Advancing Public Health Informatics – CHS Sample Barcoding System (CHS-SBS)

Introduction

Globally, health care systems continue to face challenges related to medical errors. To minimize and completely eliminate human transcription errors experienced during viral load and Early Infant Diagnosis (EID) sample labelling and to ensure completeness of patient demographics with each sample transported to the national testing laboratories; CHS developed and introduced the use of a barcode labelling system – the CHS Sample Barcoding System (CHS-SBS)  whereby, patient samples are labelled and transmitted electronically reducing the time taken labelling sample tubes manually.

What is Sample Barcoding and How Does it Work?

Sample barcoding is the electronic process of labelling viral load and EID samples. The laboratory personnel receives samples and searches for the patient records on the Electronic Medical Records (EMR) system, access the patient details and prints a barcode sticker unique for each patient thus reducing the time taken and errors experienced during manual labelling and arranging samples according to their numbers in their hundreds on a rack.

Goal

Eliminate human transcription/sample labelling errors and ensure completeness of patient demographics with each and every sample transported to the national testing laboratory.

Below is a comparison of the steps followed using the manual labelling and sample barcoding system (before and after the implementation of the sample barcoding system).

 

Manual Labelling	Sample Barcoding System
Patient samples collected and put in a cryovial tube	Patient samples collected, put in a cryovial tube
Tube labelled using a special marker pen	Laboratory personnel (collection lab) accesses the patient information on the Electronic Medical Record system including the test to be done, prints the barcode and attaches it to the tube
Laboratory personnel (collection lab) generates an excel sheet for all samples collected serialised according to how the samples are arranged in the rack	Samples are delivered to the national testing laboratory in Nairobi and scanned using the barcode reader
Laboratory personnel (collection lab) transport the samples to the national testing laboratories in Nairobi
The laboratory personnel at the national testing laboratory verify sample by sample to confirm the arrangement order in the excel sheet
**It is impossible to follow up on missing data elements like DOB and transcription errors  for every sample

 

Advantages of Sample Barcoding System

• Patient information is complete and up to date
• Manual Cryovial Tube/ PPT Tube/PCR filter paper labelling takes approximately 2 – 5 min per tube as compared to the barcode labelling that takes 5 seconds
• Eliminate the need for verification of viral load data at the national laboratory as samples are scanned directly into the Laboratory Information Management System (LIMS)
• Eliminate transcription errors noted during manual labelling
• Cut down costs for procuring permanent markers used to label tubes
• Short Turn Around Time (TAT)
• The model does not depend on the internet
• Does not require a laboratory request form
• Double sample login into the LIMS is eliminated
• Over 30 samples can be logged into the LIMS system within one minute

Key Elements of the CHS-SBC

1. Timely and accurate patient demographics
2. No transcription errors
3. No illegible handwriting
4. Completeness of patient information as all the data elements required are captured 

Lessons Learned

The barcode model has greatly improved patient sample management. It is easier to identify and manage patient samples which translates to reliable patient results and better patient management. 

With support from the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), CHS made a poster presentation on this innovation during the Public Health Informatics Conference, in Atlanta, Georgia. Exploring Automation of Viral Load Result Transmission from Reference Lab to Electronic Medical Records Systems in Kenya