Barcoding Tips
Contrary to the belief held by many in healthcare that barcoding is a time-consuming, expensive and complicated effort, hospital leaders can take comfort in learning that barcoding can be quick to implement, requires little if any financial outlay, and is simple to put into place. With these factors firmly in mind, there is no reason to delay implementation of barcoded patient wristbands that improve patient safety right away.
How Barcoding Works
Barcode scanning is based on the principle of light reflectivity from various colored surfaces. To decode the information in a barcode, a small spot of light is passed over the bars and spaces with a scanner. The barcode reflects the spot of light back into the scanner in varying amounts, based on the width of the bars and spaces. The dark bars absorb the light and the white spaces reflect the light; the differences in reflectivity are translated into electrical signals by a light detector inside the scanner. These signals are converted into computer code in combinations that stand for letters and numbers.
Why Implement Barcoded Wristbands?
Healthcare facilities have embraced barcodes because they can help reduce errors in medication administration and lab specimen labeling, and they support improved charge capture and other revenue enhancement applications. In addition, they are easy to use and are extremely accurate. What’s more is that adding barcodes to wristbands can be accomplished without requiring expensive equipment or software – and can often be seamless using existing printers. Even those sites not yet prepared for implementing bedside software solutions will find taking the first step to be a great way to prepare their facilities for future technology implementation.
Symbologies
Barcodes come in many shapes and sizes. A barcode symbology can be viewed as a “font” (just like a text font) that encodes information using particular rules. There are a variety of fonts due to the variety of purposes for which barcodes are used. Some symbologies are for specific applications or are used only in specific industries. Others are commonly used across various market segments. In healthcare, there has been an evolution in the symbologies as applications have been developed, and as the demands of those applications required specific functionalities and capabilities.
Linear Barcodes
Most consumers will be familiar with linear barcodes. UPC codes, printed on consumer products we buy every day, are one of the most common linear barcodes around. As the name suggests, linear barcodes are created using lines. The pattern of the lines and the spaces between them encodes information that can be “read” by a scanner and used by an electronic system. One major benefit of linear barcodes is that all commonly used modern scanning equipment can decipher them and collect data.
Orientation – barcodes can be printed in two directions:
- Horizontal orientation, often called “picket fence” layout.
- Vertical orientation, usually referred to as “ladder” orientation.
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Although no formal studies have been undertaken, many users report that it is easiest to scan a wristband with a vertically oriented barcode. The rationale for this preference is due to the barcode reader’s difficulty in accommodating a curvature in the band when scanning a horizontal barcode.
Common Symbologies – there are a number of common linear symbologies used in healthcare settings. Those most commonly used for wristbands include:
- PDF417 – this symbology has fast become the standard wristband barcode. The size of the barcode for the information being encoded tends to be much smaller than other symbologies, making scanning easier. PDF417 has other advantages including:
• Fully alphanumeric
• Widely supported throughout the industry
• High-density code does not waste space
• Flexibility to go from one subset of the symbology to another, even within
the same symbol
• Data security that ensures that a printing defect cannot cause a character
to be transposed into another valid character. |
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- Code 3 of 9 (sometimes called Code 39) – although this began as the most common symbology used on patient wristbands, the selection of this symbology had more to do with what Hospital Information Systems could support. Since the resulting barcode tends to be longer than many other symbologies, this barcode is falling out of favor for wristband use.
Two-Dimensional Barcodes (2D)
Two dimensional barcodes are widely used in some industries, such as express package services, and they are fast gaining in popularity for wristband use. These barcodes are made up of a block of cells which are filled or unfilled to represent data. Advantages of 2D barcodes include their large data capacity, error detection and correction features that improve scanability, and space efficiency. These features make 2D barcodes a good choice for forward-looking facilities. The major consideration hospitals should keep in mind when considering implementing a solution that involves 2D barcodes is the need for a barcode reading device that includes an “imager”.
Common Symbologies – several 2D symbologies have gained attention in the patient identification world. Those most commonly used for wristbands include:
- PDF 417 – this symbology is the most popular symbol of its type. It offers flexibility in choosing the error correction level, making it extremely robust and less likely to be damaged.
- MicroPDF417 – this is a highly space-efficient symbology that encodes information efficiently into a small area.
- Aztec – this code is the most space efficient of all symbologies recommended in the healthcare arena. One reason it has gained attention is that it is easily repeated and can form a continuous symbol, which is useful on a curved surface, such as a wristband. A unique characteristic of the Aztec code is that it doesn’t require any quiet zone.
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Implementation Considerations
Deciding to barcode means that you have committed to improving patient safety through the use of technology. But getting there takes some thought and consideration of a number of important decisions.
Printing options – Since you will always have to get printed patient information onto a wristband you need to determine what technology you will use. There are basically two printing technologies to consider: laser and thermal. What you select will be based on the wristbands you choose and the specific decision points that relate to each of these options.
Scanning equipment – it’s good to think ahead when considering which scanning equipment to purchase. Consider whether you want tethered or wireless scanners…or if you will be using glucometers with built-in scanners, PDA’s with scanning capability or other devices that can scan. More advanced technology, like 2D barcodes, requires different devices than simple, linear barcodes. Buying forward-compatible equipment may cost more in the short-run, but it is likely to save thousands and speed transitions to new applications in the long run. Always be sure that the barcode you select works with the scanning technology you purchase!
Symbology – depending on your application and the systems you are using, you should give careful consideration to the symbology¹ you are going to use. Keep in mind that the symbology is simply a means to encode data. Since data is decoded by the scanner before reaching your application, most applications should be neutral as to which symbology you select.
Wristband and/or label selection – Your wristband choice(s) can dramatically impact patient safety. Your investment in high-tech, expensive equipment cannot help you validate your patient’s identity and ensure their safety if they are not wearing a wristband or if the barcode is not scanable. Reducing medical errors takes more than a barcode, though. Selecting the right wristband¹ and implement patient identification procedures¹ are what really count. Spend extra time understanding your Admissions Wristbands, since those are most critical to positive patient identification and patient safety. Things to consider include:
- Closure type: tamper-proof/tamper-resistant, tamper-evident or repositionable
- Printer type: laser or thermal
- Print area size: some bands have smaller print areas than others; be sure the print area is adequate to your needs.
- Ability to re-band: bands are cut off for many reasons – consider the process of re-banding that would be accepted at your facility
- Durability: how long will a band last compared with your ALOS?
Training – Like anything else, getting the most out of your new patient ID system and the barcodes you print on them requires training. Aside from creating an atmosphere of competence and acceptance, it helps keep those who would find “work-around’s” from doing so. Some things to consider for training include:
- Supporting staff with “coaches” is useful, but remember to have people available during all shifts.
- Have sample wristbands and scanners hooked up and available for practice in advance of a go live. These should be in easily accessible locations or else they won’t be used.
- Consider whether or not you want patient chart labels to have barcodes. This is a common source of barcode scanning data that is not on the patient's wristband.
- Alternately, select a symbology on your wristbands that works exclusively with your POC system so scans from a label will not be accepted as valid inputs.
¹ This information is available through our archive site. Please note information and products located on the archive site are not updated and may be obsolete or unavailable.
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