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Bar codes have penetrate to our lives, thus the use of bar codes is getting more and more common over the last 2 decades. As we can see, there're many industries around the world are using bar codes technology such as hospitals, supermarket checkout point, jails, grocery stores and even in your own home. They have been accepted as a part of our society, yet what actually are they can do and what do they present? All bar codes seems to look alike with each other, but they are absolutely not. Every different industry has developed they own standard for bar code content and format.
Due to the wider use of computer, the demand for and usefulness of data had been increased speedy. All sorts of data are needed to transmit daily between companies. For instance, from the neighbourhood supermarket stock level and re-order requirements to the world money markets which are having a big movement of vast sum. As a result, bar codes were in place to solve the issue of data explosion by providing an easy and accurate way of entering data.
Furthermore, the market for healthcare bar code solution is ripe with opportunity. It is not only in term of patient safety yet also in term of unmet demand for broader applications of the technology within healthcare organizations. There are a few industry opportunities that poised for growth including automated identification, integrated medication management, inventory control, and asset management.
This chapter will briefly introduce what is bar code technology include the structure of bar code and how bar code reader work.
1.2 What is a bar code?
Figure 1.0 Sample of bar code
A bar code as shown above is a graphic representation of data that is machine-readable which conducted by using alpha, numeric or both of it. Bar codes are a way of encoding numbers and letters by using a combination of bars and spaces of varying widths. Both the lines and spaces are read. They may be thought of as another way of writing, because they replace key data entry as a method of gathering data. In business, use of bar codes can reduce inefficiencies and improve a company's productivity. Therefore, bar codes are an easy, fast and accurate way of data entry. A bar code basically does not contain descriptive data yet it is a reference number that readable by a device which is called bar code scanner to use to search for an associated record that contains descriptive data and other private information.
For example, a bar code found on a bottle of strawberry jam does not contain the product brand, product name, or the price. It contains only a 12-digit product number. When the cashier scans this number at the checkout point the bar code reader will then decode the item bar code into an article number and discover that number on the database. The matching item record (eg, price and item title) will record on the till receipt. Meanwhile, the computer instantly subtracts the quantity on hand of that item on the database. However, when the main computer is figure out the in stock level of an item was reached a pre-determined level, an electronic message will send out to the main warehouse through the telephone line. The automatic re-order information will carry by the same computer network to the certain supplier and thus the chain of supply is reducing.
As the technology behind them continues to improve, bar codes are now become a crucial part of civilization in the modern world to reduce inefficiencies and improve company's productivities.
1.2.1 Structure of Bar Code
A barcode can be defined as any set of machines or a readable parallel bars or concentric circles and spaces of a specific pattern. There are no characterizing info existed in the height of the bars and spaces and there is no relevant colour is found on the bars. In addition, each bar code contains a set of different way of encoding numbers and letters by using a combination of bars and spaces of different widths. The code uses a sequence of rectangular bars and spaces to represent the numbers, letters and other symbols. A bar code symbol usually contains of five parts which are a quiet zone, a start character, data characters (including an optional check character), a stop character, and another quiet zone (Refer to figure 1.1 below).
Figure 1.1 Structure of bar code
Quiet zone (margin)
The non-printed space held before and ends of the bar code symbol. Insufficient width of quiet zone will cause inaccurate data read by scanner. The quiet zone is recommended to be at least 10 times as wide as the narrow bar width to avoid unreadable bar code.
A pattern of bars and spaces that indicate the start and end instruction of a bar code symbol. It usually informs the scanner that the read of bar code was complete. If a start/stop pattern was not used in a variable length bar code, the bar code scanner may miss out some of the part of the code and will assume it had read a complete code.
Bar pattern which are represented data. Usually conduct by numeral or alphabet arranged from left to right. For example, base on the figure 1.1 shown above the bar patterns representing 0, 1, and 2 in sequence from the left represented the data "012".
A numeric included within a bar code. The value of the numeric is use to check for read error to ensure the accuracy when read the bar code. It places after the code data.
The length of label includes the quiet zone (both left and right side). If the quiet zone is not large enough, may lead to failure of reading the bar code.
Bar code height
The height of the bar code is recommended to be as high as the printer permits. The laser may deviate from the bar code and cause unstable reading if the height of the bar code is not high enough.
1.3 Bar Code Reader
Figure 1.2 Handheld bar code readers
A barcode reader or most people called it as bar code scanner is an electronic device used to read the printed barcodes. The reader consists of a laser beam, a lens and a light sensor that sensitive to the reflections from barcode pattern including the line and space thickness and variation. The reader translates the data contained in the barcode image into data which is readable by a computer. In addition, most of the bar code readers contain a decoder circuitry which works as an analyzer of the bar code's image data read by the sensor and sending the bar code's content to the scanner's output port.
1.3.1 How Bar Code Reader Work
The bar code reader will have a small spot of light to read the bar code by sweep across the printed bar code symbol. The laser scanner emitted only a thin red line which is a light source. The device inside bar code reader will takes the reflected light that produce by illumination system and converts it into an analog signal which represents the intensity of the reflection. The converter will then changes the analog signal to a digital signal which is fed to the decoder. The decoder translate the digital signal and make sure does that math required to confirm and validate that the barcode is decipherable, It will convert into ASCII text afterward and the text is formatted before it send to the computer with the scanner attached.
Afterward the scanner's light source will starts to read the bar code start from the quiet zone before the first bar and goes on passing through the last bar, at last ending in the quiet zone that follows it. To make it easy to keep the sweep within the bar code area, the bar height is required to higher den the bar because a bar code cannot be read if the sweep wanders outside the symbol area. The longer the bar code is, the longer the information to be coded. As the length increases, so does the height of the bars and spaces to be read.
1.4 Implementation of Bar Code
The implementation of bar codes has grown tremendous since its first implement the grocery distribution in 1970. Bar codes come in many varieties. Most of us are familiar with those seen in retail shops checkout across the world, and also throughout their distribution chain. Outside the retail arena include intra-company and inter-company distribution also using bar coding. Bar code also assists in company daily routine such as security access, data tracking, data entry for domestic video recorders and time control. In some hospital, patients are even identified by a bar code tag put on their wrist.
However, there are many others that used in various industries. In fact, there is more use of bar coding in manufacturing than in any other industry sector. Each of the industry has their own unique symbologies. In some cases, companies have developed their own proprietary bar code symbologies base on their own standard. Why are there so many different types of bar codes? It's simply because different symbologies have evolved to solve specific problems.
Chapter 2 Benefit from Bar Code
2.1 Advantages of Bar Code
There is always a wrong inception stand in a lot of people's mind that bar coding is just merely a type of technology. In fact, bar coding also contributes to a broader use such as a tool for information management. Bar codes enable faster and more accurate entry. By having accurate data available, manager can make more appropriate decision based on this valid information. For instance, with manual system you often have to record the number of inventory sold each day in an inventory book in order to be alert when should reorder the product when the inventory had reach to a minimum stock level. Meanwhile, accuracy of bar code scanning provides up-to-date information regarding the inventory levels include the value of inventory investment. With this information, it helps to maintain lower inventory level and in line to improve cash flow, which is invaluable to the clinic.
There are several benefits of bar coding and automatic data collection:
Firstly, bar coding can improve the accuracy of the data by reducing the possibility of human manually entry error.
Ease of use
In addition, bar codes are easy to use when the there is an existence of appropriate hardware and software to enhance the process of automation data collection.
On the other hand, bar coding also provide data timely feedback which captured in real time in order to enable more accurate decision making based on the current information.
Furthermore, bar codes can be used to improve the productivity as it turns manual activities and tasks into automation while it also enables resources to be utilized in the way that will improve the efficiencies.
2.2 Features of Bar Code
Bar code technology can be interpreted into three primary functions such as tracking, inventory management and validation. All these functions are in place to increase cost savings, improve productivity as well as the quality.
Tracking function can be defined as anything which can be tracked by bar code technology that identified with numeric or numeric and letters. In clinic, bar codes are commonly used in area of dealing the material management and patient medical records. However, applications continue to expand to almost every area to assist in cost tracking such as total patient cost and cost of clinicians used products.
In addition, bar codes can be used to keep track a particular item throughout the supply chain and clinical workflow. In term of supply chain, we can track a particular item back to the supplier by using bar code. For instance, if clinic personnel find out there is a supply item reached a specific inventory level, bar coding can help to track back the particular item through material management and make purchase to the supplier or the original manufacturer so they can obtain a refund.
In term of clinical workflow, bar code can be used to track the particular medicine distribute to patients and identify the clinician who is in charge for the distribution of medicine. Hence, bar code are in place to achieve time saving by reducing manual work which would involve more amount of time and more cumbersome process.
2.2.2 Inventory Management
Besides, bar codes are commonly applied on inventory management. We can find that it is widely used in most of the hospital. As we know, process of maintaining accurate inventory is very complex. Quite a number of details we need to always take note such as the product item, level of inventory, amount of inventory, supplier, location to keep the inventory, the product cost and also re-order level of the inventory. Centralized and decentralized inventories are maintained in every hospital. These inventories consist of laboratory products, medical/ surgical products, pharmaceutical products, X-ray film, office supplies, linens, cleaning supplies and etc. Bar coding can help to manage these inventories wherever they are located so that the right materials are available when and where you need them.
Furthermore, bar code also can help to monitor usage trend throughout the hospital. The nursing stations were doing every job (Eg. patient registration, dispensary and etc.) in one hospital. The collaboration with materials management department is tended to reduce the work load at nursing stations. The materials management department could create more realistic inventory levels because it documented accurate information. For example, if there are two particular unit using a certain item a day, the two groups of particular unit have to work together in order to find out a satisfactory lower inventory level of such item.
In addition, the communication and trust between the materials management department and nursing station had strengthened by this process. The reorder process can speed up by using bar code scanning function on a product. Some hospital applies system designed to reorder their products automatically when a particular product had reached a specified inventory level.
The validating function of bar coding is also one of the effective methods to ensure the quality in healthcare setting. Validation assures that appropriate action has been taken place. It also ensures that the item you want is available to use. Bar code scan is able to validate an action and yet help to reduce errors and waste. It can also provide a management checking on productivity. The most critical validating function is to verify that the particular patients being treated is going to receive the appropriate medical treatment. For example, nurses can scan a bar code to make sure that item they are about to use with a patient is the item ordered by the doctor. Furthermore, they also can validate whether the item that they have used on the patient is correct. For instance, nurses do this by scanning the bar code on the patient wristband, the bar code the employee identification badge, and the bar code on an item. This type of validation typically needs some decision making support be in place to complete the checking function.
Chapter 3 Characteristic of bar codes
There are about 100 bar code types are available in the world. The following are some of the common bar code types:
EAN is the most common bar code symbology seen in Europe and almost rest of the world. EAN is bar code systems which use numeric only for retail's product identification. EAN's unique numbers are assigned to each separate retail product, not only by product brand yet by variation such as the product weight, colour, and flavour. Furthermore, the numbers are required is also separated when the product has any changes besides when the product price has changes.
There are two basic formats for EAN symbol which is the 8 and 13 digit variants. When there is a space restricted issue, the 8 digit code is used. The 13 digit code is more commonly to be used.
Figure 3.1 Sample of EAN bar codes
EAN contain two other variants that have supplementary add-on codes which is 13+2 and 13+5. Though the add-on codes are not used in practice often, but the add-on codes are ready for encoding supplementary information.
Although some countries is using other system instead of EAN symblology, but the EAN symbology is still intended as a worldwide standard bar code. Hence, it is impossible to have the same EAN number between two retail products. To ease the number allocation job of the administration, each country will use they own country identifier at the start of the bar code. For example, the digits 50 are identified U.K. manufacture. However, some of the countries may have 2 or 3 digit for the prefixes, for example 93 are identified Australia and 773 are identified Uruguay.
The rest of the EAN 13 code is distributed into the Item Reference Number, the Manufacturer Number, and the check digit. The Item Reference Number that used in U.K. is usually 5 digits and 5 digits for the Manufacturer Number and for the last number is down to check digit. Manufacturer Numbers is assigned to each country's Article Numbering Association. The manufacturer will decided the Item Reference Number as they wish.
Although the use of EAN codes is preceded by the UPC system (one of the type of bar code), EAN was made retrospectively compatible. All scanners are designed to read UPC and also EAN. In practice, EAN scanners will read UPC yet some scanners available in USA will not read EAN. Those scanners are no longer available and it is hoped that the two systems will become compatible in time.
Figure 3.2 EAN13
EAN symbol is use magnification to describe and the allowable limit is 80% to 200%. Each of the magnification is recommended height. The purpose of the figure is recommended to make sure symbol readability when prepare by a multi-directional scanner. Hence, it should be attempted only for any reduction in height (truncation) if necessary.
Usually most other the bar code that implements EAN8 and EAN13 consider the last number on the right as the check digit. The purpose of having the check digit is for the error checking while data entry/ scanning.
Transposition (reversing order of two digits) is the most common error which found during transcribing and keying data. Thus, the following system is used:
Step 1: Start from the number from right and without includes the check digit, afterward add each alternate digit.
Step 2: Multiply the result from step 1 by 3.
Step 3: Add all the remaining digits.
Step 4: Add result from step 1 to step 3.
Step 5: Check digit is the smallest number which added to the result of step 4 and produces an exact multiple of 10.
The bar/spaces pattern that above the human readable character is encoded the 12 digits of EAN13 and UPC-A bar code symbologies. The most distinct different with EAN13 is the 13th character of EAN13 is encoded by the variable parity of the left hand side of the code. For the EAN number system, it's using 3 different character sets such as A, B and C. the given digit is different for the bar/spaces pattern of each character set. Character set C is use by the right half of the code but the left half can contain a mixture of set A and set B. This pattern of mixture is use to determine the 13th character for EAN13. For example, if the left hand half of code is ABBAAB then the digit 13th would be 5.
The Interleaved 2 of 5 (I2OF5) code was called as Code 2 of 5 since it developed from an earlier symbology. Code 2 of 5 is numeric and has wide or narrow bars. No information carry by spaces and thus their width was not a concerning critical. The I2OF5 was suggested as a way of using the spaces to carry information in order could shorten the length of the code. Pair of digits of data is encoded with the bars is representing the first character and the spaces is representing the second character.
The ratio of wide bar width and the narrow bar width can held between 2:1 and 3:1 yet in the EAN and UPC specifications for 14shipping symbols is fixed at 2:5:1 and it has become the norm. The standard outer carton bar code was chose I2OF5 because it's printed tolerances are sufficient for highly variable printing techniques which used for corrugated cartons. The allowed value of width for variation in bar is 0.3mm (0.012") at the standard 100% magnification.
Figure 3.3 Human standard readable characters that grouping for the European traded unit code.
The EAN and UPC versions of 14 digit ITF case codes is having the same check digit calculation as mentioned in the above section (EAN symbology part). Outside the outer case coding environment, a number of bar coding applications is using I2OF5 which contain varying lengths of code. When variable lengths ITF are used without a check digit, it should be noted that the danger of the scanner misleadingly a partially scanned code as a complete code. Thus the scanner should be checked a digit when using ITF or programmed to expect a fixed length of code when scanning. ITF bar codes employ a bearer bar around the code frequently to protect the symbol from excessive plate squash because of the imprecise nature of corrugated carton printing. There are three different types of bearer bar are used:
Figure 3.3.1 types of bearer bar
ITF Bearer Bars
Figure 3.3.2 H-Gauge
H-Gauge has seven variations, between each vertical bars will having a different distance. The code magnification factor is being printed and it will gain expected base on the amount of print, two H-Gauges may be selected, the vertical bars should always fill-in, the other should remain clear. It should be cleaned the printing plate or decreased the pressure on it if both fill in. There may be incorrect pressure on the plate or error in plate manufacture may cause if both gauges remain clear.
3.3 Code 39
Figure 3.4 Sample of Code 39
Code 39 or called as code 3 of 9, is use alphanumeric and it is very different from the majority of the popular bar code. Initially it only able to encode 39 different character, yet now it can encode 43 different characters. Eg. ABCDEFGHIJKLMNOPQRSTUVWXYZ 1234567890.,%$-/ and the space character too. Commonly an asterisk (*) represented the start and stop character for the barcode.
In the industrial of bar coding system, Code 39 is most commonly in used, although it is more wide-ranging in U.S. than elsewhere. Two different width size of the bar is adopted by Code 39 which called as wide and narrow. The narrow bar can hold between 2 and 3 times smaller than the width of the wide bar. The size of narrow bar could hold between 0.05 inch and 0.075 inch which mean a wide-ranging of size and printed tolerances might happen, although others types of bar code are more compact compare to Code39. The height of the bar code is not fixed and it does not base on the ratio and tends or narrow bar, it is base on setting of the application.
Misread is uncommon in Code39 due to internal security in Code39, yet to protect from wrong data entry when creating the bar code, sometime it apply check character. A lot of open-source applications appoint Code39, although nearly some have change to use Code 128. Last but not least, there theoretical limited size of the code length is not exist so a lot of internal bar code system will use Code39 and also the adjustable of ratio and narrow bar width can be flexibility to adjust base on the method of printing.
A linear barcode symbologies called Codabar that developed in 1972 by Pitney Bowes Corp. It also known as Ames Code, Monarch, Rationalized Codabar, Codeabar, NW-7, Code 2 of 7, ANSI/AIM BC3-1995 or USD-4. Although US does not registered Codabar as federal trademark status, yet its hyphenated Code-a-bar as a registered trademark.
Figure 3.5 Sample of Codabar
It was designed to read the bar code accurately even when using dot-matrix printer to print the multi-part forms such as blood bank forms and FedEx air bills. Although new developed symbologies may contain more information within using a smaller place, but Codabar contains large installed base in library. It is still possible to print out Codabar code by using typewriter (eg, impact printer) which does not need to use any digital equipment when a large number of codes within subsequent numbers are created. After each time printed a code, the printer's stamp will automatically turned to next number.
3.4.1 Check Digit
Because Codabar will do self-checking, most of the standards do not come with a check digit. The evolution of Codabar for public purpose and commercial purpose will define a check digit sometimes. For example in an all numeric word, the check digit algorithm might be the double of the odd digits.
Regarding particular specification (eg, Mobility's Uniform Symbol Specification and the Association for Automatic Identification), the body of Codabar string can only encode from 0 to 9. Some variants allow symbols such as dollar sign, colon, plus sign, dash, slash and dot.
To match the pairs for marking the beginning and the end of the barcode, the alphabetic characters A, B, C, D, E, N, asterisk and T are in used. They would not appear in the string of Codabar body.
Each character contains 7 binary identifiers which are 4 bars and 3 spaces. Certain multiple constant-width modules are made up by each of the element or identifier. Different width of modules is allowed by different specification, the smallest is 0.0065 inch and it allowed 11 characters for each inch to be encoded. The narrow and wide elements represented respectively the logical 0s and 1s.
Figure 3.5.1 Character Converter table
3.5 Code 128
Code 128 is the most complex bar code symbologies and one of the most adopted bar code. The character set contains the numeric 0-9, the alphabetic A-Z (can be lower case or upper case) and all the standard ASCII control codes and symbols. After many of today's popular symbologies had been in use, Code 128 only developed and its developer were designed it to become more compact and secure than the established codes.
Figure 3.6 Sample of Code 128
Code 128 includes 3 separate character sets and each of the set can switched between each other by using special shirt characters:
C:\Users\Liko\Desktop\seminar\Barcode Technology\code 128.jpg
There are 3 different kind of start patterns which is Set A, Set B and Set C (refer description above) that denote used for the first digits. The code may be modified afterward by using the Code A, B and C character.
Code 128 structures dictates part of the code's internal check digit forms. This digit is the last digit before the check character. It would not form part of the human readable characters normally. Code 128 is a relatively new code as mentioned previously. Thus, it is only just coming into widespread use. Its introduction in a number of areas with, many more to follow was being planned.
Most of them were fall under the UCC/EAN umbrella for the large-scale applications that so far defined. The UCC in the U.S. and the European Article Number Association have jointly agreed to use Code 128 for certain supplementary coding applications and have adopted the use of a FNC1 character immediately after the start character to indicate UCC/EAN use and a further two digit Application Qualifier (or Application Identifier) which further defines the intended use of the code.
The following are some of the defined Application Identifiers:C:\Users\Liko\Desktop\code128.jpg
The codes will not be confused if Application Identifier used. In addition, use of the FNC1 character will eliminates the risk of reading mistake of non-UCC/EAN Code 128 symbols.
Figure 3.6.1 Example of UCC/EAN numeric-only Code 128
Chapter 4 Measurement of Successful Implementation
Without doing any analyzing before implement bar code applications on the current workflow may caused problems. Accordingly, the implementation process and selection process must be involved by any related disciplines and end-users accordingly. The bar code solution is attempted to enhance thorough analysis of the problem. Furthermore, a multidisciplinary committee should perform it which acts on behalf of all services that interact with the system. Who is selected from the most affected end user group is a key for appointing a project champion. For example, if medication administration is consideration for the bar code solution, then it is essential for the head of nursing officer or director of pharmacy to get into the involvement.
Personnel who will interact with the system such as pharmacists, nurses, and staff from the information system department must participate to provide the information regarding the workflow. No technology implemented to perpetuate existing systemic problems as the purpose of implement new technology is to enhance the existing system. It is critical to understand the organization's readiness before embrace the bar code application for recognizing the technology's benefits. Key to successful implementation includes several factors such as user involvement in planning, anticipation of workflow and productivity, executive sponsorship and organizational commitment, appropriate expectations, and development and communication of success. Technology alone would not solve the problem.
4.1 Selection for Bar Code Scanners
The usability and accuracy of a scanning device is the most basic contributor to the failure or to the success of a bar code system. There are many scanner vendors available to use and each consist of their own set of advantages and limitations. Selection for the correct scanner technology for the task on hand is very important. There are some of the factors to consider when select a scanner include:
The portability of the scanner
The scanner screen resolution
Scanner battery life
Whether the scanner is hand-held or hands-free
Number and type of ports the scanner include
It is a wired scanner, wireless scanner or embedded scanner
The processor power
The scanner is operating real-time or non-real-time communication.
The following are some of the general lessons to purchase the right scanner for applications and facilities.
4.1.1 Laser Scanner or Imager Scanner
The issue of scanner technology becomes important as healthcare incorporate newer symbologies. Most scanners that used in healthcare was laser engines, therefore laser scanning is the dominant technology nowadays. To increase the scan speed and durability of scanning, linear imagers are developed and available to use. Furthermore, raster lasers ease for reading on multi-row symbols. Both raster lasers and linear imagers had offered evolutionary improvements throughout the basic laser scanners. The area imagers is a step forward to more advanced technology as it take a digital picture of data and use software algorithm to look for an image for codes, after that decode them.
Most of the scanners that used in healthcare are not able to read RSS, 2D symbologies or RSS composite. One of these new symbologies is require by certain medication in small packages especially for recording lot and expiration data purpose. The rules that specified the use of RSS symbologies was proposed by FDA on March 2003. Some manufacturer had upgraded their scanners in order to read PDF417 or RSS. Currently most of the laser scanners are have the ability on reading RSS and RSS-composite symbologies. Many expect that the cost of imaging scanners will become cheaper in 2003, so that it will be comparable to laser scanners cost. Previously imaging scanners cost was twice as expense. As time fly, many expect laser engines will replace by image engines as their high performance, declining cost and greater flexibility.
Imaging scanners may purchase by most healthcare providers as these scanners have the ability to read all the symbologies which anticipated in foreseeable future. To buy a scanner, providers need to concern several factors include their ability of the scanner to read symbologies such as the length of symbols that expected to be read, ease of use, power requirements by the scanner, cost and ergonomics.
4.1.2 Test scanners thoroughly for the environment
To ensure the scanners are function appropriate for the intended environment, it should be tested thoroughly before it started to implement. For example, at the clinical environment the major determinants would be the ease of scanner cleaning, the durability and the scanner's size/weight. The durability of a scanner is how many spare devices that a clinic must be kept on hand.
4.1.3 Test on Readability of Bar Code
It is critical to test on the readability of bar code especially for the linear bar code that having the surface curvature, for example patient wristband and medication vial as shown on the figure 4.1 below. When the patient wristband wrap around the patient's wrist or the label wrap around the medication vial, the bar code surface may found curvature. If the surface curvature is too great, it is hardly to read by the scanner. Therefore, scanner should be tested to evaluate the ability of it to handle curvature.
Figure 4.1 (Left) Patient wristbands that having curvature surface
(Right) Medication vial
Chapter 5 Critical Evaluation
5.1 The Impact of Bar Code Technology on Medical Safety
5.1.1 Unit-Dose Medication
Medications could identify accurately by bar codes technology in order to get the type, the information on recommended dosage used and the frequency of administration the level of unit-dose. Therefore, it provides a "second check" and the decision support tool for the nurses in administration the patient medicines. The information store in the unit-dose bar code is allowed to combine with the patient wristband by the nurses to ensure the rights of patient safety.
5.1.2 Track-and-Trace Systems
In compliance with the FDA rule requiring bar coding of unit-dose medication packaging, anti-counterfeiting bar code technology is being developed and deployed in pharmacies, hospitals and elsewhere to improve tracking and tracing. Bar coded lot numbers, expiration dates and unit-dose identifiers help healthcare manufacturers, distributors and consumers manage medications throughout the supply chain. Track-and-trace systems are the key component of anti-counterfeiting programs, by providing an accurate drug "pedigree" that is a secure record documenting the drug's source and date of manufacture.
There are still some of the medications without bar code when arrived at the pharmacy caused the pharmacy needed to produce their own bar code label. Bar coding is used by pharmacies for tagged unit-dose meds derived from bulk items and mixtures purpose. To fulfil most of the medication processes in pharmacy, automated dispensing equipment and bar code printers will produce on-demand and unit-dose bar codes that are secure, legible and cost-effective.
Bar code is a very adaptive technology that the total applications yet to be fully explored in healthcare environment. Bar coding in hospitals comprised many areas of clinical activities include patient registration, patient tracking, patient identification, medical history record document assimilation and indexing, patient charges collection and billing, and etc.
5.1.4 Blood transfusion verification
Blood transfusion consists of several complicated steps as following:
Step 1: A physician must order the blood and specifying the product and amount.
Step 2: Patient must be obtained the consent to a blood transfusion.
Step 3: The patient must own a blood sample drawn at their bedside.
Step 4: The sample of the blood must be labelled properly in the right test tube.
Step 5: The blood sample after that must be transported (by human transporter or pneumatic
tube) to the laboratory blood bank.
Step 6: The blood type must be determined by technologist and then the blood product must
be prepared properly, labelled accurately, and transported back to the patient bedside.
Inside the patient's room, there are two nurses is expected to identify the patient correctly, unit number and the blood product. Furthermore, the nurses must compare patient's blood type and the product's blood type, physician's order verification and the blood of patient's consent. Even with numerous checks on the working process, but the primary error means for a blood transfusion is when a nurse do the labelled of blood to the incorrect patient. When the bedside is using bar coding technology, the nurse will scan his/her name badge and enter a secure password to enter the system. The nurse will then scans the patient's wristband, blood product, blood product type, blood unit number, blood expiration date and patient's blood type through a series of prompted electronically display. If all prompts are being executed accurately, the blood transfusion will direct started by the nurse. However, if there is any of the prompts are executed inaccurately (for example the patient identification is not match with the wristband identification number on the blood product bag), an alert will be generated. Industry experts are recommended to implement bar coding systems in transfusion because it resulted 100% accurate of patient identifications.
Chapter 6 Conclusion
The future bodes well for barcodes as the technology continues to adapt to new social needs whilst maintaining low costs to implement. There are numerous of bar code symbologies that ready for use and they representing the differed function yet we are still seeing new symbologies launched. Since the technology is ever expanding which means there is always something new to learn.
In an ideal situation, there would be interoperability within the system to provide an end-to-end solution that maximizes safety and efficiency. Bar codes would be utilized throughout the clinical process and supply chain for near error-free tracking, validating, documenting, and billing. Of course, such a system would require the appropriate infrastructure, including databases and software, real-time communication, as well as decision support for alerts and warnings.
Patient health and safety is the primary goal in healthcare. With so many healthcare organizations refocusing their efforts on lessening medication errors and increasing patient safety, it is apparent that bar coding has a place at the table. Of all the functions bar coding can serve in the healthcare setting, clinical applications are among the most important from a patient safety perspective. From medication administration to blood transfusions and beyond, bar code implementation can take the risk of human error out of the equation while streamlining costs and saving time. In short, bar code technology could really help a lot in clinical management.