Barcoding 2.0: Better patient monitoring, better patient safety

Sept. 23, 2014
David Crist, Senior Vice President, Brother Mobile Solutions

Over the past decade, barcoding has become an integral part of patient care, tracking and safety initiatives throughout the United States. Or has it? The vast majority of hospitals have implemented barcode scanning and printing systems, at the very least for patient identification and medication administration, but the persistently high rate of patient error and adverse medical events clearly indicates that most healthcare systems are not using the technology to its fullest potential.  

Although barcoding outcomes to date may have fallen short of expectations, forward-thinking hospitals are taking a closer look at the promise of barcoding 2.0. Next-gen advances such as ID printing solutions in wireless, mobile formats have made it even easier to integrate barcoding into clinician workflow seamlessly, improve efficiency and enhance patient safety – all critical to success in the new value-based healthcare environment.

Tackling the stubborn patient safety challenge

Despite numerous safety initiatives, there has been only minimal progress in patient safety in the 15 years since the Institute of Medicine (IOM) estimated that preventable medical errors caused as many as 98,000 deaths and a million injuries annually. Even back then, IOM suggested that barcoding might prevent many of these errors. The introduction of the barcode medication administration (BCMA) concept and subsequent evidence supporting its efficacy is tremendously significant to the industry and the patient. 

For example, a study published in The New England Journal of Medicine in 2010 reported that using BCMA technology to monitor patients and drugs led to a 41 percent reduction in medication errors and decreased potential adverse drug events by more than half. It also reduced documentation errors – in other words, diagnostic errors – by a whopping 80 percent. 

Today, approximately two-thirds of U.S. hospitals scan most medications at the point of administration, up from around 3 percent in 2001. From a safety perspective, there’s no question that BCMA should be used to verify the Five Rights: the right patient, the right drug, the right dose, the right route and the right time. In fact, hospitals seeking to qualify for federal incentives by meeting Stage 2 Meaningful Use objectives must automatically track medications from order to administration using “assistive technologies” in conjunction with an electronic administration record (eMAR). BCMA can be used to document compliance, because it qualifies as eMAR technology.

However, BCMA is just one part of the equation for improving patient safety. Mark Neuenschwander, President of The Neuenschwander Company and a leading expert in the field of medication dispensing automation and barcode point-of-care systems, observes that even a state-of-the-art bedside scanning system can’t alert nurses to IV medication preparation errors made in the pharmacy, such as the wrong strength of the right drug. Yet, he notes, fewer than 3 percent of hospitals currently use barcode medication preparation (BCMP) technology to scan IV ingredients for accurate volumes and strengths.

To conquer the problem of patient safety, hospitals need to expand the adoption of barcode scanning and printing into all areas of the hospital, from the patient room to the lab to the pharmacy. Any time providers perform an action on or for a patient, safety best practices dictate scanning the barcode labels with accurate drug-, test- and patient-specific information, then generating a data record entered directly into the patient’s EHR.

Proper identification is critical whether patients are being admitted or operated on, receiving medication or meals, or having something collected from them. For example, incorrectly labeled items such as mother’s milk, blood, stem cells, bone marrow, specimens and biopsies can result in misdiagnosis and improper – even life-threatening – treatment, as in the case of blood transfusion errors.   

Point-of-care labeling protects patients

To encourage hospitals to take a more holistic view of barcoding and patient monitoring, Neuenschwander prefers to use the term BPOC – barcoding at the point of care – rather than BCMA. He believes safe labeling practices provide an essential foundation for the success of any barcoding system and should include: 

Proximity. On-demand printing of barcoded labels and wristbands at the point of care ensures that the labels don’t get lost, left behind in rooms after patients are discharged or attached to the wrong items. It also reduces the risk of safety-compromising clinician error resulting from distractions, interruptions and heavy workload.

Readability. Busy clinicians need to be able to quickly, easily and accurately scan and print barcodes the first time.  

Durability. Barcoded identification labels must be readable throughout a patient’s hospital stay, even after repeated scanning. For patients, that requires antimicrobial wristbands that can survive exposure to soaps, solvents, blood and other elements. For medications, label media must also be able to withstand moisture, refrigeration and freezing.

ID printers with wireless, mobile formats are increasingly being deployed to support patient monitoring and safety at the point of care, ranging from on-demand printing of labels for medication, laboratory, trauma and surgery, to bedside identification of patients and specimens, to printing matching mother and infant identification wristbands in labor and delivery.

The availability of mobile printing capacity does not automatically promote patient safety, of course. The key is to integrate mobile and cart-based printing solutions seamlessly into the workflow, encouraging clinicians to view them as tools for providing safer, more efficient, higher quality care rather than another administrative burden they need to work around. To be effective, these solutions must integrate easily with the hospital’s existing admission, laboratory information and EHR systems, yet also be able to meet patient ID, barcoding and monitoring needs well into the future.

It’s high time to recognize that barcoding technology and utilization are both maturing, providing healthcare systems the opportunity to make great strides toward improved safety, workflow and quality of care – at a fraction of the time and cost investment required for an enterprise-wide EHR implementation.


1. Institute of Medicine. To Err is Human: Building a Safer Health System, The National Academies Press, 1999.

2. Neuenschwander, Mark. HIMSS Presentation, 2014.

3. Poon, Eric G., Carol A. Keohane, Catherine S. Yoon, et al. “Effect of Bar-Code Technology on the Safety of Medication Administration,” New England Journal of Medicine, 2010.

4. “Q&A Barcoding and Ministry—from Preacher to Barcode Evangelist,” Patient Safety & Quality Healthcare, 2010.

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