Revised Hospital Medical Error Death Rates: HealthGrades, Inc.
In late July 2004, a shocking report hit the healthcare news wires that 195,000 deaths in the U.S. could be attributed to hospital errors. This number nearly doubles the Institute of Medicine's (IOM) 1999 study that claimed 98,000 people a year die from what it characterized as preventable medical errors.

HealthGrades, Inc. a Lakewood, CO based company took into account the Medicare records of 50 states and Washington DC over a three year period from 2000 through 2002. Out of 37 million hospitalizations tracked, there were 1.14 million "patient-safety incidents" reported, and "of the total 323,993 deaths among Medicare patients in those years that developed one or more patient-safety incidents, 293,864, or 81% of these deaths were directly attributable to the incidents." Thus, between 2000 and the end of 2002, 1 out of 4 Medicare patients died of a patient-safety related incident. See: http://www.msnbc.msn.com/id/5536730/

In an effort to reduce costly medical errors and increase patient safety, more and more hospitals and health systems have begun to initiate positive patient identification (PPI) strategies which include Bar Code-Enabled Point-of-Care technology (BPOC). BPOC systems, when augmented with sophisticated computer logic, can protect patients from prescription, transcription and dispensing errors. This technology allows for real time confirmation of patient identification, medication, dose, time and route of administration.

HIMSS (Healthcare Information & Management Systems Society) in its 15th Annual Leadership Survey sponsored by Superior Consultant Company and released in June, 2004, reported cost pressures and patient safety issues were the top two business challenges that will have the greatest impact on healthcare over the next two years. It was also reported that the top IT priorities in terms of automated clinical applications were: #1: Electronic Medical Records (EMR); #2: Computer-based Practitioner/Physician Order Entry (CPOE) and # 3: Clinical Information Systems.

As for which healthcare technologies will have the greatest focus over the next two years: highspeed networks, data security, and bar coding garnered the most survey votes from information technology (IT) executives at healthcare provider institutions and vendor organizations across the U.S. The rise of bar coding in importance, can probably be attributed to increased industry awareness of the role that bar code technology can play in helping to reduce misidentification errors that ultimately will lower the number of patientsafety- related or Sentinel Events.

Regulatory Influences: HIPAA, FDA & JCAHO
The Healthcare Insurance Portability and Accountability Act of 1996 (HIPAA) was the kick start for healthcare institutions to seriously consider bar coding as a means of safeguarding the way they transmit, store, and access protected health information. HIPAA regulations state that a common set of codes must be adopted by healthcare facilities that encompass all medical procedures as part of an electronic exchange of information to increase efficiency and reduce medical errors.

More recently, however, the U.S. Food and Drug Administration (FDA) released its final ruling in February 2004 requiring a linear bar code (that conforms to Unified Code Council "UCC" specifications) be on many over-the counter and prescription drugs, vaccines, and blood products administered in healthcare settings to help improve patient safety at point-of-care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also views correct specimen labeling and accurate patient ID as cornerstones of their Patient Safety Standards & Guidelines:

• Use at least two patient identifiers (not including the room #) whenever taking blood samples or administering medication or blood products.
• Prior to surgical or invasive procedures, conduct a final verification process.

Positive Patient ID at Point-of-Care & PDC’s Role
The reduction of medication errors at point-of-care is the primary goal of many healthcare institutions that have opted to automate their medication administration processes: e-MAR (electronic medication administration). Nearly one third of the medication administration errors that have been cited as the cause of ADE (Adverse Drug Events) occur at bedside and only 2% are caught. Clinical research released in September of 2002 concluded that "healthcare facilities are experiencing as many as 1 error per every 5 administered," leaving a huge gap in acceptable patient safety standards.

To ensure positive patient identification, successful bar code implementation integrates the responsibilities of healthcare professionals in Admissions, Pharmacy, Laboratory, Blood Bank, Emergency and other patient care departments. Healthcare personnel in Patient Safety, Quality Control, Risk Management, and Information Technology are also involved in the development and implementation of Bar Code Point-of-Care (BPOC) systems. To that end, Precision Dynamics has committed to a Bar Code Solutions team approach that offers a total solution option to healthcare providers that is customized to meet institution-specific needs in hardware: (printers & scanners), media (wristbands & labels) as well as connectivity-based software (middleware or firmware) when deemed necessary by certain HIS/LIS (Hospital Information System/Laboratory Information System) protocols.

Through the entire patient point-of-care process, the ultimate goal is to provide quality healthcare to each patient and to ensure the accurate administration of the five rights: Right Patient, Right Drug, Right Dose, Right Time and Right Route of Administration.

This reference guide is for all healthcare managers and practioners who are evaluating bar code wristband or bar code label systems to ensure positive patient identification in their facility. We hope this information will assist you in selecting the best solution to meet your needs.

Inside you will find a summary of Precision Dynamics' portfolio of bar code solution options including the advantages and disadvantages of each. The three areas of focus will be:

• Thermal Printing Wristband Solutions
• Adhesive Label Wristband Solutions
• Laser Printing Wristband & Label Solutions

Regardless of which option you select, we at Precision Dynamics want to go on record to urge you to choose a solution which offers you optimal security with a positive tamper-evident closure in a wristband, along with optimal scanability and freedom from smearing, moisture or other vulnerabilities in a label. The American Hospital Association (AHA) calls for a "tamperproof, non-transferable identification band…that minimizes the possibility that identifying data can be lost or transferred from one patient to another." (See: the American Hospital Association Management Advisory: Identification of Newborns & Other Patients, 1992.) All of Precision Dynamics media products meet these important criteria for patient safety and have a long history of successful use in the healthcare field.

A Glimpse at RFID
RFID represents the next advanced step in positive patient identification after bar coding. PDC pioneered the development of the Smart Band® RFID Wristband System in 2000 and continues to lead the way in Auto ID. PDC RFID solutions ensure the integrity of information between patient, host device, and/or hospital information center. Unlike bar code, RFID’s non-line-of-site data transmission can be read through and around the human body, clothing, bed coverings, and nonmetallic materials. Furthermore, RFID wristband solutions help to ensure that the "Five Rights of Medications Safety" are achieved, facilitating real-time confirmation of the Right Patient, Drug, Dose, Route, and Time. To learn more, call +32 67 89 56 38 to request a PDC RFID Healthcare Solutions brochure.

Wristbands for Direct Thermal & Thermal Transfer Printing

Print bar code information directly on the wristband GENERAL ADVANTAGES: Most popular method of bar coding in ID bands in U.S. hospitals Efficient process saves time Durability of bands prevents folding or wrinkling of bar code (which can interfere with scanning) Secure snap closure prevents tampering or removal of band Suitable for decentralized admissions via low-cost printers in remote locations Full range of wristband sizes and colors available

GENERAL DISADVANTAGES

• Requires dedicated direct thermal printer
• Material may not be perceived as soft enough for infant patient identification

Thermal Transfer Printing Wristbands
ADVANTAGES

• Provides high quality bar code
• Will not turn dark over time
• Suitable for both long term medical records and short term applications

DISADVANTAGES

• More expensive---requires thermal ribbon that must be replaced
• Printed information is more susceptible to abrasion or smearing than direct thermal printing (premium resin ribbons will provide best results)
• Disposal of used ribbons present some HIPAA security or patient privacy-related issues if not properly destroyed

Adhesive Labels are applied:
(1) to All-in-One Wristband System with Clear Adhesive Shield (Option 1)
(2) Directly on Wristband (without Covering) (Option 2)
(3) Inside Clear Protective Pocket (Option 3)

GENERAL ADVANTAGES
Security & Safety

• Non-transferable, secure plastic snap provides maximum security, as opposed to adhesive closures
• Complies with HIPAA, JCAHO, and American Hospital Association industry standards

Scanability & Functionality

• Clear adhesive shield provides easy and accurate bar code scanning and optimal protection from water, solvents, and other abrasives
• Provides carrier for capturing data for medication administration, point-of-care-testing (POCT), transfusion verification, specimen collection/tracking, and patient charging
• Large label area accommodates both laser and thermal labels

Comfort & Quality

• Soft, smooth, and non-abrasive to sensitive skin
• Water-resistant, durable, and strong, yet lightweight and comfortable

GENERAL DISADVANTAGES

• Three step application may be considered too labor intensive, requiring more handling than other options listed in this booklet

Adhesive Label Wristband Option 1 All-in-One Wristband System with Clear Adhesive Shield	Allows you to use laser or thermal labels Secure snap closure prevents tampering or removal of band Supports text, linear and 2D bar codes, photo ID and graphics Plastic band prevents folding or wrinkling of bar code (which can interfere with scanning) Full range of wristband colors available	Not a one-step process Must center the label beneath the clear adhesive shield to ensure proper alignment	Sentry® Bar Code LabelBand™ (2005 PDC Healthcare Catalog, page 9)
Adhesive Label Wristband Option 2 Labels are Directly Applied to Wristband (no covering)	Special ClearImage surface on wristband allows for superior label adhesion Durable & strong; yet lightweight and comfortable Available in 3 sizes and up to 7 colors This option supports text, linear and 2D bar codes, photo ID and graphics Secure snap closure prevents tampering or removal of band Full range of wristband sizes and colors available for color coding options	Exposed label may be affected by moisture and abrasion over time Quality of the bar code produced by laser printers is very dependent on the printer capabilities and the label stock used	Sentry® DataMate® System (2005 PDC Healthcare Catalog, page 10)
Adhesive Label Wristband Option 3 Labels are Inserted inside Clear Protective Pocket	Allows you to continue using current insert style wristbands Allows you to continue using current bar code labels Bar code can be scanned through the clear insert pocket Insert pocket protects the bar code from moisture and tearing Plastic band prevents folding or wrinkling of bar code (which can interfere with scanning) Secure snap closure prevents tampering or removal of band Full range of wristband sizes and colors available for color coding options	Requires more handling than other options listed Clear protective pocket may not allow for consistent scan rates	Safeguard® Sealident®, Securline®, and PrimeBand® (2005 PDC Healthcare Catalog, page 11)