By Rob Raschke, BS, MS, and Vince Trier, BS

A FEW YEARS AGO, AURORA HEALTH CARE BEGAN LOOKING for ways to expand our use of electronic health records (EHR) with the goals of creating an integrated patient record across all of our facilities and improving patient safety. As we explored options for automating our day-to-day processes and taking advantage of new technologies to complement our patient safety efforts, we introduced the use of bar coding in the pharmacy of our facility in Sheboygan, Wisconsin, in February 2003. Since our initial installation, we have deployed bar code technology in an additional 10 hospital pharmacies.

Initially, we faced a number of decisions related to our use of bar coding, such as determining which medications to bar code first, which facilities to bring live next, and how to eventually extend the benefits of bar coding to the patient bedside. After evaluating our unique needs and developing a comprehensive strategy for the entire organization, the next step was selecting a bar code printer that would allow us to create linear bar code labels for a range of applications, including the labeling of IVs and special mixes, as well as the repackaging of unit dose medications from bulk liquids and oral solids.

For us, one of the most important considerations in selecting a bar code printer was ensuring a smooth integration between the printer and our Cerner PharmNet pharmacy information system. We also wanted a solution that was both durable and reliable, since we would be using the printers for a fairly high volume of labels.
With these criteria in mind, we selected a combination of bar code printers from Zebra Technologies. Aurora’s radiology file room staff had been using Zebra bar code printers to help manage file folders since 2001 and had a positive experience to report. The printers also received positive reviews from Cerner.

Bar Coding in Action
Today, Aurora uses Zebra’s Stripe printers at nine of its smaller hospitals and a combination of Zebra’s S600 and Xi printers at the remaining locations, where the printing volumes are significantly higher. On average, we find that our lowvolume facilities range from 6,000 to 25,000 orders per month, while the larger volume sites print anywhere from 43,000 to 53,000 bar code labels per month.

By using a variety of printer models, we can ensure that each pharmacy has the right printer to suit its unique workflow and volume requirements. We are also able to maximize our return on investment, because we do not have printers sitting idle in any of our facilities.

Each model is a thermal, on-demand printer that offers 600-dpi resolution for very small, high-quality symbols. This enables us to create bar codes with the durability and clarity we need to ensure high scan rates and more streamlined pharmacy operations.

One of the biggest benefits we have experienced through our use of bar coding is a more efficient method for processing the charge credits that occur when medications are returned to the pharmacy. In the past, a staff member would have to manually key in the order number or patient name into our pharmacy information system before processing the credit. Now medications are clearly labeled code, which staff members can quickly scan to add the medication back into the inventory, saving a significant amount of time.

Moving Forward
In the future, Aurora is moving toward a centralized medication repackaging operation for all of its hospitals, allowing us to increase efficiency and reduce costs across the organization. This will also support our ultimate goal of deploying bar coding technology at the bedside to ensure patient safety at the
point of care. Using Zebra’s bar code printers in the pharmacy to label medications at the unit-dose level has provided the foundation upon which we can build a successful bedside medication administration system. With this important step behind us, we are currently in the process of deploying bar coded patient identification wristbands — which we will print using the Zebra 2844 printer — at all of our facilities. We anticipate the rollout of the patient identification wristbands will be complete in the next nine months, paving the way for a fully operational bedside medication administration system in late 2007.

With bar codes on our medications and patient identification wristbands, nurses will be able to scan both of these items and document their actions in our enterprisewide EHR. As a result, Aurora can avoid adverse drug events and achieve a truly integrated medication administration process that delivers a higher standard of care.

Rob Raschke, MS, BS, has served as a manager of electronic health record systems at Aurora Health Care for four years. He has more than 18 years’ experience in the health care industry, spanning the provider, payor, and life sciences segments. The recipient of a BS in medical technology from the University of Wisconsin, Milwaukee, and an MS in health care administration from California’s University of La Verne, Raschke is currently president of the Wisconsin Dairyland chapter of HIMSS.
Vince Trier, BS, currently serves as a manager of electronic health record systems at Aurora Health Care. The recipient of a BS in management computer systems from the University of Wisconsin, Whitewater, Trier is responsible for the implementation of Cerner PharmNet, bar code medication administration, and CPOE in 13 Aurora hospitals.