Chapter 43. Prevention of Misidentifications

Machine-readable automatic identification (ID) systems, including bar codes, magnetic stripes, optical character recognition and radiofrequency labeling, have improved productivity and quality in diverse industries. Bar codes represent the oldest and most common of these machine-readable ID systems, and are widely used in industrial manufacturing, shipping and inventory tracking operations. Prior to bar coding, these processes would have involved keystroke entry of identification numbers, producing approximately one error in every 300 entered characters. In contrast, bar coding produces misidentification errors at rates ranging from one character in 15,000 to one character in 36 trillion. The use of bar coding in health care was first described over 30 years ago in clinical laboratories and blood banks. In 1984, Rappoport identified 3 areas for the use of automatic ID technology in lab medicine: patient identification, document identification, and specimen identification. However, in a 1987 survey by the American Hospital Association, the use of bar codes was most widespread in materials management departments, rather than in clinical application. Other areas in which hospitals employed bar codes at that time included the clinical laboratory, pharmacy, radiology, medical records and asset management. Despite the Health Industry Bar Code Council’s call for standardization in the mid-1980s, the implementation of bar code technology has been stymied by lack of industry standards and failed cooperation among all stakeholders. As bar coding has the potential to substantially increase productivity and accuracy, one would expect it to be applied to important patient safety practices. Unfortunately, the published literature contains very little evidence regarding health care applications. In this chapter we focus on 4 areas in which bar coding shows promise for improving patient safety: patient identification, medication dispensing and administration, specimen handling, and medical record keeping.