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One Size Does Not Fit All: An Initiative to Improve Pediatric Patient Safety at Children’s National Medical Center continued from Page 5 room. This set of data would require 3 lines of text on the band. Next, feedback was solicited from several hospital departments to determine any other required elements. Additional requirements and considerations were discovered during this design phase: • The Radiology and Imaging department and the Operating Room required the date of birth (DOB) as an identifier to differentiate same name and similar name patients. • Hospital administration required inclusion of the CNMC Bear logo • Patient’s hyphenated names would not fit on one line with current limited print characters. • Adding DOB and separating the first and last names on 2 separate lines increased lines of text on the band from 3 lines to 5 lines • Barcodes for future use and current technology Barcode Technology In order to prepare for future barcode technology envisioned at CNMC, the task force team realized that addition of a barcode to the ID band was needed. They proceeded to learn more about barcode technology than they ever expected. First consideration was given to using a 2 dimensional barcode that would contain the required patient data elements. However, the equipment currently used in Laboratory Medicine department cannot read a 2 dimensional barcode. They use barcode scanning of a linear, onedimensional barcode on the received specimen label. Because barcode scanning for nursing and patient care activities is not yet in use at CNMC, the team decided to begin with a linear, one dimensional barcode that only captures the patient’s medical record number. In the future, use of either 2-dimensional barcoding or RFID is anticipated and Laboratory Medicine expects to upgrade their system accordingly. Pilot Testing Before advancing further in the project, a pilot test of proposed ID bands was implemented for one week on an inpatient psychiatry unit, a surgical care unit, and the NICU, to determine the integrity of the material, security of the adhesive used, and ease of use by staff. The bands were pre-printed with “TEST BAND” and were applied to the patient along with the official ID band in current use. Informational letters were given to the parents to explain the project. Next, a survey was conducted to elicit feedback on the piloted bands from parents, staff, and patients. The feedback results included the following: • The majority of the staff responses indicated approval of the new band. They found it easy to use and apply. All staff responses showed preference of the band to display the patient’s last name on the first line in bold font and that the pediatric and adult bands be the same width. Three of the staff responses suggested a bigger font size. One response suggested addition of a data element - medical service. • The adhesive area of the band was less secure for older children because they could pick at the seam. • Parent responses indicated the desire for a band that would fit their child appropriately instead of attaching it to a crib or bed. This feedback led to a modification of the design of the adhesive area by the Figure 1 Serrated Slits in the Band Adhesive Overlap Area vendor to replace the smooth even seam with a serrated seam. This seam format strengthens adhesion as well deters a child from lifting the entire edge. The serrated seam in a jagged format adheres more easily and will be more difficult for the child to lift. If the child picks at the edges and lifts a seam, the serrated portion will shred but not lift the whole edge. See Figure 1. The team also elected to standardize the width of the ID bands for neonatal, pediatric, and adult as well as a band format to print the last name on the first line in bold font. Figure 2 shows the new ID band design. Figure 2 continued on page 7 CARING • Page 6
One Size Does Not Fit All: An Initiative to Improve Pediatric Patient Safety at Children’s National Medical Center continued from Page 6 Printing Logic Over several months, the team worked with another vendor, Optio, to design the software logic for printing the correct size band using data entered during the registration process in admissions. Although using patient weight information might be preferred for determining band size, the majority of the patients have not been weighed prior to admission. Therefore, patient age was selected for use in printing the initial ID band. Of course, the possibility exists a band based on age will not fit the patient. Thus, the availability of printing a replacement ID band on the unit at the discretion of the nursing staff was very important to the task force charter. Three replacement ID band sizes were chosen for availability on the units: SIZE LENGTH WIDTH AGE PARAMETER Neonatal Band 6 inches 3/4 inch 0-30 days Pediatric Band 7 inches 3/4 inch >30 days < 7 years Adult Band 11 inches 3/4 inch > 7 years The concept of reprinting patient care labels and face sheets on the inpatient units from a clinical registration system is already established. With assistance from the software vendor and CNMC’s information technology services (ITS) staff, three additional files were Figure 3 created in the clinical registration system to represent a neonatal, pediatric and adult ID band. When needed, the new ID band process will allow the nurse to access the clinical system on the unit, select the patient, and request a reprint file for the appropriate size ID band plan after the patient is assessed for the appropriate size. Dedicated Zebra printers for the ID bands will be located on each inpatient care unit, as shown in Figures 3 and 4. Network Preparation In order to implement the new ID band process, preparation for printer installation was required. This included use of the local area network to retrieve clinical information to formulate an ID band, but an internal technology survey revealed insufficient availability of data cables and data jacks to connect to the printers. With support from the ITS Figure 4 department, the team developed a plan for the location of each printer and worked with a consulting technology company to install the data lines and drops. Each data jack was activated and tested. The jacks were clearly labeled for patient ID printer and a road map of data jack locations was provided as a resource for the ITS department. In addition to the need for additional cabling and jacks, all ID band printers required an IP address and description in order for the network to locate the correct printer. In a similar way, the printers were added to a table in the clinical registration system which identified the location of the patient care unit for point of care reprinting. The network preparation phase of the project used most of CNMC’s technology personnel resources and required more time than expected to complete. Next Steps To prepare for implementation of the new ID band process, the task force will develop and execute an educational plan for <strong>Nursing</strong> and support staff to use the new software and printers, begin actual use of the new patient ID band process, and evaluate its success. A follow up discussion of these next steps and lessons learned is planned for a future issue of the CARING newsletter. Reference: Technology in patient safety: Using identification bands to reduce patient identification errors. (2005, April). Joint Commission Perspectives on Patient Safety, 5(4), 1-10. Additional Reading: Use of Color-Coded Patient Wristbands Creates Unnecessary Risk. (2005, December). Patient Safety Authority, Vol 2, Supplement 2. Retrieved February 15, 2007, from http://www.psa.state.pa.us/psa/lib/psa/advisories/v2_s2_sup __advisory_dec_14_2005.pdf Page 7 • 4th Quarter 2006
Page 1 and 2: CARING Vol. 21, No. 4 4th Quarter,
Page 3 and 4: Clinical Care Classification (CCC)
Page 5: Photo courtesy of Karl Oyri One Siz
Page 9 and 10: Page 9 • 4th Quarter 2006
Page 11 and 12: Central Florida CARING November Mee

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