A Louisiana health system is improving safety and patient outcomes by expanding its use of barcodes and other tracking under the commonly used GS1 standards. The effort also is yielding better inventory management. Along the way, the health system developed a GS1 implementation program that other organizations can use.

The Franciscan Missionaries of Our Lady Health System (FMOLHS) is a nonprofit healthcare system in Prairieville, LA, that serves more than half of Louisiana’s population. It includes eight large hospitals and 350 physician clinics.

Its recent implementation of the global GS1 standards means operating room (OR) nurses can scan product barcodes to capture product data, such as expiration dates and recall information, while also entering product-related information into the patient’s electronic medical record (EMR).

The system also could help improve patient outcomes by allowing the chief medical officer to access detailed information about the variability of items used in procedures and the impact on care, notes Sandi Michel, system director of supply chain strategy at FMOLHS.

Standardizing Across System

GS1 is a not-for-profit organization that maintains global standards for business communication, including the well-known barcode on retail products. GS1 standards are designed to improve the efficiency, safety, and visibility of supply chains in many industries.

To fully adopt GS1, FMOLHS began by reviewing its standardization vision and strategy with about 80 suppliers and group purchasing organizations, Michel reports.

The health system asked them to start using the GS1 Global Trade Item Number (GTIN) in barcodes to uniquely identify each of their products, Michel says.

FMOLHS plans to standardize the use of the GTIN for all items used in the health system. Manufacturers now are required to use them when selling to the health system, Michel notes.

About 85% of implantables in the system now have unique GTINs, Michel adds. FMOLHS also adopted the GS1 Global Location Number (GLN), which identifies each location within the FMOLHS health system.

The use of barcode scanners improves efficiency and accuracy, Michel observes. Even when part numbers or other identifiers were available, numbers and letters could be mistyped into a patient’s record. Scanning the barcode ensures the correct device number is entered in the patient’s medical record, which can be vital in the event of a recall for an implantable device, for instance.

The effort began in 2012. Michel and other FMOLHS leaders attended conferences and consulted other resources to learn about the potential improvements for safety, outcomes, and inventory management. Once the potential benefits became apparent, they looked for a sort of master plan for how to implement GS1 standards in a large organization, but they could not find one.

So, leaders decided to create their own.

Opening Their Own Warehouse

FMOLHS worked with seven vendors in developing a GS1 implementation plan, with the intention of making it available to other health systems afterward. FMOLHS started by establishing an Office of Data Standards and Interoperability. Divisions within the office addressed particular areas of GS1 implementation, such as the GLN, pharmacy, and interoperability.

FMOLHS opened its own warehouse in 2015, allowing the organization to better control its inventory and provide “just in time” delivery of products throughout the health system. The GS1 program tracks the products, and the GLNs indicate exactly where the item is at any moment, Michel explains.

The inventory system also allows FMOLHS to provide the “best unit of measure” for any product to any location identified by a GLN, Michel says.

If a particular clinic needs only two pieces of an item from a case of 24, the GS1 program allows the warehouse to properly divide the case and deliver only what is needed rather than sending an entire case because that is the only unit available.

“Typically, this would mean that surgery will request the specific products and quantities they need, transmit that to us, and our warehouse has already broken down that case into the individual items. We will put together what they need in a tote and have that delivered directly to the location using the GSN,” Michel says. “We went a little further and used the GSN to create a hierarchy tree, all the way down from the top of the health system to each facility location, to each storage location. It could be a closet, a shelf, a bin. The tote with what they need is delivered directly to that location, just in time for the procedure.”

In 2017, FMOLHS started scanning into the EMR any supplies or product that were used on a patient, Michel says. Not every supplier uses GS1, but the outliers are minimal now, she adds. “We started four years ago telling suppliers that this was the expectation. Eventually, we will get to the point that we will make buying decisions based on whether you use the GS1 standard for your product so that it can fit in seamlessly with our system,” Michel notes. “Recently, we changed our group purchasing organization and realized this was a chance to get all of our suppliers using GS1.”

The health system determined that when considering vendor options, any company using the GS1 standard would be its first priority. Companies moving to adopt GS1 might be considered, but those with no GS1 plans would be considered last.

Educating Nurses About Scanning

Implementing the system required educating nurses about which barcode to scan when several are on an item.

Michel says nurses have embraced the program because the scanners reduce their workload and improve accuracy. Sometimes, nurses will hold onto a package that did not scan properly so FMOLHS can notify the vendor and fix the problem.

FMOLHS also provides feedback to vendors on how they use barcodes, suggesting better ways to label the products. In one case, the health system reported the labels on small tubes were not scanning properly. The manufacturer switched to a different type of barcode more suitable to the small tube size. In another case, the health system reported barcodes on reflective material were difficult to scan properly. “We want a device that can be scanned so the OR nurse doesn’t have to manually type in a lengthy number, which can include a serial number, a manufacturer number, and an expiration date,” Michel says. “We’ve been consistent over the years and communicated well with our suppliers, so we can record accurate information provided by the supplier themselves into that patient record. It helps us with recalls, decreases errors, improves efficiency, and it allows us to feel confident that this isn’t a counterfeit product that was just brought in off the street.”

The program has improved patient safety through both the increase in information put in the patient record and the reduction in errors with that information, Michel says. The GS1 implementation also can be useful if The Joint Commission conducts an audit, Michel says. In an audit, FMOLHS can provide an accurate assessment of inventory throughout the system.

FMOLHS makes all of its GS1 implementation plans available for use by any healthcare organization. “There is a myth out there that this is very difficult to do, but it’s really not that difficult to do because we’ve done all that early discovery and design,” Michel says.

More details about the FMOLHS model are available at the link in the resource list below. “That is available to anyone who wants it,” Michel adds. “It will provide a framework for implementing GS1 as effectively as we have at FMOLHS.”

RESOURCES