Medical error remains healthcare’s most stubborn and deadly problem, but could the answer be as straightforward as scanning a box of cereal at the supermarket checkout? An intriguing new report builds on an emerging movement to make healthcare cheaper, more transparent – and safer – by adopting the trappings of supply chain management. Assigning unique bar codes to drugs, medical devices, nurses, doctors and patients would allow facilities to digitally track and monitor treatment, creating an early warning system to head off mistakes before they happen, said Anne Snowdon (pictured), author of the white paper.
If things still went wrong, such a system could produce a transparent, objective record, unsullied by faulty memories or intentional omissions, the head of the University of Windsor’s World Health Innovation Network said.
“For patients, it would be a complete game changer,” said Snowdon, a former nurse and professor at Windsor’s Odette business school. “It could not only mobilize and bring much safer care for patients, I think it rebuilds confidence of Canadians in their healthcare system.”
Lori Turik, the Odette school’s executive director, is on one of the boards of GS1 Canada, the non-profit group that oversees barcode standards.
Under Snowdon’s proposal, instruments would be scanned before use in an operation, generating an electronic catalogue to ensure none are left behind in the patient.
Scanning a bar code on the patient’s bracelet would indicate when that patient was last turned, helping avoid potentially fatal bed sores, the report says.
Radio-frequency identification technology could ensure wandering dementia patients do not come to harm, and matching bar codes on mothers and newborn babies would prevent the infant from being abducted or discharged to the wrong parents.
Some early attempts are already being made to implement the concept.
A few Canadian hospitals are bar coding medication, with at least one reporting dramatic improvements in safety.
Alberta Health Services has begun a project to introduce GS1 identifiers – the international system of bar codes – more broadly within its facilities.
“I absolutely believe this is the way we need to go,” Chris Power, CEO of the Canadian Patient Safety Institute, said. “The grocery business is way ahead of us. We need to standardize, we need to be bar coding, we need to be tracking.”
Still, she said that making virtually all parts of medical care electronically scan-ready would be a costly challenge for a system struggling just to move from paper to electronic records.
Darrell Horn, a Winnipeg-based patient-safety expert said such systems almost always have unintended, negative consequences.
“Technology doesn’t eliminate human work, it creates new kinds of human work and therefore new opportunity for human error,” he warned. “Providers could find themselves overwhelmed with new and unfamiliar tasks.”
And the wide adoption in healthcare of another trendy business idea – the Toyota Lean system – has had decidedly mixed results.
But there is at least motivation. Underlying Snowdon’s report is the massive toll still taken by medical error.
A landmark 2004 study – based on analyzing a representative sample of hospital charts and extrapolating the results to the whole system – concluded that 9,000 to 23,000 Canadians die from preventable “adverse events” in hospitals every year.
And one of the authors concluded last year the numbers have likely not changed much, despite a decade of intense effort.
“Although we’ve made lots of great gains, we’re still (inadvertently) harming people at an alarming rate,” echoed Power.
As it turns out, most products in healthcare already have bar codes, used by manufacturers and distributors, but ignored once they reach the hospital loading dock, says Snowdon.
Her proposal is that patient wristbands would include a bar code providing access to digitized medical information, which could be cross-referenced to the treatment provided.
Under the drug systems already being implemented, for instance, an alert goes off if the medicine or dose of medicine or timing of the dose does not match what had been prescribed.
Overall medication errors dropped more than 30 per cent at London, Ont., hospitals after the system was put in place, and cases specifically of administering the wrong drug fell 90 per cent.
The same concept should be applied from the operating room to the diagnostic-imaging suite, the paper says. Patient bar codes could stop surgeons from operating on the wrong body part, or warn if an individual has metal implants that might prove lethal once the MRI machine’s magnetic field is activated.
Using advanced supply chain management would save money, as would reducing the incidence of medical error and the longer hospital stays they trigger, Snowdon said.
Source: National Post