On Track

The need to identify and track healthcare entities within the healthcare delivery process–whether they be equipment, medications, devices, patients or staff–has never been greater. Information technology is at the ready to serve. Here is a look at how three healthcare organizations address their own challenges of identification and tracking.

The need to identify and track healthcare entities within the healthcare delivery process–whether they be equipment, medications, devices, patients or staff–has never been greater. Information technology is at the ready to serve. Here is a look at how three healthcare organizations address their own challenges of identification and tracking.

Keeping track of expensive equipment, key staff members, administered medications and patients themselves can save hospitals time and money while boosting day-to-day efficiencies.

How often does a piece of equipment that normally resides in one department mysteriously find its way to another department? How many times has a staff member not been able to hear an intercom page? How uncertain are nursing supervisors that every patient in their unit was given the right meds at the right time? And how often are patients stacked in admissions until enough beds become available?

With the refinement of technologies such as radio frequency identification devices (RFIDs), bar-coding and bed-tracking software, more and more hospital administrators are starting to answer those questions with a resounding, “Never.”

Tagged and Located
As an emerging technology with widespread use in a number of verticals, RFID is also proving to be an effective tool in healthcare. At Yale-New Haven Hospital in New Haven, Conn., for example, RFID technology is being used to track down equipment. “Equipment was being moved in and out of units and not being returned,” says Joe Lederer, director of perioperative support systems. “It was not an issue of equipment being stolen, just an issue of departments that paid for equipment not getting that equipment returned. The end result was wasted labor hours searching out needed equipment.”

While Yale-New Haven is licensed for 944 beds, the hospital has three patient towers with access shared among the three. On the third floor of one building are 21 rooms that comprise the inpatient OR. On the third floor of the second building are 10 rooms for the outpatient OR. In the third building is the pediatric OR with five rooms. Not only was it difficult to hunt down equipment that might have been moved from one building to another, Lederer says, “but finding something even in the same building could be a challenge.”

There had to be a simple and effective way to keep track of equipment, he reasoned. Four years ago, the hospital began using bar codes on instrument sets and today still uses bar-code technology to inventory and manage instrument sets and supplies in operating rooms and supply storerooms. But bar-coding technology is only as good as the staff’s adherence to scanning at each scan location. “Every year the hospital develops a business plan and process, and technology is part of that business plan,” Lederer explains. The hospital reviewed RFID’s applicability and decided to test its effectiveness. Yale-New Haven also decided to pilot the technology in the operating rooms that are extremely equipment-intensive.

The search for an applicable RFID system led the hospital’s IT department to Lawrence, Mass.-based Radianse Inc., a company that shipped its first commercial indoor positioning solution (IPS) in December 2003. The location accuracy of the Radianse IPS had already been documented at virtually 100 percent as a result of a double-blind, peer-reviewed study conducted at Massachusetts General Hospital in 2003. That study was funded in part by a grant from the National Institutes of Health. By January 2005, 10 hospitals were using Radianse systems.

Yale-New Haven implemented the wireless, Web-based Radianse IPS at the start of June 2005, Lederer says, and installed the necessary wireless infrastructure on the third floor of each tower to accommodate the ORs and the cardiothoracic ICU. The basement also was wired to track equipment in central supply, as well as in basement areas where tagged items could end up if inadvertently discarded. Approximately 1,000 pieces of equipment, including supply carts, were “tagged” using reusable, programmable tags, Lederer says.

Simple to program, the tags can send hospital-defined alerts such as “equipment tag removal” or “equipment leaving defined usage perimeter.” Because these are “active” tags, they include a battery that sends out a signal every 10 seconds, which is picked up by wall-mounted wireless receivers.

Where’s My Manager?
Finding a piece of equipment is as simple as selecting an icon on a PC’s desktop and clicking “find equipment,” which then presents an inventory of all tagged equipment and their location in either list or map format. Lederer says the system is getting about 25 hits a day from staffers looking for equipment.

Although receivers were not installed on the other floors of each tower, the hospital currently is working with Radianse to develop a cart-mounted PC with an attached receiver. Traveling those floors with the cart would enable a staff member to find equipment that may have been moved out of the OR. If the OR pilot is successful and the remaining floors are covered with the appropriate infrastructure, this cart would no longer be needed and an entirely new set of tracking applications would open up.

Yale-New Haven also has begun to track operating room department managers using RFID tags. “It’s a good way to begin to experiment with the ‘find staff’ functionality to identify where critical managers are when we need them,” Lederer says, adding that the hospital also has asked Radianse to “come up with a ‘blueprint of movement,’ showing lines or paths of tag movement during a shift.” Lederer admits it will take time for some of the staff to overcome the Orwellian notion that wearing an RFID tag means Big Brother is watching their every move, but the organization itself has made progress in this direction. In fact, Lederer, like 25 other Yale-New Haven managers, now sports an RFID tag.

“Our goal is to get people used to seeing us wearing these tags, so it’s perceived as a positive development,” he says. By September 2006, the hospital plans to begin tracking patients as well. For that project, Radianse single-use active RFID tags, which are wristwatch-size devices, may be used.

Safety Through Coding
Bar coding is not a new technology, but according to the Journal of the American Society of Health System Pharmacists, less than 5 percent of hospitals provide bar code-enabled patient safety measures nationwide. The use of this technology at the point of care, however, can ensure that the right patient gets the right dose of the right medication at the right time.

To address the possibility that medication errors can occur, Sutter Health in Northern California has embarked on a multimillion dollar safety program that will place a bar-code scanner at every bedside throughout Sutter’s 26-hospital system. When fully implemented by the end of 2007, Sutter will be one of the largest health systems in the U.S. using bar-code technology as a tool for patient safety.

With its network headquarters located in Sacramento, Sutter Health’s healthcare system includes community-based cardiac and cancer care centers, rehabilitation clinics and behavioral health centers. Its network of 26 hospitals has about 5,800 beds. Stressing Sutter Health’s priorities, Chief Information Officer John Hummel says, “We’ve invested $50 million in patient safety initiatives,” adding that $25 million of that was earmarked for bar-coding technology.

Whole-hearted Support From Nurses Hummel says he began to seriously look at bar-coding options in 2001, but discovered that the healthcare industry was slow to adopt the technology. “Most software vendors hadn’t started looking at it.” By 2002, though, he had the funds to begin a pilot program in 10 of Sutter Health’s hospitals and chose the eMAP bar-code system from Solana Beach, Calif.-based Bridge Medical Inc. That company was subsequently acquired by Cerner Corp. of Kansas City, Mo.

The eMAP system, which Sutter Health rolled out in 2003, is able to read bar-coded patient wristbands, pharmaceutical products and staff badges–steps required to accurately track the administration of medications. The system also alerts nurses to possible allergies and drug interactions, potential look-alike or sound-alike drugs and high-risk meds. Plus, “We can bill a patient directly on what has actually been administered, not just ordered,” Hummel says.

In addition to the eMAP system, Sutter Health installed bar-code printers from Vernon Hills, Ill.-based Zebra Technologies Corp. That company, originally incorporated in 1969 as Data Specialties Inc., merged in 1998 with Camarillo, Calif.-based Eltron International Inc., a leading manufacturer of desktop bar-code label and plastic card printers. In 2000, Zebra acquired Comtec Information Systems, a leader in innovative mobile printing solutions. Today, the company provides thermal bar-code label and receipt printers, card printers, RFID smart label printers/encoders, label design/integration software, and a wide range of thermal printer connectivity and networking solutions.

In selecting its bar-code printers, Sutter Health chose a small desktop printer and a midsize tabletop printer. Used in conjunction with the Mediware WORx pharmacy application, the printers are being used to print pharmacy medication labels and in one facility, Sutter Roseville Medical Center, to print patient wristband labels. “We chose Zebra printers because of their reliability, and we’re using them now for wristbands and nurses’ tags,” says Hummel. “A few years ago, most label printers were big and bulky, but they became smaller and easier to attach to PCs.” Because both the printers and the eMAP system run on a Windows NT platform, they were easily linked.

Every hospital that has initiated a bar-code program knows how difficult it is to get bar-coded unit doses to the patient. At Sutter Health, less than 35 percent of medications are received from the manufacturer bar coded. As a result, the organization bar codes unlabeled unit-of-use level medications, which total approximately 32 million doses per year.

As part of a strategy to tie in the bar-coding system with the laboratory system, the first bar-code printers were installed in the laboratory, according to Hummel. They also are located in the pharmacy and at nursing stations. But because this pilot program spans a number of hospitals, printers at some nursing stations are on a wireless network while others still use a wired local area network, he says. The combination of these two technologies also is evident at the bedside. While most of the hand-held, bar-code scanners are wireless, there are some that are wired.

Surprisingly, the decision to begin deploying bar-coding technology was greeted with enthusiasm among the nurses at all 26 hospitals. “I’ve never had nurses want a system this much,” says Hummel. “We did a presentation to nurse managers, and there was 100 percent agreement. We asked them who wants to be first, and everybody raised their hands.”

Preventing Medication Errors
Ultimately, choosing the first 10 hospitals was based on a number of criteria including size, whether they were currently in the middle of a new system install, CEO and CFO involvement and whether they had staffing support.

Some healthcare organizations have experienced resistance from nurses who believe scanning three times to administer each medication will take more time. But not at Sutter Health. “We showed them they could eliminate one hour per shift in paperwork,” he says. “We also showed them that this would prove they’re doing a good job, not that we were going to catch them making mistakes.” In fact, after just one year, Sutter Health reported that its bar-code system prevented an estimated 28,000 medication errors over the course of 2.6 million drug administrations. Of these, about 2,600 (approximately 9 percent) could have produced moderate or severe clinical effects.

“I’ve never had nurses want a system this much. We asked them who wants to be first [to use the system], and everybody raised their hands.”

–John Hummel
Sutter Health

Physicians also welcomed the new system and even used it as leverage to get Sutter Health to begin rolling out an electronic medical record. “There has always been a suspicion on the part of physicians that we wouldn’t have enough PCs,” Hummel says. “Then they saw the PCs at every bedside.”

The goal now is to roll out the bar-coding technology to all of Sutter Health’s hospitals in conjunction with an enterprisewide EMR by the end of 2007.

Finding Enough Beds
The availability of beds in nursing units that can meet the specific healthcare needs of patients is a challenge at most large hospitals. When the number of patients awaiting admission is compared to the number of discharges, it can appear that beds are available. But that may not always be the case. Even if enough beds have opened up, and the right kinds of beds have opened up, there is often a delay in getting patients into these beds because the housekeeping staff has yet to clean the rooms.

To keep track of which beds are, in fact, available at any given time, the University of Wisconsin Hospital in Madison, Wis., rolled out in 2002 all components of the Bed Management Suite of software from Pittsburgh, Pa.-based Tele-Tracking Technologies Inc. Then in May 2005, the hospital rolled out a mobile version of the bed-tracking software which can now be viewed in real time from a hand-held device.

The initial deployment of Tele-Tracking’s automated workflow solution integrated the BedTracking and PreAdmitTracking modules with an electronic bedboard so that environmental services, admissions and patient placement staff know the status of any patient, as well as which beds are occupied, available or needing to be cleaned. In addition, the TransportTracking module uses the hospital’s existing telephone network to allow the staff to log a patient transport request, and to be alerted if a specific request has not been addressed within a predetermined length of time, explains Heidi Norwick, R.N., M.S.N., director of nursing operation support.

Beds to Meet Individual Needs
Before rolling out this system, tracking beds was no easy task. The University of Wisconsin Hospital is a tertiary regional academic medical center in central Wisconsin. It has a Level 1 trauma center, a large transplant center, comprehensive cancer center, clinical cardiac center, neurosciences center, children’s hospital and offers a full array of tertiary services to citizens of Wisconsin, the upper peninsula of Michigan, Iowa and Illinois. While the hospital has 560 licensed beds, there are specific medical needs that must be met. For example, there are beds for children; security beds for prison inmates needing medical care; beds for psychiatric patients; beds in the intensive care units; and other special-needs beds located throughout the facility, Norwick says.

In trying to keep track of all these different beds, the University of Wisconsin Hospital had developed its own “homegrown bedboard.” But it lacked an ADT (admission discharge transfer) interface and required the double entry of data, which increased the probability of errors. By installing Tele-Tracking’s color-coded electronic bedboard, data entered once is immediately available throughout the institution and can be accessed from any computer.

“If a major trauma comes in, we need to know if there is the appropriate type of bed immediately available for that patient’s specific needs.”

Heidi Norwick, R.N., M.S.N.
University of Wisconsin Hospital

Nursing coordinators–those responsible for assessing where a patient’s care can best be met within the beds and units available in the hospital–are multitaskers who regularly use their PDAs while walking from one unit to another or waiting for an elevator, Norwick notes. To “maximize their downtime,” Norwick says the hospital upgraded its bed tracking software by deploying Tele-Tracking Technologies’ “bedboard mobile,” the healthcare industry’s first digital bedboard for a hand-held, wireless device.

“One thing we could see was that nursing coordinators weren’t getting real-time information,” Norwick says. “This device allows them to have all this information literally at their fingertips.”

Make It Mobile
Designed to leverage a hospital’s existing wireless infrastructure, bedboard mobile offers the same information that is available on the PC version but looks slightly different, Norwick says. “It’s formatted so it’s easy on the eye and easier to navigate.”

As an example of how important it is to have this information available on a hand-held, Norwick says, “Seventy percent of our admissions are unplanned. They often come through the emergency room or are admitted directly from clinics.” The hospital is a Level 1 adult and pediatric trauma center and the burn center for most of Wisconsin. “If a major trauma comes in, we need to know if there is the appropriate type of bed immediately available for that patient’s specific needs,” she adds.

During the triage phase, nurse coordinators are constantly talking to the expert nurse and expert physician, Norwick says. “So while you’re talking to them, you’ve got real-time information at your fingertips.” It’s also important to be able to add information that can then be seen by others throughout the enterprise. “Given the volume of patients we deal with, you’re constantly taking notes,” she says. “Notes written into the comment field on bedboard mobile become part of the electronic bedboard data.”

Another feature of the product is that it not only allows nurse coordinators to see a current census, but also a projected census. “It’s one thing to know that we have five empty beds. But if the nurse coordinator also knows that there are seven surgical patients scheduled for the morning and they will need those beds, what looks like a handful of empty beds is actually a possible shortage of beds, and the nurse coordinators know it.”

The bedboard mobile product even includes a “find” feature. “If a physician wants to know, ‘where did the patient go,’ we press ‘find’ and the system will identify exactly where the patient is,” Norwick says. “You can search by patient name or medical identifying number.”

Since nurse coordinators were already familiar with Tele-Tracking’s electronic bedboard, it took them only about a day to get used to the mobile version.

The real challenge came in building the wireless infrastructure. “Our institution was not wireless, so we worked with the IS department and went floor by floor to create a wireless network,” she says. “Making our institution wireless was one of our goals. This just kicked it up a notch.”

For more information about RFID solutions from Radianse,
www.rsleads.com/601ht-205

For more information about bar-code technology and printers from Zebra Technologies,
www.rsleads.com/601ht-206

For more information about bedboard mobile and bed-tracking solutions from Tele-Tracking Technologies,
www.rsleads.com/601ht-207

Richard R. Rogoski is a free-lance writer and contributing editor to HMT. Contact him at [email protected].
 

© 2006 Nelson Publishing, Inc