I was recently inspired by Zebra Technologies’ white paper, It’s All in the Wrist: Improving Patient Safety with Barcode Wristbands, to comment on the increasing role of barcoded patient wristbands in ensuring accuracy of delivery and record keeping of medication administration. But, that’s not the only topic covered by that important Zebra resource. Barcode technology is also playing an increasingly critical role in blood administration as well.
As noted in my previous blog on this subject, I was surprised to learn that errors relating to patient identification dominate those that result in negative patient outcomes. The Joint Commission has taken a leading role in correcting this state of affairs. Founded in 1951, it is an independent not-for-profit entity organized for the certification and accreditation of U.S. healthcare providers. In 2003, it published the first National Patient Safety Goals, or “NPSG,” which has in every annual edition listed accuracy of patient identification as the first consideration in its hospital-accreditation program.
Specifically, NPSG 2013 lists “Goal 1” as: “Improve the accuracy of patient identification,” and its first section (NPSG.01.01.01) requires that caregivers “Use at least two patient identifiers when providing care, treatment, and services.” Its rationale for ranking patient identification as a primary requirement is: “Wrong-patient errors occur in virtually all stages of diagnosis and treatment. The intent for this goal is two-fold: first, to reliably identify the individual as the person for whom the service or treatment is intended; second, to match the service or treatment to that individual.” In notes explaining these provisions, The Joint Commission goes on to advise: “The two identifiers may be in the same location, such as a wristband. Electronic identification technology coding, such as bar-coding or RFID, that includes two or more person-specific identifiers (not room number) will comply with this requirement.
The second provision (NPSG.01.03.01) of NPSG Goal 1 deals specifically with blood administration:
“Before initiating a blood or blood component transfusion:
- Match the blood or blood component to the order.
- Match the patient to the blood or blood component.
- Use a two-person verification process or a one-person verification process accompanied by automated identification technology, such as bar coding.
The reliance that The Joint Commission ultimately places on barcode identification technology is thus clear.
Zebra compares the barcode-based blood administration procedure to that recommended with regard to medication administration. The patient is identified by a wristband scan plus one-person verification, then the blood product that is to be transfused is scanned – in the process, the patient’s blood type and consent to treatment are confirmed, and the physician’s instructions are verified. The potential for human error is minimized and a record of all barcode assisted identification steps is automatically created.