July 2011
Feature Story

Anne Ford

Like their colleagues everywhere, the phlebototomists at Southern Regional Health System, Riverdale, Ga., take their jobs seriously. After all, excellent patient care doesn’t consist of fun and games. Or does it?

To explain: In late 2005, Southern Regional implemented McKesson’s Horizon MobileCare Phlebotomy, a software solution that allows phlebotomists to positively identify patients using wireless-enabled PDAs and to print specimen labels at the point of care. Trouble was, in those pre-iPhone days, many of the phlebotomists weren’t used to handling PDAs, or, for that matter, any touchscreen device. “In 2005, not everyone had a smartphone,” outreach and business manager April Bashaw points out. So “initially, people were very reluctant” to swap their tried-and-true system of pre-printed collection labels for these unfamiliar electronic gadgets.

That’s where the fun and games came in. To coax phlebotomists into giving the MobileCare handhelds a shot, “we allowed them to practice using them by playing solitaire on them,” Bashaw says. That way, “before we ever even loaded the MobileCare Phlebotomy software, they got used to the interaction with the stylus on the screen.” So used to it that when the software went live (and the solitaire disappeared), “within a three-month time frame, if we had threatened to take the handhelds away, we would have had mutiny. They won’t work without them.” In fact, the phlebotomists’ response has been so enthusiastic, and the software so effective, that “when MobileCare Phlebotomy is used for collections, we’ve had zero patient labeling errors in over three years,” she reports.

Southern Regional’s story, or one much like it, is playing out in many other laboratories that have adopted wireless, handheld devices for positive patient identification at the point of care. While some phlebotomists are initially reluctant to change their workflow, the devices’ ease of use, efficiency, and ability to reduce the number of, or even eliminate, identification errors soon wins them over. In many cases, laboratories are also reporting additional gains.

One improvement at Southern Regional, for example: greater patient satisfaction. “We’ve tre­mendously reduced the number of multiple sticks on a patient,” Bashaw says. That’s because before adopting MobileCare Phlebotomy, a phlebotomist would often sort labels, prepare a cart, take the labels to a patient’s room, and draw the specimen—only to discover, upon return to the laboratory, that an additional specimen requiring a different tube type had been ordered on the same patient. “All that may have happened during a 15-minute period,” she says. Now the laboratory has set the MobileCare devices to auto-refresh orders every 120 seconds, thereby lessening the chance that the phlebotomist will have to return and draw a second specimen. “I don’t have direct measures, but we know for certain that we’ve decreased the number of multiple sticks on patients,” Bashaw says.

In addition, Southern Regional has seen its preanalytical turnaround time drop by 23 percent as a result of combining MobileCare Phlebotomy with front-end automation. “The user scans their ID badge, then scans the patient armband, collects the specimens from those orders on the patient, labels the specimen, and then scans the labeled specimen to submit an indication back to the LIS that this is complete,” says Bashaw. That information is captured through the wireless network. The specimens are delivered to the laboratory, where someone removes them from the pneumatic tube system and places them on the front-end automation. The automation scans that bar code and sends a message to the LIS that this specimen is received at the lab. By contrast, “If you have a stack of preprinted labels, the LIS doesn’t know who collected that specimen and when it was collected until it is received into the lab and someone manually enters it. And if you have front-end automation and no MobileCare Phlebotomy or its equivalent, you still have a manual process that you have to manage.”

That’s not to say that all has been smooth sailing. “If our wireless network goes down, that’s when we have problems,” Bashaw says. “It’s not the MobileCare application; it’s the connectivity. When we have experienced that on occasion, it’s a big dissatisfier for the staff. To combat those issues, we’ve worked diligently with our IT department.”

It’s not just the wireless network that occasionally falters. “Human beings are notorious for finding a workaround,” notes Bashaw, and just because people embrace a technology does not mean they don’t sometimes try to use it improperly. For example, specimen labels were sometimes preprinted. MobileCare’s settings were adjusted to disallow that. A second issue: If a phlebotomist encountered an unreadable armband, he or she might scan a chart label instead. “We had 100 percent leadership buy-in for a zero-tolerance policy of scanning the chart labels,” Bashaw says. “Now if a phlebotomist encounters an unreadable armband, he or she refuses to draw the blood until the patient is re-armbanded.”

Unlike Southern Regional, Norman (Okla.) Regional Health System had to make more than one attempt to find a suitable positive patient identification system. The PPID software Norman originally implemented was too cumbersome, says Janet Johnson, RN-BC, MPH, director of nursing informatics. For one, the person using the device had to select from a number of different printers to print a label, “and if they chose the incorrect printer, there wasn’t anything that notified them of that. Meanwhile, the label was printing on a different unit”—where, of course, it ran the risk of being misapplied to another patient’s specimen.

Then, too, adds Judy Wampler, Norman Regional’s manager of outpatient and outreach services, “after you scanned your patient’s armband, there was a lag time before the labels would print. That was very frustrating. You had the right patient and the right tube, but now you had productivity issues. Then, because of that lag, staff didn’t want to use the product.”

That initial negative experience meant that when Norman Regional decided two years ago to switch to Iatric Systems’ MobiLab positive patient identification system, Johnson and Wampler realized they were under extra pressure to make sure the new product was implemented smoothly. “That past system failed, so that if we brought in something new and anything went wrong, the staff wouldn’t have any interest in it,” says Johnson. “We tested and tested and tested. And when we went live, there were no issues.”

No software or hardware issues, anyway. After implementation, Johnson discovered that the laboratory still received a certain number of specimens that didn’t bear a MobiLab label. Upon investigation, she discovered that the cause could usually be traced to a workflow issue, such as the nurse or laboratorian who drew the specimen forgetting to bring a portable label printer to the bedside. In response, “I started sending a daily report of any specimens that went to the laboratory that did not have MobiLab stickers on them,” Johnson says. “I gave that information to the manager of the unit, and they had to respond and tell me why that sticker hadn’t been used.” Shortly after the software went live, she says, noncompliance rates dropped.

And, to make the process quicker, “we put bar codes on our printers,” Johnson explains. “The person drawing the specimen just scans the printer, and that associates it with whatever device they’re using,” whether that’s the handheld device the phlebotomists use or the computer-on-a-cart the nurses use.

The most widely appreciated feature of MobiLab, however, may be its simplest—its automatic printing of the “three things you want on every tube,” namely, the specimen’s draw date, draw time, and collector, Wampler says.

“It seems like such an easy thing, but that was such a big thing,” Johnson agrees. “On the nursing side, they hated dating and initialing those specimens. It sounds so simple, but they hated it. And now they love it. And on the lab side, now they know who did the draw.” Is there anything else she wishes MobiLab could do? “Maybe vacuum and start the dishwasher,” she says.

At Sturdy Memorial Hospital, Attleboro, Mass., positive patient identification is achieved via the Lattice MediCopia system, which was put in place in November 2009. Before then, “we had a handheld system that we used for patient identification, but it was really an outdated system,” explains Colleen Jost, laboratory support services supervisor. “The program on the handhelds was unidirectional, so they would upload information to our computer system but wouldn’t receive any information or print labels. All they were really doing was capturing the time of the draw.” In addition, “our old handhelds kept breaking, and it was very difficult to get them fixed.” Lattice captures the date of the draw, time of the draw, and the phlebotomist’s initials, and prints this information on the specimen label. This saves a lot of time for the phlebotomist and makes it easy for everyone to read, Jost says.

Maybe that’s why, when the Medi­Copia system was implemented and new handheld units obtained, the hospital’s phlebotomists were so enthusiastic: “I liken it to Christmas morning when my kids were little—everyone could feel the excitement,” Jost says. “With the old handhelds, the phlebotomists would draw 20 or 30 patients and then all of a sudden the handheld would stop working; the batteries didn’t hold a charge anymore. So the effort of scanning each patient was futile because they couldn’t upload to the LIS—they would have to receive everything individually. Whereas with MediCopia, it’s a superhighway. As soon as a patient is selected, the patient’s full name and date of birth pop up. Then they scan the bracelet, and if it’s an okay scan, it allows you to go to the next window.” If there are comments, there’s an asterisk on the screen so the phlebotomists know to look for a note. They can add extra tubes or cancel a draw. “So many of the functions they used to have to do in the LIS, they don’t anymore. It allows them to stay on the unit, draw the blood, and send it down to the lab,” Jost says.

Then, too, MediCopia improves patient care by making it easy for phlebotomists to prioritize their draws. “On the handheld, it highlights in yellow the blood draws that are overdue, and it shows the priority,” Jost explains. “Urgent” and “stat” have red exclamation marks next to them. The software also sends a message if there is a priority draw. Most important, “We haven’t had any specimen collection errors since we’ve gone live. Before then, I probably saw four or five errors a year. Although they never reached the patient, that’s four or five too many.” MediCopia has been so successful that the hospital’s nursing units are planning to implement it soon as well.

Like her counterparts at Southern Regional and Norman Regional, however, Jost has had to iron out a kink or two in the PPID system along the way. In her case, one of the issues was label size. The portable printer Sturdy Memorial uses with Medi­Copia “takes a different label than what we were used to,” she says, “and the information on the label would truncate off the side. We have so many people with hyphenated names now, like our ob-gyn patients who kept their maiden name and their married name. Our blood bank supervisor felt this just wasn’t okay, to have the name go off the end of the label. So we talked to Lattice about changing the font. We ended up making the bar code a little bit smaller and putting the last name on one line, so it wouldn’t truncate anymore.”

MedCentral Health System, Mansfield, Ohio, implemented the Siemens Patient Identification Check system in March 2006. “It has been a fairly easy process,” says laboratory clinical analyst Karen Phalor, MT(ASCP)SBB. “Since we implemented PIC, we have not had any patient labeling errors. Before we implemented it, sometimes somebody wouldn’t notice that two different patient labels were stuck together, and the wrong label would go on a tube. Or we would test orders that were collected by mistake—somebody would think they got the right tube but they hadn’t. We no longer spend a lot of time trying to track down a sample that somebody didn’t actually collect.”

She appreciates, too, a couple of small but crucial features, such as the fact that PIC uses a specially notched label. “It was made for the BD collection tubes,” she says. “There’s a triangle on the tube and a notch on the label that helps the phlebotomist line up the label on the tube so it can be read by instruments. Before we had PIC, we would get labels that were wrapped around the wrong way, and you had to re-label.” With new phlebotomists and nursing staff in particular, it’s helpful, she says. In addition, Siemens has customized MedCentral’s installation of PIC so that “we are able to use customized labels for specific things. For example, with blood cultures where we have two collection bottles, PIC automatically will print out two labels for us, and for blood bank orders PIC prints both a demographic and tube label.”

Like Southern Regional, however, MedCentral has run into problems with its wireless network. “When we first started using PIC in 2006, the hospital was going wireless with so many devices that we had some issues with the wireless structure itself,” she recalls. “We had some dead spots within the hospital, but those issues were resolved once we upgraded the system. The other thing we didn’t anticipate was how often to budget for replacement equipment. The handhelds are pretty rugged, but after a while, they get beat up.”

By this point, it’s starting to sound like a mantra, but that doesn’t make it less true: “Ever since we started using PDAs for positive patient identification, we haven’t had a mislabeled specimen,” says Ethel Urbi, MPA, MT(ASCP)SH, DLM, laboratory regional director of the three-hospital Community Healthcare System, Munster, Ind., which implemented SCC Soft Computer’s SoftID technology last year. “It’s being used by all three of our sites. Not only have we implemented SoftID for inpatient phlebotomy, but it is also used in the emergency department, because the emergency department draws our blood specimens. And then certain nursing units, such as the IV team in our flagship hospital, also use SoftID.”

In addition to eliminating mislabeled specimens, SoftID has indirectly shortened turnaround time, Urbi says. That’s not only because “now everyone knows where the specimen is,” but also because “once the information is collected by the SoftID, it’s transferred to the LIS. Then we put the specimen on an automated track that does auto-receive. Now the phlebotomist can take care of another run, if they have to, instead of spending time receiving. So we have seen some improvement in morning turnaround time.”

In the future, Urbi says, she’d like to streamline matters by combining SoftID with the device the nursing units now use to check vitals, “so that there’s only one PDA that’s being used instead of multiple PDAs. I think that’s going to be happening in the future.”

“Honestly,” Urbi concludes, “I think that indirectly the SoftID has promoted our system to the public as very patient-conscious and focused on patient safety. Because I recall one time when a patient asked, ‘Aren’t you using the PDA on me?’ And she was an outpatient. I said, ‘Well, ma’am, you don’t have a wristband.’”

Related Links

• Barriers to bringing in PPID systems