Patient Safety It All Starts with Positive Patient Identity APRIL 14, 2016 Maximizing patient safety and improving the quality of care is the ultimate goal for healthcare providers. Doing so requires staying within regulatory compliance, while also advancing staff retention and meeting fiscal constraints. Barcode technologies provide that degree of visibility to patients, applications and workflows necessary for positive outcomes. Barcoding accomplishes this by laying a solid foundation for enhancing patient identification, providing visibility into medical practices, and driving efficiencies throughout healthcare applications, and is an integral part of electronic medical record (EMR) adoption. According to The Joint Commission Wrong-patient errors occur in virtually all stages of diagnosis and treatment. This is why the commission recommends the use of at least two patient identifiers when providing care, treatment, and services The National Patient Safety Agency (NPSA) of England states that failure to correctly identify patients constitutes one of the most serious risks to patient safety and cuts across all sectors of healthcare practice. The importance of a standardised procedure across the National Healthcare Service NHS is the foundation all safe patient identification practices. The Newsletter for RadioTherapy Professionals in France notes that 7% of reports regarding a radiotherapy report noted patient identification was at issue.
Introduction When talking about patient ID across it is important to understand the numbers so let s take a look at the scope and begin with Hospitals 32 million admissions in US hospitals in 2015 41,500 patients admitted to a hospital every day in England (http://www.hscic.gov.uk/ article/3674/41500-patients-admitted-to-hospital-every-day-in-england---up-nearly-13-per-centin-five-years) 2,000 Acute Care Centers in Germany Over 150 million specimens taken from patients Over 150 million medications administered within the acute care environment Nearly 13 million signees on the Healthcare Exchanges in the US And there still are between 20-30% of hospitals without barcoded wristbands in the US Nearly 50% of hospitals within Europe do not use a barcoded wristband So these are very large numbers. The aspects of Positive Patient ID are varied so we will look at a number of aspects including of the process: Positive Patient ID Process Workflows and PPID EHR and PPID Staffing issues and PPID Analytics and PPID Ambulatory Positive Patient ID
Workflows and PPID Let s look at a typical patient stay and where the need for Positive Patient ID, and the ID of all aspects of their care that rely on PPID, reside. Where does PPID Begin? One of the gaps in a patient ID workflow is how to get the patient information, both at admissions, and throughout their treatment, into the EHR, this is where Barcodes provide that crucial bridge, connection or link. The use of barcodes, including in wristband or armband formats provide a host of benefits: Key to clear Identification More accurate and faster than manual process Information is always available at point of care Improved patient safety and time savings 2 zebra technologies
HERE ARE STEPS OUTLINED ABOVE: 1. With a robust Positive Patient ID Solution, patient is clearly identified from the moment they are admitted. Clinicians are linked to up-to-the minute information about patients 2. With a comprehensive mobile specimen collection, patient samples are ID ed at point of care eliminating 3. Patient samples are processed in the lab using a complete package of identification tools. After physician makes a diagnosis based on tests, they prescribe medications 4. These are filled and ID ed with the pharmacy 5. Clinician administers medication with positive ID of the medication, the patient and the clinician enabling the five rights of med admin 6. Upon discharge, the patient can obtain scripts for med fulfilment output from a secure Rx printer 7. Patient retrieves critical, secure information on the patient portal This comprehensive PPID is not possible without step one to begin all of these processes. zebra technologies 3
EHR and PPID The advent of Electronic Health Records heralded a new era in patient ID because now there was a mechanism by which the information could be captured, analyzed and aggregated for future use. 1 84 percent of providers reporting their care delivery has improved 2 3 4 5 56% of large hospitals deploying EHR in the last 18 months 32% rolling out HIE at the same time EHRs (once optimized!) represent big help Central repository for patient ID In several countries, including France, usage of EHRs outpaces most developed countries, including the US. According to the Health Law of 20 January 2015, the DMP now known as the d ossier médical partagé (shared) will be accessible to all chronically ill and their healthcare professionals in order to share the entirety of the patient s medical history. See more at: http://www.healthcare-in-europe.com/en/article/14069-france-stillseeks-an-electronic-health-record.html#sthash.xjiqcarm.dpuf For those implementing these systems the benefits are clear. Barcode utilization, when combined with Electronic Medication Administration Records (emar), increases patient care accuracy and safety. 41% drop in medication administration errors 0% Medication transcript errors 50% drop in adverse drug events (non-timing errors) So we have seen some of the areas where EHRs can help and a status of EHR implementations in the US. But as many current stories note, not all of the news is good about EHR implementations leading to some important questions: How do you get a patient at admissions seamlessly into the EHR system? How do you manage patients across a multi-location health system? How do you manage any downtimes? And how do you make the overall Patient ID workflow shorter CLEAR PATIENT ID DRIVES SAFETY AND EFFICIENCY When healthcare staff can see more, they can do more for the patient accurately and safely. Barcode based ID systems not only allow caregivers to identify patients and document the associated treatments, but they also enhance emr adoption in terms of both accuracy and completeness by helping to ensure that clinicians have access to the information they need to deliver the safest, most effective care, while reducing administrative costs. Upon deploying barcoded wristbands that provide basic patient identification, healthcare facilities can add numerous other identification, tracking, and data collection applications to take advantage of precise data entry. electronic medication administration records (emar), emrs, computerized physician order a Zebra technologies White Paper entry (CPOE), barcode point-of-care (BPoc) and other automated procedures for improving patient care all rely on accurate input that barcoding provides. Consider this: the FDA s own research concluded that increased use of barcode-based bedside medication administration systems would prevent 500,000 adverse drug events and blood transfusion errors over a 20-year period. Doing so would keep an estimated $93 billion in treatment costs out of the healthcare system. And that s not to mention the potential for saving lives due to incorrect treatment. In a staggering admission, the institute of Medicine reported that preventable medical errors cause up to 98,000 deaths and 770,000 adverse events in the U.S. annually. 4 zebra technologies
Staffing Issues and PPID So the numbers Involving PPID are big and are going to get bigger. Consider this: In 2010, an estimated 524 million people were aged 65 or older 8 percent of the world s population. By 2050, this number is expected to nearly triple to about 1.5 billion, representing 16 percent of the world s population. https://www.nia.nih.gov/research/publication/global-healthand-aging/humanitys-aging Let s look at who is going to be administering the care to all of these patients. There has been talk that the nursing shortage is a myth. The myth is that there are plenty of clinicians to administer care. According to the U.S. Bureau of Labor Statistics, about 233,000 additional jobs for registered nurses will open each year through 2016, in addition to about 2.5 million existing positions. However, only about 200,000 candidates passed the Registered Nurse licensing exam last year, and thousands of nurses leave the profession each year, according to the AP/Post. About one-third of the nursing workforce is older than 50. The average age of nurses has increased over the past decade by almost two years for RNs and 1.75 years for LPNs, reflecting aging within the very large cohort of nurses aged 41 to 50 in 2000. Employment for both salaried and hourly workers in the health care industry will increase 27 percent through 2014, compared with 14 percent for all industries combined. What does this mean for PPID? With more work required of less clinicians, specifically nurses, the ability to quickly, efficiently, and safely ID patients and all of the aspects of care around them becomes even more crucial. In the future of healthcare there will not be much time to go back and verify identities or spend time in the initial ID. zebra technologies 5
HEALTHCARE ANALYTICS MARKET TO EXCEED $10BN BY 2017. $10BN ANALYTICS And one more area where the EHR can help: There are headlines nearly every day about the current and future impact of analytics in HC. The growing use of analytics in healthcare to improve outcomes at both the individual and population means that there has to be an ecosystem in place to get to big data help. The EHRs can serve as the central repository for the data that can lead to analytics but the number one issue is getting the data or the capture piece (2012 IBM Global Healthcare Study). PRIMARY OBSTACLES TO WIDESPREAD ANALYTICS Ability to get the data Culture does not encourage sharing information Lack of understanding how to use analytics to improve the business 37% 35% 34% Lack of management bandwidth due to competing priorities Lack of executive sponsorship Lack of skills internally in the line of business 25% 24% 23% Organizational Data Financial What is the relationship of the term Big Data to Analytics you need the former to get to the latter. Now I will not be providing you a high level analytics course here, but I do want to note how the building blocks of big data are constructed. PROVIDERS SEEK ANSWERS TO THE FOLLOWING QUESTIONS: Which of my patients are at risk of readmitting within 30 days of discharge? What is each patient s expected length of stay? How do I reduce/eliminate infections and HAC (Hospital Acquired Conditions)? How do I eliminate physician variability? How do I maximize patient satisfaction while keeping costs down? 6 zebra technologies
AMBULATORY NUMBERS The acute space is, and will continue to be, the volume leader in healthcare but as healthcare shifts, the numbers in the preacute, and post-acute spaces will grow. So let s look at Ambulatory. A total of 5,357 ambulatory surgery centers treated 3.4 million fee-for-service Medicare beneficiaries in 2012, and the Medicare program and its beneficiaries spent $3.6 billion on ASC services, according to a report from the Medicare Payment Advisory Commission. The US Center for Medicare and Medicaid required ambulatory surgery centers that receive Medicare payments to report on five safety metrics including patient burns; patient falls; wrong site or wrong patient procedures; hospital admission and transfer; and prophylactic IV antibiotic timing for all ambulatory surgical centers. In 2013, they were also asked to report on use of safe surgery checklists and volumes for certain procedures. A facility that fails to report can have its Medicare payment docked by 2%, and the CMS aims to eventually begin publically reporting the data. Here are some additional statistics on the growth of this area of the continuum. Growth rate of 6.7% $88 billion of spend 10% of hospitals Ambulatory Surgery Centers 5,600 locations 23 million surgeries As more and more care shifts from the acute space to ambulatory, the need for the same processes to maintain PPID will follow as well or we will be seeing the adverse events that plagued acute care prior to the advent of these processes. BARCODE IDS ENABLE KEY HEALTHCARE APPLICATIONS Barcoded patient wristbands provide the foundation for preventing errors by ensuring that accurate patient information is always available at the point of care. This creates opportunities for other identification, tracking, and data-collection applications. Because barcodes store data in less space than is required for the equivalent text, barcoded wristbands can include more information than traditional text-only wristbands. a barcoded wristband can provide two forms of identification in one location by encoding the patient name and identification number satisfying the national Patient safety Goal (npsg) for positive patient id. This enables healthcare facilities to earn a fast return on investment while meeting a key compliance mandate and extending the use of wristbands into additional applications, as outlined below. zebra technologies 7
PRECISE MEDICATION ADMINISTRATION Patients and their families want assurance that healthcare staff provides the right medication in the right dosage. Automated medication administration improves patient safety by preventing errors. A 2006 study released by the institute of Medicine states that medication errors are among the most common types of medical errors, affecting 1.5 million patients each year. The financial impact of these errors is quite significant, generating approximately $3.5 billion in extra costs annually. Thus, there is a strong financial incentive to prevent medication errors in addition to safety and moral considerations. Combining barcoded wristbands with automated medication administration systems is an essential way to implement closed-loop medication administration. A significant portion of the guidelines that hospitals must meet to demonstrate compliance involve medication administration. To meet Meaningful use requirements, most facilities will rely on an emar. Barcoding closes the loop for healthcare facilities looking to improve the safety and efficiency of medication administration. During the closed-loop medication workflow, a nurse scans the barcoded wristband id with a scanner interfaced to a mobile or bedside computer to identify the patient. The nurse then scans the barcode on the medication to compare the information in the patient s electronic record, verifying that the patient should receive the medication at the indicated dosage and time. This closed-loop process helps ensure that medication administration follows the physician prescribed orders entered in the CPOE. ACCURATE BLOOD ADMINISTRATION According to the FDA, an average of 414 transfusion errors occur annually in the U.S. About one in 38,000 transfusions. When transfusion errors do occur, incorrect identification of patients is a leading cause. A recent industry study shows that bedside or labeling mistakes contribute to nearly 80 percent of blood transfusion errors. To help promote a culture of safety and minimize the incidence of preventable errors like these, the centers for Medicare and Medicaid services stopped reimbursing hospitals for never events, which includes the treatment of blood transfusion errors. All blood products carry standardized barcode identifiers that make it easy to create scan-based safety checks. The process for verifying that patients receive the right blood products is very similar to the process for medication administration. After verifying patient identity using the barcoded wristband, the nurse scans the blood product for transfusion, confirms the patient s blood type, and verifies both the physician s order and the patient s consent. 8 zebra technologies
ENHANCED SPECIMEN COLLECTION Medical professionals can only make the right diagnosis when they have the right information and this means having accurate specimen matchups. Studies report that 160,900 adverse events occur in U.S. hospitals annually due to specimen identification errors. At the typical medical facility, staff creates specimen barcode labels when they receive lab orders. The lab orders are assigned to a technician who is responsible for collecting the specimen requested on the lab order. Unfortunately, this process is not failsafe because staff can easily place the wrong label on the wrong specimen. Labels can also be easily lost or misplaced. Barcode-driven patient ids are vital quality-assurance tools for tracking collected specimens. By scanning patient wristbands prior to drawing specimens, and by producing barcode labels on-demand at the patient bedside with a mobile printer, caregivers can minimize the potential for error and create digitally precise tracking visibility. The use of barcode systems can also help to drive productivity enhancements by reducing duplicate tests and the need for re-draws. Scanning the barcode on the specimen container in the lab also saves technicians the time of entering the patient information into their computers. IMPROVED POINT-OF-CARE TREATMENT Incidents of incorrect X-rays, incorrect routine bedside checkups, and procedures performed when not indicated comprise the second leading cause of malpractice claims after medication errors. It s another reason patients need their virtual voice heard. Wristband scanning for precise patient verification could help surgical teams, respiratory therapists, radiology technicians, physical therapists and other professionals ensure they are providing the right treatment or service for the right patient. Avoiding Quality care begins with quality wristbands. Maximizing patient safety from the start of care requires that a barcoded id wristband stays on the patient and remains readable for the duration of the hospital stay. It must uniquely identify the patient in a manner that meets strict regulatory compliance. It must also improve workflow efficiencies so staff can spend quality time with patients, and address the center s goals to reduce costs. Barcoded wristbands produced with printers built specifically to print wristbands conveniently and cost-effectively satisfy all these conditions. There are many ways to benefit from barcoded patient wristbands and take advantage of the accuracy and these errors provides enormous safety and liability benefits from the bedside to the bottom line. ZEBRA TECHNOLOGIES COVER PATIENT IDENTIFICATION LIKE NOBODY ELSE CAN, VISIT WWW.ZEBRA.COM NA and Corporate Headquarters +1 800 423 0442 inquiry4@zebra.com 2016 ZIH Corp and/or its affiliates. All rights reserved. Zebra and the stylized Zebra head are trademarks of ZIH Corp, registered in many jurisdictions worldwide. All other trademarks are the property of their respective owners. 07/2015