Barcoded Wristbands Help Ensure Accurate Patient Identification

 

In 2003 the United States Joint Commission cited the misidentification of hospital patients as a major cause of medical error and made improved patient identification a top safety goal within the scope of hospital accreditation standards [1] The commission took concerted steps to bring the need for improved safety practices to the forefront of the medical profession by admitting the unfortunate reality of too many historical instances of patient harm due to negligent healthcare practices.

One year later, the Presidential Administration created a new position within the Department of Health and Human Services to address improved patient care outcomes. The White House appointed the first National Coordinator for Health Information Technology to oversee a developmental plan that would eventually result in every American having a transferable electronic medical record (EMR) by the year 2014.[2] The President believed that the creation of a scannable health record would help to appreciably decrease medical error and improve patient services outcomes in the healthcare sector.

The President’s Healthcare Initiative has continued to prioritize the need for quality assurance in medical care practices. Through the Health Information Technology for Economic and Clinical Health Act, the government has promised incentives of close to $100,000 to clinicians who will participate in the creation and use of electronic health records. It has also offered additional funding to help subsidize clinics in purchasing equipment necessary to implement an EMR system.[3]

But without the use of the electronically scanned wristband, electronic medical records still lack the necessary checks and balances to guarantee appropriate patient identification and ensure that accurate medical services are administered in a timely manner. Scannable wristbands are an essential link between the patient’s record that contains physician’s orders, and the onsite locations for point of care.

Although wristbands have been used in the hospital setting for several decades, their efficacy has been limited by human error. Use of color-coding to designate patient alerts and end-of- life directives has too frequently resulted in confusion due to lack of a regional or national protocol calling for standardized colors for specific designations. This confusion has compromised patient safety and even resulted in death. A number of states are now moving toward the use of three primary colors to code wristbands. These will be used to identify patients who are at risk of falling, have allergies, or have “do not resuscitate.” directives.

The further edition of electronically scannable wristbands can significantly decrease patient risk due to medication errors and performance of incorrect procedures. The use of barcodes provides an effective system of cross-checking patient identification with medical record prior to administration of medical and laboratory services.

In case studies done, medical errors connected to the use of existing manual wristband protocols have highlighted several areas of vulnerability. These include mistaken identity through use of the wrong wristband, illegible writing on wristbands and incomplete data due to lack of uniformity in regulations regarding the information that is required.

Bar-coding of patient wristbands reduces the risk of patient error and provides for a comprehensive system of checks and balances. Electronically scanned patient data improves communication between the patient, his medical record and the healthcare service providers and technicians that execute a physician’s orders. Electronic scanning by means of bar- coding standardizes data and helps to prevent human error due to manual transcription of the incorrect information on a patient’s wristband. The patient’s wristband can then serve as both an entry and exit point in checking to be certain that the same five rights associated with medication administration apply to the administration of other healthcare services.[4]

As a part of The Joint Commission’s safety initiatives, it has recommended that two pieces of identification be used on each wristband to reduce the risk of medical error. Its primary safety goal is twofold; The Commission seeks to ensure that each patient is correctly identified and that he/she receives the correct treatment.[5]

The use of wristbands in home healthcare and outpatient settings has become equally important due to the larger volume of services that are rendered to patients in settings other than the hospital. Many outpatient laboratories are now demanding wristbands as a means of identification prior to drawing blood or performing other diagnostic services. An equal number of home health services are beginning to consider requiring that patients receiving care at home on an ongoing basis be fitted with wristbands as a requirement before blood draws or home urinalyses may be done. It is important to realize that The Joint Commission’s safety initiative focuses on both inpatient and outpatient services.

Bar-coded wristbands are available in several styles to accommodate specific needs of patients. Snap closure wristbands are tamper-proof and cannot be removed without destroying their integrity. Foam wristbands are available for patients who have allergies to nylon and latex as well as for elderly and preemies or newborns whose skin is susceptible to breakdown due to chaffing. Wristbands are also available that have adhesive closures that can be adjusted to fit a variety of wrist sizes. Thermal barcode wristbands are made to retain their integrity in the presence of moisture, alcohol, and wear and tear due to rubbing during patient movement.

Patient wristbands are an essential part of the delivery of quality healthcare. Bar coding offers the opportunity for healthcare professionals to further partner with their patients toprovide the most reliable healthcare practices while minimizing risk of medical error due to lack of quality assurance in patient identification and delivery of services. The Federal Drug Administration currently requires that all bedside prescriptive medications be bar-coded. Acting now to incorporate bar-coded wristbands into your health services protocol will likely prepare you for future regulations that may well require wristband bar-coding.

  1. http://www.ccforpatientsafety.org/common/pdfs/fpdf/presskit/PreambleandSolutions.pdf [2] http://www.healthcareitnews.com/news/market-emrs-pegged-16-billion-2013
  2. http://content.nejm.org/cgi/content/full/NEJMp1006114/
  3. http://www.dora.state.co.us/Nursing/news/TheFiveRights.pdf
  4. http://www.endonurse.com/articles/2006/04/patient-identification-nbsp.aspx

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