1. Application in Brigham and Women's Hospital
A recent study in the "Internal Medicine Literature" shows that in the United States, almost every fifth dose of medicines taken by patients in the hospital is wrong. As a leading institution in patient safety research, Brigham and Women's Hospital (BWH) in Boston, USA hopes to create an automated guarantee system through the preparation and use of prescription drugs to reduce the possibility of such accidents. BWH concluded that barcode scanning is the best system to improve the safety and accuracy of all operations. An effective system will require all prescription drugs to be affixed with a separate barcode label, and only about half of the drugs shipped to the hospital are marked with the unit barcode.
When BWH plans its system, the US Food and Drug Administration (FDA) is brewing new rules that require the use of unit labels on medicines. The hospital did not passively wait for the FDA to propose barcode labeling requirements for individual drugs, nor did it rely on suppliers to provide barcode labels. In contrast, the hospital produces individual 2D barcode labels for more than 3.5 million copies of medicines each year.
solution
BWH implemented a system to track and record medicines through bar code scanning. From the treatment of medicines in the pharmacy to the use of patients, all cases are recorded. Barcodes are also used on patient wristbands, employee ID badges, prescription drug orders, and laboratory samples to facilitate automatic tracking and accurate information recording. In pharmacies and laboratories, we use various types of labels. Similarly, there are various labels for medicines used by patients on sickbeds, said Bill Churchill, director of BWH medicine services. We rely on barcodes to achieve highly accurate operation, therefore, we must ensure the reliability and continuous availability of the printer.
Doctors enter drug information into a computerized system that records the order time and the time the pharmacy received and reviewed the order. The pharmacist looks at the order in the computer and then prints out-a bar code prescription for the pharmacy technician to prepare the medicine and execute the order. Before placing an order, the bar code on the medicine and the order scoop will be scanned to ensure that the medicine dispensed matches the order.
When orders and medicines in stock are sent from the pharmacy for delivery, the barcode is scanned and the record system is automatically updated. Doctors, soil guards and pharmacists can check the status of orders at any time through computers throughout the hospital. The hospital has a wireless LAN, so information can be updated and obtained in real time. When receiving medicines, you can scan the barcodes of the medicines to record their receipt. When the medicines are removed from the drug library, you must scan the medicine barcodes again. Employees must scan their barcode ID badge during each drug transfer process to automatically create a chain of custody record.
When using medicine, the nurse scans the barcode on the patient's wristband, and then scans the barcode label on the medicine, medicine bottle or precision infusion set. Calcium will verify the correctness of the medicine to ensure that the correct dosage and composition of the medicine are provided to the correct patient at the right time.
We have a fully integrated tracking and control system. Barcodes will maximize the accuracy of our operations. Churchill said. Labeling various medicines, medicine bottles and precision infusion sets with barcodes is a large project. About 50% of the packaging used in BWH does not have a separate barcode label. Those drugs are usually only compiled with the National Drug Code (NDC), which is not sufficient to meet the information needs of BWH.
In order to ensure that all medicines have sufficient information in the barcode, BWH has established the first fully functional, completely hospital-based medicine repacking center. The center will label about 3507 products every year. In addition to the National Drug Code (NDC), Brigham and Women's Hospital has also included the drug lot number and expiration date in the Data Matrix two-dimensional barcode label produced.
We want to make sure that all the information is compiled in the barcode to help us complete the work more accurately, Churchill said. Two-dimensional barcodes allow us to collect more detailed information in the smallest available space. Compared with one-dimensional barcodes, two-dimensional barcodes can provide us with more information about each drug.
The FDA has required pharmaceutical manufacturers to label all drug products dispensed in hospitals by using the bar code of the taking unit before 2007. However, this requirement may not reduce BWH ’s need for secondary labeling, because FDA only requires one-dimensional barcodes to be included in the National Drug Code (NDC) (while drug lot numbers and expiration dates / \ recommendations are included, but it is not mandatory ) Without including the Data Matrix.
Data Matrix symbols can encode up to 3,116 numbers or 2,335 alphanumeric characters, which is far from the traditional one-dimensional barcode (for example, ordinary UPC symbols can encode 12 numeric characters :). Data Matrix symbols have no fixed size and can be very compact, which is one of the main reasons why hospital planners choose symbols. BWH has compiled data such as the national drug code, drug lot number, and expiration date in symbols that are not half a square inch.
The high density resulting from the compilation of data in such a small space requires high-quality, accurate printing. BWH uses the Zebra industrial label printer, which can maintain high print quality in high-volume printing. Zebra thermal printers fully support DataMatrix symbols and have an optional 300dpi resolution printhead, which is ideal for making compact, high-quality symbols.
A high-quality printer needs to be used for two-dimensional barcode coding. If such two-dimensional barcodes are small enough to be attached to a one-ml medicine bottle, Mr. Churchill said.
Data Matrix barcodes can also be used on wristbands to encode information such as the name of the patient, the doctor on duty, the date of admission and the date of birth. Encoding the wristband information meets the HIPAA privacy requirements and meets the National Patient Safety Objective (NPSG) requirements of the United States Medical Institutions Joint Review Committee (JCAHO) for identifying patients with medical tests that block Wow.
Because hospitals use imagers instead of laser scanners to read barcodes, the labels will be easier to read when the labels are attached to curved surfaces (such as medicine bottles or patient wristbands). According to BWH, the scan rate is very high.
effect
Barcode systems have been used to prevent mistakes during prescription entry, prescription execution and dispensing. Barcode data entry and computerized control also provide accurate and up-to-date records, thus improving medicines at Brigham and Women ’s Hospital: brother tracking and inventory management. Since we implemented the barcode system, we have made tremendous improvements in reducing pharmacy errors, Mr. Churchill said. For example, the surplus phenomenon in the implementation of prescriptions is almost beneficial: absolutely. However, the most prominent feature of our system is the ability to reduce the use of drugs. From the content of this document, you can understand that by using barcodes, the use of drugs is expected to be reduced by 60% to 80%. This is very consistent with what we have observed.
In the future, two-dimensional symbol technology will provide us with more opportunities to innovate further. One of the potential applications is to use patient ID, weight, drug concentration and other information to encode the infusion pump, Mr. Churchill said. For such detailed data, we must use a two-dimensional barcode.
2. The application of bar codes in the laboratory of hospitals-the application case of bar codes in Zhejiang Shao Yifu Hospital
In the past ten years, laboratory medicine has developed rapidly. The advent of various new technologies has completely changed the traditional laboratory working mode, and also reduced the labor intensity of staff. However, the management of hospital information is far from keeping up with the rapid development of information technology in laboratory medicine. Laboratory quality control, intelligent management, standardization and integration have brought a crisis to the research and management of laboratory medicine.
Modern medicine requires medical institutions to collect, archive, process, supervise and manage large amounts of inspection and treatment information. The traditional manual transcripts and thermal paper reports in hospitals have not kept up with the development of laboratory medicine. Even Chinese stand-alone reports and intra-laboratory networking only use the computer as a processor to receive, store, print, or send data in the department or department, but do not fully utilize the resource advantages of the computer network, so that computer management stays in one direction. Network or intranet status.
Shaw Shaw Hospital Affiliated to Zhejiang University School of Medicine was established in 1994. It is a modern, comprehensive, domestic demonstration level funded by the well-known Hong Kong businessman Sir Shaw Shaw, supported by the Zhejiang Provincial People ’s Government, and assisted by the management of the Roman Linda University Medical Center in the United States. Sexual, research-type tertiary A hospital. The hospital is located in the center of Hangzhou, with 33 clinical departments and a Shao Yifu Clinical Research Institute of Zhejiang University.
First-class hospitals need first-class information systems to improve the operational efficiency of the entire hospital. Shaw Shaw Hospital applied automatic identification technology to the laboratory department, which greatly improved the hospital's information management level. They introduced an advanced management model and carried out laboratory management. System integrators, through full communication and communication with hospital inspection personnel, design a reasonable data flow, implement practical and feasible plans, and select the best equipment to make the hospital's inspection information operation achieve unprecedented efficiency.
Data flow
The hospital's test data is mainly concentrated between the nurse station and the laboratory (see Figure 1). The work flow of the nurse station, that is, the process of generating an inspection order includes: after the application of the medical order is checked, the label is printed, the sample is printed, the signature (work number, time) is sent for inspection.
The laboratory workflow, that is, the process of a laboratory doctor's order flowing inside the laboratory: sample reception, confirmation, automatic charging, distribution to each team, a task list, a computer test, a result review, and a corresponding nurse station print regularly.
Laboratory maintenance and quality control process: maintenance operations (such as cleaning the instrument, scrubbing the workbench, recording the temperature, preparing cleaning agents, instrument calibration, etc.)-quality control on the machine to determine the quality control results.
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