Versatile PDAs Pick up RFID, Bar Codes

Beckie Kelly Schuerenberg, Senior Editor
Health Data Management Magazine, December 2005

St. Clair Hospital managers' goals were akin to those of many provider organizations. How they were achieved, however, was a little unusual.

The Pittsburgh-based, 331-bed hospital wanted to improve patient safety by using I.T. to identify patients during medication administration. St. Clair also wanted nurses to feel comfortable enough with the technology to use it with all their patients.

St. Clair made good on its goals in early 2004 by implementing a medication verification system that runs on PDAs. Hospital executives decided PDAs would appeal to nurses because they would be easier to maneuver in and out of patient rooms than other types of mobile hardware, says Rich Schaeffer, CIO and vice president of technology. St. Clair also involved its nurses in the PDA selection process to further ensure their adoption of the technology.

"The key part of reducing medication errors hinges upon nurse adoption," Schaeffer says. "If a nurse doesn't use the technology every time, you won't get the results you are looking for."

St. Clair initially bought PDAs from Toshiba American Information Systems Inc., Irvine, Calif., and equipped them with scanning devices from Socket Communications Inc., Newark, Calif. It later switched to PDAs from Hewlett-Packard Co., Palo Alto, Calif.

The scanning devices, which fit into the PC card slot on the PDAs, enable nurses to use the hand-helds to scan bar codes on patient wristbands, medications and their own badges during the identification process. Although nurses quickly adopted the technologies, they found the new automated process added some time to medication administration.

The hospital's homegrown software required nurses to log in by scanning the bar code on their ID badge or typing in a password on the PDA via a virtual keyboard. This security measure added several seconds to each patient's medication administration process.

Additionally, nurses had to position the PDA near a patient's bar coded wristband to scan it, which meant they often had to pull up a patient's sleeve or pull their arm out of the covers to find the wristband, which also delayed the process. Further, wristbands quickly became worn, and it took nurses several tries before they could get a good scan on older bands.

To ensure nurses didn't become frustrated with the automated process, St. Clair executives decided to integrate a different technology, one they believed could help save time. The scanning devices were removed from the nurses' PDAs and replaced with the vendor's CF RFID Reader-Scan Card Series 6. The new cards enable the PDAs to read both bar codes and radio frequency identification tags. Technicians also put RFID tags on patient wristbands and nurse identification badges.

Out of sight

Because RFID technology doesn't require a direct line of sight to transmit data from a tag to a reader, St. Clair nurses were able to move more quickly through medication administration. They spent considerably less time scanning the RFID badge and wristband than those with bar codes.

"It's easier now that we don't have to pick up or move anything," says Lori McAninch, R.N. "Now we can wave the PDA over the patient's covers to read their wristband. It's saving us time."

St. Clair had the flexibility to switch from bar codes to RFID because its technicians had a hand in developing the medication administration software. I.T. staff worked with the provider's software development subsidiary, Sculptor Developmental Technologies Inc., to design the 5-Rights Medication Verification system to accommodate clinicians' workflow and mobile technology needs.

When St. Clair wanted to use RFID technology in medication administration, Sculptor added it to the system. Many other health care organizations, however, don't have the same influence on the mobile hardware their medication administration system works with, says Gregg Malkary, managing director at Spyglass Consulting Group, Menlo Park, Calif.

Additionally, there are only a small number of medication administration systems that use RFID technology. As a result, most hospitals haven't added RFID technology to their medication administration process, Malkary says.

"Large health care I.T. vendors should step up to the plate and enable their medication administration systems to work with RFID," he says. "But doing so would open a Pandora's box because they also might have to deal with hospitals that want to use RFID to verify medications."

RFID and bar codes

A few pharmaceutical companies are placing RFID technology on their drugs to ensure they aren't intercepted on the way to a pharmacy. But inpatient care is a different story because most medications are dispensed on an individual dose basis. So the burden of repackaging medications and putting RFID chips on each dose would fall upon the hospital, Malkary says.

St. Clair leaders thought using RFID on medications would be too expensive to implement, so they decided to continue using bar codes. The hospital, however, wanted to use RFID wristbands and printers that could encode patient information onto a RFID chip.

The hospital chose a combination of RFID wristbands from Zebra Technologies Corp., Vernon Hills, Ill., and Precision Dynamics Corp., San Fernando, Calif. St. Clair also purchased a printer from Zebra Technologies that it's using to encode the RFID wristbands with a patient's account number.

The same printer encodes RFID tags that attach to nurses' badges with their identification information. St. Clair also purchased the new peripheral cards from Socket Communications to enable PDAs to read both RFID chips and bar codes.

The hospital began a pilot of the RFID technology and new peripheral devices at the beginning of September and expected to be live with it enterprisewide this month. After full rollout, managers plan to implement an RFID printer in all admissions areas so nurses can give every patient a wristband upon arrival.

Additionally, St. Clair plans to expand the information it encodes on the RFID wristbands to include a list of a patient's allergies or other alert conditions, Schaeffer says.

Now when nurses begin medication administration, they wave a PDA near the RFID tag on their badge to log into the 5-Rights system. Then they wave it near the patient's wristband to bring up their information in the system. Finally, they scan the bar code on the medication to verify the information.

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