Using Bedside Labelling to Reduce Errors and Improve Efficiency

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Written by Allan Neo, Director, Systems Engineering, Intermec APAC   
Friday, 25 March 2011
Allan NeoThe foundation for patient safety in Asian healthcare institutions is positive sample and patient identification. Preventing procedural and medication errors depends on accurately identifying patients. But consider that for each individual patient, there may be dozens of different samples and test results that a hospital or healthcare institution has to manage.

While the patient can only be in one place at one time, his or her blood, urine, tissue and other samples may simultaneously be in departments throughout the hospital and other labs and healthcare facilities.

Accurate sample identification and management processes need to begin at the patient bedside: The greater the time or distance between when a sample is drawn and when it is identified, the greater the chance for error.

A major study1 of specimen labelling published in 2008 claims mislabelled specimens were the most common error in the healthcare environment. The study states:

“Mislabelled specimens are perhaps the most serious errors, since they may be associated with subsequent problems for patient care. A consequence of mislabelled specimens can be a wrong result for a patient, which may, in turn, cascade into wrong therapy. Mislabelled specimens can have a significant impact on patient safety and health care costs”

To put into context how serious a problem not having the correct specimen labelling and recording procedures in place in healthcare organisations can be (not just for a single facility but for a country’s healthcare reputation overall) a high profile fertility centre in Singapore - Thomson Medical Centre (TMC) - was recently forced to admit that their facility had used the wrong sperm for an IVF procedure which ultimately produced a baby whose DNA did not match the father's genes.
The fallout from this specimen misidentification error has produced untold damage to the family who sought IVF treatment at the TMC facility. Alarmingly for the Singapore’s healthcare sector though, this incident has been recognised by the government to not only have damaged the reputation of the IVF clinic in question, but also to have negatively impacted on perceptions of the state of Singapore’s’ healthcare sector overall. Health Minister Khaw Boon Wan said: The incident has not only 'hurt the reputation' of the centre's IVF facility, but it has also 'indirectly affected Singapore's reputation as a regional medical hub.'*

To confirm just how serious an issue specimen labelling errors play in the healthcare sector, a recent study2 found that misidentification was the root cause of 72 per cent of adverse effects and that specimen mislabelling key contributing factor within this.Additionally, a UK study found that missing wristbands and wristbands with incorrect information were directly responsible for 236 incidents and near misses in a 19 month period3.

There is a clear opportunity to improve patient safety by improving specimen and patient labelling. Leading healthcare organisations such as the Joint Commission (JCAHO) require that samples are labelled in the presence of the patient to help reduce misidentification errors. Technology tools can make the process even more effective by solving labelling problems such as missing or illegible labels. By using mobile printers to produce sample labels at the patient bedside, hospitals can eliminate sample misidentification while also improving the durability and legibility of labels so they remain readable for as long as they required.

One of the most prevalent ways of combating issues within the healthcare sector has been the implementation of automatic bedside labelling using mobile printers. Creating and applying sample identification labels at the time the sample is drawn can virtually eliminate unlabelled and mislabelled samples, which together account for more than 50 per cent of all sample labelling errors.

Using the proper printer and label material can help ensure the labels will not become illegible or fall off the sample container during transport, testing and storage. To gain these benefits, hospitals need the proper processes, computers, scanners, printers and media to ensure label quality and effective identification.

The general process for automating bedside sample collection begins with using a handheld computer – such as Intermec’s new ruggedized CN70e – to automatically identify the patient by scanning his or her bar-coded wristband.

The scan triggers a patient record lookup, either from the handheld computer’s onboard memory or by accessing a host system over a wireless network. Once the patient is identified and the physician’s order for the sample is confirmed, the clinician or nurse collects the sample and records the transaction on the handheld computer. This action automatically triggers the computer to send a label request (either wirelessly or through a connection cable) to a mobile printer. The printer then outputs the sample label. This label may include the patient name and ID number, clinician ID, sample type, time of collection and other information, plus a unique serial number to identify the sample, with a bar code to facilitate automated tracking and confidentiality. The clinician or nurse then immediately applies the label to the sample. A duplicate label may be printed and affixed to the patient’s chart.

Perhaps the biggest benefit of the automated process described above is that sample labels are printed at the time they are needed and can be applied immediately, which significantly reduces the chance that the label will be applied to the wrong sample. Pre-printing patient sample labels is a common practice, and the process has been cited as a leading source of specimen mislabeling.3

Dr. Elizabeth Wagar, director of clinical laboratories at UCLA and lead author of the College of American Pathologists Q-Probe study on specimen labelling errors, noted the link between labelling delays and sample misidentification in an interview: “Some laboratories will generate a whole stack of label sheets for the phlebotomists, and it’s really easy to mix sheets of labels.4“

Ensuring that the right technology is used to print the labels is essential in ensuring that patient safety is maintained at the highest level. Ensuring that the correct technology is put into each room and that labels are crafted to withstand the environments that they are being used in (as opposed to settling for a cheaper option) will provide insulation from mistakes where litigation could be an issue, not to mention protecting (or even improving) the reputation of the healthcare providers.

In 2011, it is unacceptable for labelling mistakes to occur, and yet they continue. The technology is available for effective prevention, but is being underutilised.

About Intermec :
Intermec Inc. (NYSE:IN) develops and integrates products, services and technologies that identify, track and manage supply chain assets and information. Core technologies include rugged mobile computing and data collection systems, bar code printers, label media, and RFID. The company’s products and services are used by customers in many industries worldwide to improve the productivity, quality and responsiveness of business operations. For more information about Intermec, visit
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