Barcode Labeling: It Saves Time, Money, and Lives

Healthcare consists of an array of clinicians, departments, and specialties working together. It’s an understatement to say that the opportunity for errors is high. The prevention of medical errors continues to be one of the greatest healthcare goals. In order to improve patient safety, policies and workflows are constantly being reviewed and updated. One overlooked yet important aspect of preventing errors is specimen labeling. There are an estimated 160,900 adverse events that occur in U.S. hospitals annually due to specimen identification errors. Lab testing is vital to patient care and diagnosing diseases. It is an everyday task performed in hospitals, medical offices, and free-standing laboratories. Along with the risk of patient harm, labeling errors have serious financial consequences. Labeling mistakes causing redraws, retesting, and unnecessary treatment cost the healthcare industry a staggering 200 to 400 million dollars every year. 

A major solution for labeling errors is the implementation of barcodes and automated scanning processes. Barcode labeling has benefits at the point-of-care, or time of collection, by ensuring proper patient identification. It extends to the lab where staff can track samples through processing, testing, and storage. These automated data systems are highly accurate. They eliminate many human errors while also saving time of clinical staff and in turn, cutting costs.   

The Background on Barcode Labeling 

The Story of Labels in Healthcare provides an in-depth history of barcoding and labeling technology.  In 1977, blood banking institutes were one of the first healthcare entities to utilize barcodes in order to reduce errors and ensure expiration dates weren’t exceeded. Next, in 1990, diagnostic agencies began using chemical-resistant barcode labeling in conjunction with technology to automate microscopic slide staining. Finally, in 1999, some hospitals began adopting barcode technology for improved medication administration. Over the next 15 years, the FDA introduced regulations on barcodes for medication packages and labels as well as medical devices. 

Statistic quote detailing how barcoding is less likely to produce errors than manual entry systems.

Barcode labeling has since become the rule and not the exception. Barcoding is four times less likely to produce errors than manual entry systems. It isn’t hard to understand why. Humans make mistakes, and instituting an automated system takes away a large part of that risk. Even now, there are facilities and labs where nurses and phlebotomists manually write their initials and time on lab tubes. This undoubtedly causes mistakes due to incorrect or illegible handwriting. Vials simply being dropped off at nursing stations (and then moved or misplaced) are extremely outdated processes that cause delays in completing STAT orders or inaccurate treatment from blood work drawn too late or too early.  

How Does Barcode Labeling Work? 

There are many types of barcodes. Everyone is familiar with linear barcodes – a pattern of thin and thick bars with spaces found on every item in a store. Sometimes barcodes are vertical (microscope slides) or horizontal (lab tubes and vials). Healthcare facilities often use a 2D or “two-dimensional” barcode which is a square block with a pattern of cells to create a sort of matrix. These are smaller than traditional barcodes yet have a huge capacity for information while taking up less space on labels. They are also a better fit for curved tubes, vials, and patient wristbands. Additionally, they are especially helpful in automated scanning.  

A barcode and lines detailing what each piece of the barcode is including perimeter, edges, and light and dark data cells

Some types of medical products require very specific labeling and coding that goes beyond simple patient identification and order information. Products with a human origin such as blood, tissues, and organs, require highly accurate and efficient identification between donor and recipient. This international standardization is known as ISBT 128. This level of compliance cannot be fulfilled by manual labeling. It requires electronic tracking using linear barcodes, 2D barcodes, and the introduction of a newly-developed type of label, RFID, or Radio Frequency Identification, for added security.  

Barcode Equipment Involved 

A barcode specimen collection system has three parts: Computer (or handheld device such as a tablet), barcode scanner, and label printer. 

Often, hospitals required to draw labs and collect urine or respiratory specimens. Nurses utilize stationary computers in the patient’s room or mobile computer workstations to administer medications via a barcoding system. The ability to have a software program available on those computers or on a handheld device for phlebotomists creates an ease of use that allows for timely collection and results. 

Thermal barcode printers are highly accurate at producing the exact number of bars and spaces for barcodes as well as durable images. Thermal printers are best for use in laboratories. They take up minimal space and print tiny labels for an array of uses. These uses include blood bag labeling, cryogenic storage, cellular slides, and applications of curved surfaces such as vials and syringes.  

Barcode Printers and Scanners

For printers used outside of the lab, at the point of care, it is necessary for these printers to be lightweight, easy to carry or transport, and user-friendly. It is crucial to choose a printer that offers excellent print quality, as a scanner cannot read inconsistent or poor printing. Wireless printers offer the ability to receive new orders, add-ons, or cancellations in real-time as well as transmit completed collection data instantly. This reduces redraws and cuts down on lost time for staff as they are not having to return to the lab to retrieve labels. 

Scanners read barcodes by deciphering the space between narrow and wide elements and the contrast between dark and light. A scanner may have difficulty decoding if these ratios are even slightly off. Frustrated clinicians who can’t get a barcode to scan are under the impression that the fault lies with the scanner. On the contrary, the inability of a scanner to read a label is often due to the poor print quality of the barcode. 

Step-by-Step Process 

It is recommended that labels are printed and attached at the time of collection, known as point-of-care, as a best practice standard. This works by staff first scanning their ID badge to identify themselves as the specimen collector. They then scan the patient’s wristband which also contains a barcode to ensure they are the correct patient. (It is also recommended to have the patient state their name and date of birth as a second identifier). The patient’s ID is matched to the LIS (laboratory information system) which contains the order information. A portable printer prints the label, the specimen is collected, and the label is attached immediately, in the presence of the patient. There may also be an additional scan of the sample after label adherence as a second verification. There is strong evidence within medical literature that bedside collection of specimens greatly reduces errors.  

Graphic detailing a hospital study where they eliminated 44 steps in the lab collection process where errors occured

The risk for error increases when more time and distance is put between the printing of labels and the actual collection and application of labels. A hospital in New Jersey was able to identify 63 steps in the lab collection process where errors could occur. After implementing a bedside labeling process, they eliminated 44 of those steps. They found that carrying multiple patient labels into a room was the number one cause of mislabeling. Labeling away from the bedside was the second-leading cause. By implementing bedside collection and labeling, multiple hospitals have reported a significant reduction in errors.  

Labeling Inside of the Lab 

After collection, specimens are taken to the lab where barcode labeling continues to assist with processing. Clinical information is readily available in the Laboratory Information System (LIS) database which is software that supports and manages all laboratory functions. This automated system acts just like other electronic health records in a hospital or medical office. The LIS contains chain-of-custody information such as the technician ID, timestamp, and location of the collection. Once a specimen has arrived in the lab, the barcode is scanned again as another record that the specimen has been received and by whom. The sample is then ready for testing. The result? All the collection data is uploaded and available in one place with no manual entry required. Accordingly, testing becomes a streamlined process with little room for error. 

Audit Trails 

An audit trail is an integral part of the LIS. Think of an audit trail as a receipt of every lab sample. It keeps a timestamped history of any changes made, who made them, and why they were made. Audit trails allow for better security and transparency. In the unfortunate event that a specimen goes missing or is damaged, an accurate record of who handled it and any actions that were taken can be accessed. This isn’t to place blame or punish, but to better prevent future occurrences. Audit trails also ensure laboratories remain in compliance with regulatory guidelines which ensures the integrity of lab results and reporting.  

Label Adherence, Durability, and Legibility 

Labels consist of a substrate, adhesive, and protective coating. It’s important to select supplies that are compatible with the specific printer being used as well as the usage and storage of the specimen being collected. Ink must be smudge-proof for readability, and text, barcodes, and graphics must be clear for scannability. It is worthwhile to choose a type of label that will withstand changing temperatures, handling, centrifuges, chemical contact, and storage without losing its adherence and legibility. Certain specimens are kept in storage for years – decades even. Labels must be durable to maintain their adherence through changing storage temperatures and environments. A high-quality label should not easily smudge if in contact with water, blood, or hand sanitizers.  

Case Study: Caresfield Cryogenic Labels 

Some samples require freezing during transportation and storing and are thawed upon testing. It is imperative that these specimens are labeled correctly upon collection. In addition, labels need to remain affixed during the entire process for proper tracking and identification. 

Unfortunately, a laboratory was using a cryogenic label from another vendor that only adhered to pre-frozen vials and failed to adhere to an already frozen specimen, causing labels to detach. Technicians were using a rubber band as a solution to keep labels in place which was an ineffective and unsafe practice. 

Caresfield engineered a cryogenic label to withstand all temperatures and environments and was compatible with already existing equipment. Their rigorous testing has proven that their labels remain in place on a pre-labeled specimen whether at room temperature, frozen, or thawed. Labels also maintained their readability and scannability. These innovative labels allow for a huge savings potential for labs around the country. In addition, this reduces the risk of errors and improves process efficiency. 

A roll of cryogenic labels by Caresfield
Caresfield’s cryogenic labels

Streamlining Workflows

Barcode scanning, labeling, and automated information systems have proven to be an essential solution for hospitals, clinics, and laboratories. Patients have also reaped the benefits of these safeguards. With a reduction of errors in patient identification, they can rely on accurate, timely results. By streamlining workflows in real-time, lab orders can be combined. An example of this is drawing blood for morning lab work as well as another test all at once. Patients appreciate the least amount of needle sticks as possible, and staff appreciates the more efficient use of their time. The cost savings is also an undeniable benefit. By reducing waste and resources and increasing productivity, hospitals and laboratories save millions. 

But above all, improved patient safety is the greatest achievement and why barcoding technology is an evidence-based “best practice.” Barcode labeling prevents the tragic instances of a patient receiving incorrect results, prompting misdiagnosis and unnecessary (or delays in proper) treatment. There is a reduction in lost or unusable samples, and test results are available quicker. With the ability to track specimens in a database along with identifying any changes that are made and by whom, errors are significantly reduced, and mistakes that are found can be corrected.  

About Caresfield

Caresfield understands there is no room for error when it comes to lab testing and the labels they use. Caresfield is proud to offer the highest-quality labels created to adhere firmly to surfaces despite extreme environments such as centrifuges, water baths, and freezers.  

Request an onsite visit from one of our Certified Healthcare Label Technicians

References: 

https://learn.barcoding.com/hs-fs/hub/73917/file-260708060-pdf/bedside-specimen-en-us.pdf

https://www.computype.com/hubfs/Images/downloads/pdf/
eBook_-__Life_Savers__Game_Changers_-__The_Story_of_Labels_in_Healthcare.pdf?hsLang=en

https://www.dasco.com/resources/learning-center/2020/03/18/barcodes-in-the-lab/

https://www.mlo-online.com/home/article/13004414/barcoding-the-way-to-patient-safety

https://www.iccbba.org/home/isbt-128-basics/what-is-isbt-128

https://www.mlo-online.com/home/article/13007805/barcode-specimen-collection

https://www.caresfield.com/case-study-cryogenic-labels-that-dont-fall-off

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518452/

https://www.caresfield.com/labels/laboratory/material/
direct%20thermal%20synthetic%20cryogenic.html#bottom-category-description


Maegan Wagner, BSN RN CCM has over 10 years of healthcare experience. Her nursing career has led her through many different specialties, but her passion lies in educating through writing for other healthcare professionals and the general public.

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