State task force develops protocols for wristbands

Statewide initiative launched in wake of adverse event caused by conflicting color codes. New system includes printed information on wristbands, in addition to color coding. Several hospitals voluntarily agree to adopt a uniform color code for wristbands.

Surgical Site Verification: A Through Z

Performing the correct procedure on the correct patient has always been of prime importance to all health care providers. For the past six years, it has been a patient safety initiative priority of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Before JCAHO took the lead in this arena, however, health care facilities handled this issue with individualized policies and procedures. This became problematic because physicians practice in multiple institutions that could have conflicting policies, which could confuse the issue. This case study presents the evolution of the surgical side marking and site verification policy at St Joseph's Wayne Hospital, Wayne, NJ. It has been a painful process, requiring numerous policy rewrites with updated information as prescribed by JCAHO. Enforcing physician compliance and continually re-educating nurses with each new JCAHO change proved challenging. The marking of surgical sides and verification of all sites, however, has proven to be a collaborative effort with safe patient outcomes as the shared goal.

Transfusion recipient identification

Recent reports from different haemovigilance systems indicate that errors in the whole-blood transfusion chain - from initial recipient identification to final blood administration - occur with a frequency of approximately 1 in 1000 events. Although mistakes occur also within the blood transfusion service, about two-thirds of errors are associated with incorrect blood recipient identification at the patient's bedside. To prevent the potentially fatal consequences of such mistakes, specific tools have been developed, including patient identification bracelets with barcodes and/or radio frequency identification devices, mechanical or electronic locks preventing access to bags assigned to other patients, and palm computers suitable for transferring blood request and administration data from the patient's bedside to the blood transfusion service information system in real time. The effectiveness of these systems in preventing mistransfusion has been demonstrated in a number of studies.

Helping hippocrates: a cross-functional approach to patient identification

BACKGROUND

The Joint Commission on Accreditation of Healthcare Organizations National Patient Safety Goal 1, which requires the use of at least two patient identifiers, is the foundation for other patient safety goals. St. Francis Hospital involved staff and patients in the "Helping Hippocrates" Project, which used a "game" with staff and patients to ensure the accuracy of information on patients' identification (ID) bands.

THE PROJECT

Members of all hospital departments assigned to a specific day were to compare the ID band with the patient census report and identify patients who had no ID band on their wrist and patients who had a band with inaccuracies. They were to also ask patients if the staff had checked the ID band before treatments or procedures. Also, the nurse manager was to select a patient to add to his or her own ID band a special band bearing the name Hippocrates. The department conducting the survey had to find Hippocrates.

FINDINGS

Internal data showed that patient identification errors declined from 8.2% to a sustained zero. Patient satisfaction data showed that since the inception of Helping Hippocrates, patients' perceptions of staffs compliance with ID verification showed steady improvement.

CONCLUSION

Helping Hippocrates demonstrates the value of using an innovative problem-solving strategy that engages the entire organization.

Oxygen alert cards and controlled oxygen: preventing emergency admissions at risk of hypercapnic acidosis receiving high inspired oxygen concentrations in ambulances and A&E departments

BACKGROUND

Appropriate resuscitation of hypoxic patients is fundamental in emergency admissions. To achieve this, it is standard practice of ambulance staff to administer high concentrations of oxygen to patients who may be in respiratory distress. A proportion of patients with chronic respiratory disease will become hypercapnic on this.

OBJECTIVES AND METHODS

A scheme was agreed between the authors' hospital and the local ambulance service, whereby patients with a history of previous hypercapnic acidosis with a Pao2 >10.0 kPa--indicating that oxygen may have worsened the hypercapnia--are issued with "O2 Alert" cards and a 24% Venturi mask. The patients are instructed to show these to ambulance and A&E staff who will then use the mask to avoid excessive oxygenation. The scheme was launched in 2001 and this paper present the results of an audit of the scheme in 2004.

RESULTS

A total of 18 patients were issued with cards, and 14 were readmitted on 69 occasions. Sufficient documentation for auditing purposes was available for 52 of the 69 episodes. Of these audited admissions, 63% were managed in the ambulance, in line with card-holder protocol. This figure rose to 94% in the accident and emergency department.

CONCLUSION

These data support the usability of such a scheme to prevent iatrogenic hypercapnia in emergency admissions.

Patient tracking system used to reduce urinary tract infections

Reducing urinary tract infections at hospitals is a very attainable goal if health care professionals have the data, track patients with catheters or those susceptible to infections and make several process improvements. Intermountain Healthcare is developing a urinary catheter duration program that will be linked with its electronic medical record system to identify patients who may not initially need catheters or those who could have them removed.

Time accuracy of a radio frequency identification patient tracking system for recording operating room timestamps

A patient tracking system is a promising tool for managing patient flow and improving efficiency in the operating room. Wireless location systems, using infrared or radio frequency transmitters, can automatically timestamp key events, thereby decreasing the need for manual data input. In this study, we measured the accuracy and precision of automatically documented timestamps compared with manual recording. Each patient scheduled for urgent surgery was given an active radio frequency/infrared transmitter. The prototype software tracked the patient throughout the perioperative process, automatically documenting the timestamps. Both automatic and traditional data entry were compared with the reference data. The absolute value of median error was 64% smaller (P < 0.01), and the average quartile deviation of error was 69% smaller in automatic documentation. The average delay between an activity and the documentation was 80 seconds in automatic documentation and 735 seconds in manual documentation. Both the accuracy and the precision were better in automatic documentation and the data were immediately available. Automatic documentation with the Indoor Positioning System can help in managing patient flow and in increasing transparency with faster availability and better accuracy of data.

Computerization can create safety hazards: a bar-coding near miss

Increasing numbers of hospitals are implementing bar-coding systems to prevent errors in patient identification. In the present case, a diabetic patient admitted to a teaching hospital was mistakenly given the bar-coded identification wristband of another patient who was admitted at the same time. When a laboratory result that documented the diabetic patient's severe hyperglycemia was entered into the other patient's electronic medical record, the latter patient seemed to have a very high glucose level and was almost given what could have been a fatal dose of insulin. This near miss shows that computer systems, although having the potential to improve safety, may create new kinds of errors if not accompanied by well-designed, well-implemented cross-check processes and a culture of safety. Moreover, computer systems may have the pernicious effect of weakening human vigilance, removing an important safety protection. Researchers should continue to study real-world implementation of computerized systems to understand their benefits and potential harms, and administrators and providers should seek ways to anticipate these harms and mitigate them.

End-to-end electronic control of the hospital transfusion process to increase the safety of blood transfusion: strengths and weaknesses

BACKGROUND

Incorrect blood component transfused is a frequent serious incident associated with transfusion and often involves misidentification of the patient and/or the unit of blood.

STUDY DESIGN AND METHODS

This study extended the evaluation of an electronic system involving bar code technology and handheld computers. Electronic control of collection of blood from blood refrigerators was incorporated into a previously described process for blood sample collection and blood administration. Practice was evaluated before and after its introduction in cardiac surgery.

RESULTS

The baseline audits revealed poor practice. Significant improvements were found following the introduction of the electronic system, including from 8 percent to 100 percent in checking that the blood group and unit number on the blood pack matched the compatibility label and the pack was in date (p < or = 0.0001). Similar significant improvements were found in blood sample collection, the collection of blood from blood refrigerators, and the documentation of transfusion. Staff found the system easy to operate and preferred it to standard procedures.

CONCLUSIONS

A bar code patient identification system improved transfusion practice, although areas for improvement were identified. These results provide support for further work on the development of such systems for both transfusion and other procedures requiring patient identification.

Safety portal: the safest goes through the air--ubiquitous high-risk reminders bridging out the patient safety in emergency department

Under the safety net of hospital-based patient safety informatics (PSI) system, RFID is build to adapt emergency department safety needs and the process improvement activities. We implemented the RFID framework as the electronic patient identifier into the process improvement of ED workflow; it defined as the safety portal to introduce PSI safety features on the real-time basis.

METHODS

Since 2004, we were applying RFID technology into a 200 daily visits emergency department of the regional medical center in Taipei, Taiwan. We then developed wireless web-based RFID safety portal to implement the real-time safety reminders such as the laboratory and radiology reports to the physician who can make decision promptly to the patients in the ED.

RESULTS

Under the ED safety portal, the diagnosis time for physicians to make clinical decision is largely reduced nearly 40 percent due to the safety enhancement RFID system. ED physician who could actively receive patient's updated clinical data to make clinical decision via web-based informatics system reasonably decreases.

CONCLUSIONS

The effectiveness of RFID system not only enhance patient identification during ED process but combine ED safety net which providing needed data for ED physician and staff who visit ED patients with valuable real-time data on time. Patient safety on ED can be clearly improved from the embracing modern technology and build up a patient centered ED environment.

Using biometrics for participant identification in a research study: a case report

This paper illustrates the use of biometrics through the application of an iris-based biometrics system for identifying twins and their parents in a longitudinal research study. It explores the use of biometrics (science of measuring physical or anatomical characteristics of individuals) as a technology for correct identification of individuals during longitudinal studies to help ensure data fidelity. Examples of these circumstances include longitudinal epidemiological and genetic studies, clinical trials, and multicenter collaborative studies where accurate identification of subjects over time can be difficult when the subject may be young or an unreliable source of identification information. The use of technology can automate the process of subject identification thereby reducing the need to depend on subject recall during repeated visits thus helping to ensure data quality. This case report provides insights that may serve as useful hints for those responsible for planning system implementation that involves participants' authentication that would require a more secure form of identification.

Smartcards. Smart move

European nations outside the UK use smartcards to speed up reimbursements. France has had a card since 1998 and this may soon include health data. The UK is at present only issuing smartcards for healthcare staff's use.

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan

PURPOSE

To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems.

SETTING

TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients.

METHODS

We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail.

RESULTS

The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%).

CONCLUSIONS

Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.