Transposing of CSN numbers when scanned
We started to experience something disturbing several months ago in one region of our hospital system. When a barcode was scan (either armband or patient sticker) one, two, or more numbers were being transposed by the time they reached Telcor and stopped in the results exceptions bucket. We are also seeing symbols in place of numbers (&%$). We know they are nonsense numbers because when we look them up in EPIC, no patient was seen that day at that facility. This is happening on iSTAT, Nova StatStrip, Hemochron, ABL, and has recently started to occur on Rovers that the phlebs are using (so not directly tied to POC). Additionally, now our other two regions across the state are slowly starting to see the same issues at their major hospitals.
Of note: It started after a major EPIC upgrade. All EPIC analysts insist nothing was changed that would affect this. As more hospitals are seeing this issue, it jumps after each upgrade.
What we have investigated:
1) Barcode quality: We sent our barcodes to an outside source to be graded for quality. We sent both a barcode that scanned wrong and a barcode that scanned right. They both failed a number of quality checks but....they both failed. Even the barcode that scanned correctly in our meters.
2) Checked with all vendors: Barcode settings, maskings, symbology all checks out.
3) Printer settings: We employ a vendor that has checked and made sure all printers (especially the ones that print barcodes initially) are all at the highest settings.
4) EPIC Printer drivers: This has been the main focus. Original print jobs use EPIC drivers. Reprints use client print drivers. It is nearly impossible to tell which printer the barcode came from because we don't know who the patient is to track back to. Unless we catch the error in real time (like sitting in front of Telcor all day), we have not been able to catch this. We are still getting huge pushback from EPIC analysts who insist this isn't the issue. So far, I have been successful in getting them to change printer drivers in the EDs and I feel like I have seen a decrease.
Here is the catch: I'm starting to see them at an affiliate hospital that uses their OWN instance of EPIC. They aren't our drivers. Now I'm stuck and I'm reaching out.
If anyone has had this issue...PLEASE email me at Mary.Hammel@UCHealth.org
If you made it this far, thank you!
Mary
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...WOW, Mary!...
I don't have Telcor so sorry no help from me but I wondered if your system uses Beaker?
Here the nurses say 'it's connected to EPIC' but in reality, we have EPIC and EPIC Beaker (and RALS).
I am usually apprised when EPIC upgrades but I don't always know about the EPIC Beaker upgrades. And frankly, whenever possible we blame Beaker for mishaps due to the struggle we have using Beaker overall (which may or may not be an exaggeration on our end).
Mary,
Can you tell me what version of EPIC you are on?
We are all gasping here for you and hope that this isn't something that we will see. So far, if this is happening here, we don't see it or hear any complaints.
Hi Mary,
I second Jeanne. Could you provide the version and maybe when your upgrade happened?
Best,
Hi Mary,
Is there any noticeable difference in looks, format or sheen between the corrupt barcode and the working barcode? Are they both supposed to be the same CSN? I would be leaning towards barcode quality or format.
One troubleshooting step you could try is find a free online barcode generator and generate a barcode for a true CSN and the CSN that was actually read (ie. 12345 vs 123$5). Do they look similar? Is one line slightly off? If so, it could be the resolution or the barcode is too compact.
Good luck and absolutely stress positive patient ID with your end users during this time.