are able to produce FDA-approved unit doses that come equipped with scannable bar codes containing all the information necessary to meet federal guidelines.
In the future, scannable bar codes on unit doses of medication will help to ensure more accurate reporting of improved medication management practices in the hospital setting. More important, pharmacy unit dosing guidelines will significantly reduce medication error and vastly improve the overall quality of patient care.