Preventing Workarounds to Barcoding at the Point of Care – Part 2. Wristbands

If there are other patient identifying barcodes in your environment that may be scanned to identify a patient to your BPOC system, they will at some point be scanned, bypassing a major component of the safety net that a correctly implemented system can provide.

Check Digit or other functionality may be used to prevent users from scanning labels other than the patient armband in a BMV environment.

Any barcode in the hospital environment that identifies a patient account number MAY be scanned in BMV to identify a patient to the system.  This works great and is a safety enhancing operation when the barcode scanned is attached to a patient.

Unfortunately the simple circumvention of scanning patient labels away from the bedside can and will completely remove the entire safety net provided by BMV.  If there are other scanable barcode labels in your environment, they will at some point be used to bypass scanning a patient armband.

To avoid this workaround in your environment you need to make sure that Other Patient Identifying labels are NOT Scannable by a barcode reader in your system.  You also need to make your Wristbands easy to scan by using 2D Barcodes on them.

There are 3 main ways of making a NON Patient Armband unscannable.

Option 1. Add a Check Digit to ALL of your patient Labels.

Example:  If your Patient Account Number is H123456789, you would append say an L to all of your patient labels so they would contain the data LH123456789

Result, scanning a patient label would not be a valid identifier to your other systems.

Fallout: You will need to program your LAB, Materials Management Barcode scanners to remove the L for scanning patient labels.  You need to setup you scanning and archiving system to be able to see and remove the L from the barcode for paper document archiving.  Be prepared to find out that your Blood Glucose reader users have been scanning the labels and not the patient armband.

Option 2 and 3 are a little less intrusive but rely entirely on being able to program your scanners to see / recognize a patient account number.  I have talked with Hospital Systems that have accomplished this with Code Corp and Motorola and Symbol Scanners.  Other vendors of “Smart” Barcode Scanners should be able to accomplish the same thing.

So again, if your patient account number is H123456789 you would program you scanner that an H followed by 9 Numeric Values is an ACCOUNT Number.  Please note if your account number is numeric only this will not work.

Once your scanner recognizes that it is seeing an account number and NOT a medication label you have Option 2 and Option 3.

Option 2.  Add a check digit to your Wristbands and make it required on the scanner.  So again we could make our Wristband Account Number look like LH123456789.  Your scanner would be programmed so that if it saw “LH” followed by 9 numeric values, that this is a Patient Account Number, it should then remove the L and forward the H123456789 to the computer.  IF the scanner were to scan H123456789 it would have to have logic that said, This is an Account Number, there is no “L” Reject this scan as someone is trying to scan a patient label.

Fallout, you will need to leave a code 128 barcode on the armband for your blood glucose readers.  You will not stop scanning of patient labels for blood glucose.

Option 3.  Program your scanners to only read a patient account number if it is in a 2D barcode format.  We would add 2D Datamatrix or Aztech, or QR Code encoded barcodes to your patient armband.  We would then program the scanners to recognize that H followed by 9 numeric values, that this is a Patient Account Number.  It would then check the barcode encoding.  And if it were a Linear Code 128 barcode it would Reject this scan as someone is trying to scan a patient label.

Fallout, you will need to leave a code 128 barcode on the armband for your blood glucose readers.  You will not stop scanning of patient labels for blood glucose.

Again the programming is key as many alt NDC’s are set as 10 digit numeric values.  So you simply cannot require 2D only barcodes as most medications are (by law) code 128.  Your scanners have to be intelligent enough to be programmed to read the data they are scanning and react accordingly if they see a patient account number.

The next thing you do need to do, is to setup a routine where you run an audit trail on RE-Printing Extra patient armbands.  We setup a routine where we monitor ALL nursing armband reprints.

You could do this with the Meditech Audit report and I have it emailed to me 2 times a day and I manually review it for armband reprints.  If I see a nurse prints more than 1 armband at a time, I forward the data to the Nursing Unit Supervisor for them to review.

Finally, I have also included the NAME of who printed a patient wristband and the date and time it was printed on every single armband.  So if I were to find an armband not attached to a patient, nurse leadership could readily tell who printed it and find out why.

[Previously Posted to the Meditech-L]
Leave a Reply

You must be logged in to post a comment.