Glucometer Configurations: Accu-Chek / RALS

We use the CSN as the patient ID in all of our interfaced POC devices. For glucometer we use Nova Statstrip, Telcor QML, and Epic.   Our Epic armbands consist of one linear barcode CSN and multiple 2D barcode CSNs.  On the 2D barcode CSNs, there are two letters before the CSN #. We programmed our Nova Statstrip meters to ignore the first two letters of the 2D barcode and only read the numbers after that.  I've heard of other organizations having armbands that are too shiny for the glucometers to consistently pickup the patient ID. I feel your pain and wish you the best of luck! 

You may want to verify with Roche that their actual scanners have not changed.  This was probably about 7-8 years ago, but we encountered scanning issues in new and returned meters and finally found out that they had changed the scanner (we were not informed) and it was not compatible with our armbands.  Their solution was to just simply change our armband symbology, like that's a quick, easy feat and no one else in the hospital uses that barcode!  Just maybe something to rule out.  Once we really looked close, we could see the difference when looking at the scanning window; it was very evident. 

Hi,
We have always used the CSN for scanning with Accu-cheks and have been using EPIC  since 2012. Recently we switched from RALS to TELCOR and went from linear barcodes to QMR barcodes but it is still the CSN used and no issues.  Is there a problem with the wristband configuration of the actual barcode  or the  material of the wristband is too shiny? Your Epic team should be able to reach out to other accounts and see what they are using. It shouldn't be the CSN that's the problem. 

We have altered the wristbands to a matte finish to cut the shine of the bracelets. We have also changed our barcode symbology to only pick up the linear barcode - still issues. EPIC is suggesting the CSN could be the issue due to patients receiving multiple CSN's upon their visit but most often a single HAR at admission. When we have patients of extended stays over 4 weeks, we start running into the issue of the glucometer picking up a randomized number starting with a 0. We feel like we have exhausted all options.

We have this scanning problem with multiple POC instruments - mostly on the Nova Statstrip due to the high volume, but have also seen it on GEMs, ISTAT, CT Status, and Hemochron.  This started happening when we moved from Optio printing to Epic printing in 2021 and then also there were changes made in the armband paper.  Usually, it goes back to bad print quality.  We are wanting to move to the 2D barcode to help with the issues, but we are not anywhere close to that.  We have tried manipulating the barcode, changing the paper out, etc etc.  Numerous meetings and task items completed with Epic, Nova, Quality, etc.  Nova continually "grades" our armbands as a D or F.  We use Telcor.

We are set up the same way as Ms. Etchtenkamp. We have not experienced any issues since we went live with EPIC on July 1st.

CSNs - INFORM II - RALS - EPIC/Beaker
No problems  that I am aware of as long as POC Operator does scan CSN and not MRN if using the registration labels which have both barcodes.

Hannah,
Are your barcodes not actually scanning or is the information not being picked up correctly? At our facility , the patient gets a new CSN and wristband as they move for procedures  like going for an x-ray . It will still scan but the result will get held up in the data manager if the patient isn't re-wristbanded each time. Picking up extra digits is strange since the masking shouldn't change because the patient stays longer . We use QMRs now for Accu-cheks so that won't help you. We did have to keep the linear for i-stats. Are other departments having trouble scanning the bracelets? like pharmacy?

Only the Accu-cheks are causing issues. Med carts and other areas in the hospital utilize the 2D barcode. The barcodes are not actually scanning. 

We use the CSN with EPIC and we have RALS.  We have multiple hospitals, and use the AccuChek Inform and Nova StatSTrip.  We have the same issue and have to manually upload and edit CSN numbers for those who have been longer than 15+ days.  

Danialle - we have to do the same, I check my work queue each morning and some throughout the day for manually entered sample ID's that get held in the work queue. What is the work around that you suggest to the operator? I have tried to ask team members to manually enter the CSN when they have trouble so that the result will interface and so that they can verify the patient's information but often they skip right to manually entering in the MRN or the HAR which pushes the result to my work queue.

Some of our operators 'refuse' to print the correct armband visit (CSN) and will use a series account that was created upon initial encounter.  Others have told us that they are unable to print the current armband admission CSN armband (not sure why?!).  It is a lot of clean up for us each day.  

Hannah,
I have found multiple issues with scanning patient's armbands using the Inform II. We have the paper armbands and use the patient id that is on a 1D linear barcode.  Our linear barcode is really long and narrow and sometimes gets wrapped around the patient's wrist. When this happens and the user holds the device farther back to catch the whole thing, the scanner will come in contact with the 2D barcode that is also on the wristband and gives either an obscure number or the number that is on the 2D barcode. I have asked the users to try and cover the 2D barcode with a finger or something to try and block it. I think most people do this now and it works, but you'll always have those people who just won't even try to fix the incorrect number.  
My Inform II devices are also really old too and many times the scanner won't work because the battery needs to be replaced.  It seems like if the battery is old and dying the whole device wouldn't work, but I have found that most of the time when there are weird problems with the Inform II like the scanner won't stay on or it will scan the QC and strips barcode but not the patient's wristband, etc... if I change the battery, it works fine again. The majority of the batteries I've had to change have been in the devices since the hospital started using them (so I've been told) and were manufactured between 2016 and 2018.
Lastly, I have also found that when the device is reportedly "broken" and won't scan correctly, it is because either the scanner window is dirty or there is a partial haze on it after someone cleaned it with the cleaning wipes. Some cleaning wipes will leave a haze when the device is left to air dry. You can wipe the haze away with a Kimwipe or something similar. There are a few other scanning issues I've seen. Some of them have been addressed by others in their replies, but they aren't as frequent for me as the 3 I mentioned.

I hope you find a resolution. 
Good Luck!

Thank you all for the suggestions and guidance! I have one last question - Are your facilities utilizing a thermal printer for bracelets?