1. McCartney, Patricia R. PhD, RN, FAAN

Article Content

Accurate patient identification (ID) is essential for patient safety, especially with our smallest and most vulnerable pediatric patients. A recent study of misidentification in the neonatal intensive care unit (NICU) over a 1-year period found "not a single day was free of risk for patient misidentification" (Gray et al., 2006). These researchers, along with other experts, regulatory and accrediting agencies, recommend barcode technology to reduce patient ID errors in multiple aspects of care, including medication administration; there is even an acronym for it: barcode medication administration (BCMA). The US Food and Drug Administration is now requiring a National Drug Code (NDC) barcode on medications. Nurses on Internet lists often discuss barcodes on newborn ID bands (search Perinatal Nursing List Archives for infant ID bands, baby arm bands, mom/baby barcoding, and medication barcoding at


Newborn Identification Bands

If you use BCMA, the ID bands must be attached securely to the newborns limbs. This poses challenges, because the bands are small (limited barcode space and band is more curved) and newborn skin is fragile. Use of bands in the NICU is even more challenging because of smaller band size, more fragile skin, Isolette humidity, and a long length of stay. BCMA bands must be durable and withstand exposure to soap, water, and provider hand sanitizer. Gulker and McLaughlin (2007) reported that their institution was committed to implementation of BCMA as a standard of care for all patients, including babies in the NICU, and these nurses tested a 2D barcode band in the NICU. They demonstrated accurate and reliable scanning, including scanning through the Isolette so the infant would not be disturbed.


Barcode Technology

Barcode technology is constantly improving. A barcode is a pattern (dark ink on white spaces) that is scanned (read) and translated into information. Symbology is the language that encodes information-or the data structure-into the barcode pattern. There are many different and unique symbology standards for barcodes, with certain types used in healthcare (the NDC is a barcode standard). The barcode print must be clear and durable so reading is accurate and reliable.


A 1-dimensional (1D)-or linear-barcode encodes alphanumeric characters in a single dimension: a horizontal row of parallel lines and spaces (picket fence). When the amount of data is increased, the number of lines and width of the barcode increases. A blank space (quiet zone) is required before the first bar and after the last bar in the pattern to avoid confusing the scanner and causing a "no-read." A linear barcode is read with a laser scanner held directly in front of the barcode. Bright light can be reflected into a laser scanner and cause interference (one may need to shade the glare). A linear barcode that is too wide, not held flat, or without acceptable quiet zones will not scan. Most linear patient ID bands currently use symbology called Code 128.


A 2-dimensional (2D) barcode encodes data in both horizontal and vertical dimensions (box of dark squares and spaces), has a much greater data capacity than a linear barcode, and can be scanned from any direction. A 2D barcode can only be read with an imager that is similar to a digital camera (a linear barcode can be read by both laser and imager). The most common 2D symbologies are called PDF417 and Aztec. (Aztec has more compressed data and does not require quiet space.) Two-dimensional barcodes are common on ID cards, passports, and driver's licenses. A small 2D barcode is the perfect solution for the newborn band!! You can make accurate newborn ID a patient safety goal in your setting!! Search the Internet for commercial options for 2D barcode newborn ID bands. Collect data on your implementation, and don't forget to publish your results in the nursing literature to help other nurses to create best practices!!

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Gray, J., Suresh, G., Ursprung, R, Edwards, W., Nickerson, J. Shiono, P., et al. (2006). Patient misidentification in the neonatal intensive care unit: Quantification of risk. Pediatrics, 117, 43-47. [Context Link]


Gulker, L., & McLaughlin, K. (2007). Launching barcode scanning in the neonatal intensive care unit. Cerner Health Conference, Kansas City, MO. [Context Link]