Patient safety is very important to the healthcare provider, healthcare facility or organization. One area that continues to be a safety issue is mislabeled or unlabeled specimens. Mislabeled specimens happen for a variety of reasons but regardless of the reason the outcome can be devastating to the patient, family, provider and institution (Intermec, 2010). Mislabeled specimens are not intentional and providers do not want harm to come to the patient, fortunately there are solutions that can help prevent this from happening.
Organizations that are trying to achieve The Joint Commission’s 2017 National Patient Safety Goal of identifying patient’s correctly to make sure that each patient gets the correct treatment look to positive patient identification software systems through barcoding as a solution (The Joint Commission [JCAHO], 2016). By utilizing the barcode technology that is currently being implemented with electronic patient records, bedside clinicians can be instrumental in reducing mislabeled specimens by using positive patient identification.
The company SCC Soft Computer has been in existence since 1979, it is one of the leading information systems in the laboratory field (Soft Computer Company, n. d. ). The company has a strong background and proven track record showing continued growth and development of new products. SCC Soft Computer has SoftLab which is part of the company’s software program suite called Laboratory Information System Suite and is currently at use at Maine Medical Center (Soft Computer Company, n. d. ).
This program suite has been recognized for as a market standard in interfacing, strong functionality and cutting edge solutions (Soft Computer Company, n. d. ). This laboratory software pioneer has continued to develop and improve its functionality by bringing the positive patient identification to the bedside with their supportive product called SoftID. The SoftID program is a supportive product that improves mislabeled and unlabeled lab specimens at the bedside by using positive patient identification and label printing at the bedside (Soft Computer Company, n. d.).
This program supports nursing and phlebotomists with an effective tool to verify patient identification by utilizing barcode technology at the bedside and decreasing mislabeling of specimens (Soft Computer Company, n. d. ). Rationale Mislabeled specimens are a significant problem for hospitals in the United States, this identification problem happens to hundreds of specimens a year (Stein et al. , 2011). This can be costly to the patient and organization, uncomfortable for the patient and cause delays in treatment of the patient’s condition (Stein et al. , 2011).
Positive patient identification is a very important step when administering medications, treatments and diagnosis. By implementing barcoding technology clinicians are able to positively identify the patient and thus reduce the incident of errors, prevent unnecessary redraws of labs and prevent delays in treatments (Brown, Smith, & Sherfy, 2011). By using SoftID for positive patient identification the clinician is able to increase the safety of the patient. Collecting specimens by using barcoding technology the clinician is able to confirm that the right test is for the right patient and the right specimen (Intermec, 2010).
Additionally, the benefits of bedside printing of specimen labels helps with unreadable labels since it eliminates the need for handwritten transcription, it automatically time stamps and dates the specimen removing human error and eliminates unlabeled specimens (Intermec, 2010). Since this system is already in place in the Maine Medical Center laboratory the product is a great addition and has a lower cost to implement since it only requires the bedside scanners, printers and a small amount of interface with EPIC (Vahman, 2013).
Implications for Change Since the SCC Soft Computer software is already in place at Maine Medical Center in the laboratory the next logical step is to implement the bedside verification and printing of labels. To implement this system will not require any significant change in the current laboratory flow other than the real-time printing of labels at the bedside with the patient and the use of handheld scanners to positively identify the patient (Vahman, 2013). Printing patient labels at the bedside would decrease phlebotomists waiting for labels to be sent through the pneumatic tube station and potentially increase productivity (Vahman, 2013).
With the handheld devices, the phlebotomists have the opportunity to see all labs that need to be drawn even those added on while they were in transit from dispatch and will be able to collect them all at once saving the patient pain and discomfort from multiple draws (Vahman, 2013). According to testimonials from other hospitals that have started using SoftID, the number of mislabeled specimens have dropped from four to seven mislabeled or unlabeled specimens to one in a three-year period (Soft Computer Company, n. d. ).
This is a significant cost savings for duplicate draws or specimens being sent and has the potential to improve patient satisfaction scores around safe care. The change to positive patient identification and bedside labeling will be a change in the workflow for nursing. This flow will also require that the system work with the current system, EPIC to collect the specimen and print the labels. Hardware and software will need to be installed in order for the program to work properly and there will need to be training and an implementation schedule (Vahman, 2013).
Even though there will be more of a workflow change, the amount of mislabeled or unlabeled specimens is expected to decrease significantly and thus creating safer patient care overall and cost savings for redraws. Making sure that clinicians are aware of the reasons behind why this is being implemented is important as preventing harm is a significant driver for engagement (Nelson & Staggers, 2014). Implementation and Interprofessional Collaboration Since the laboratory already has the SCC Soft Computer software in place implementation of the added positive patient identification will be easiest to implement there.
Anytime there is a new product that will impact the workflow of the department no matter how small there needs to be an interdisciplinary workgroup developed (Nelson & Staggers, 2014). This workgroup should include phlebotomists, nursing, nursing informatics, IS and the management of those areas (Nelson & Staggers, 2014). One of the goals of this group is to take the institutional goal that is influenced by The Joint Commissions Patient Safety Goal of positive patient identification and determine how the system will accomplish that goal (Nelson & Staggers, 2014).
In addition to the overall goal the group than needs to look at how the proposed system will change workflows and come up with the best way to handle that with the company representatives from SCC Soft Computer (Nelson & Staggers, 2014). Once this has been designed the laboratory will decide on training schedules for the staff, mostly phlebotomy, and hardware purchase and installation (Vahman, 2013). Once these things are determined a start date of when the new system will be in place will be determined (Nelson & Staggers, 2014).
In addition to this the representatives will work with the informatics department on how to hear about and trouble shoot issues that come forward with the new system and workflow. This is an important part of the implementation since any issues will need to be figured out quickly so that front line staff do not get frustrated and develop their own way to work around the system issues that could negate the full purpose of the system (Nelson & Staggers, 2014).
Simultaneously implementation of this new system on inpatient nursing units will need to be chosen and trial out this system with the laboratory. This will be a little bit more challenging since the workflow will be different. At Maine Medical Center there are fifteen to seventeen inpatient units that will need to implement this new system once it is operational so the trial units will need to be units that will represent the majority of all the units and encompass the greatest number of mislabeled specimens (Vahman, 2013).
This will help the implementation team have a baseline of errors and be able to show the success by adding this program. These units need to be willing to work out flow and system issues and be able to give positive feedback (Nelson & Staggers, 2014). This trial needs to be collaborative and include the leadership of that unit, front line staff from that unit, the informatics team and company representatives that work together to make sure that training, hardware and support are provided throughout the trial (Nelson & Staggers, 2014).
A constant feedback loop from within this group is important so that any issues that come up can be fixed quickly to prevent frustration with the system or the workflow change. Evaluation Once the first trial units have implemented the system, there needs to be thought on how to implement this throughout the organization. This next step should not happen until the other units have success and have given feedback on improvements, if the trial units are not successful than the interdisciplinary group needs to meet again to discuss the issues that are being faced and develop a new plan.
If the first units are a success than the selection of the next units will start, this should include more than the original amount of trial units with the strategies from the first trial units implemented for better success of implementation. An ongoing loop of feedback on issues encountered must be maintained throughout the new implementing units as other units different from the first few may encounter different issues not originally figured out.
Once the second round of implementation is complete next units are chosen with each group increasing in size until the entire organization is onboard. Reports of mislabeled specimens are monitored throughout the process to figure out system or workflow issues with an overall goal of zero mislabeled specimens six months after the final unit is online. At this point the interdisciplinary group is converted into a maintenance group much smaller in size to continue to monitor how the system is working and looking for improvements.