08 Mar The Essential Guide to Bedside Specimen Labeling
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The specimen label produced at the bedside is the crucial link between the benefits of automated management systems and real-world processes. There can be no specimen accuracy and patient safety benefits without durable labels and consistently excellent print quality.
Label readability is the most important criteria when selecting a printer for specimen labeling. Bar codes, text and graphics must be clear and long lasting to provide accurate identification from the time of collection through to final disposal or storage. Printers should also be fast enough to produce labels on-demand without inconveniencing the phlebotomist.
Printer ease-of-use is also important. Mobile printers can be worn on belts or shoulder straps, and can also be mounted on carts. Weight becomes an important consideration if the printers will be carried or worn. So does the ability to perform after being dropped to the floor multiple times. Check specification sheets for printer drop ratings. Evaluate user-friendliness by observing how easy it is to access controls and to check indicators during normal operation, and the convenience of changing media.
Mobile printers can connect directly to hospital wireless networks, which enables label orders to be sent directly from a laboratory information management system or other central application. If wireless printers are used, they should support all the same security protocols used for mobile computers.
Getting Started with Bedside Specimen Labeling
Because exceedingly high bar code scan rates are essential to the success of specimen identification, thermal printing technology is an excellent option for specimen labeling. Thermal is the leading technology for bar code labeling applications because of its print quality and suitability for use in many challenging environments. To understand and appreciate the benefits that thermal technology has over laser and ink jet for bar code label production, you need a basic understanding of bar code symbols and how each print technology produces them. Scanners decode the information from bar codes by measuring the differences between narrow and wide elements, and the contrast between dark bars and light spaces. If the ratios or contrast are slightly off, the bar code may be difficult or impossible to read, or may be read incorrectly. Appropriate printers and supplies greatly reduce the chances of these problems occurring, and thus are important contributors to patient safety. The following sections outline the advantages and disadvantages of print technologies commonly used for specimen labeling.
Thermal printing is classified as either direct thermal or thermal transfer. The two technologies are suited to different applications. Direct thermal printers create images by using a printhead to apply heat to selected areas directly to the chemically treated label material. There is no ribbon or ink required. In thermal transfer printing, the printhead heats a ribbon, which melts the image to the material. Thermal transfer is used for high- durability, long-lasting labeling applications. Direct thermal printing is the technology of choice for most
unit-dose labeling applications. It has many advantages and a few limitations.
- Direct thermal printing produces sharp print quality with good readability.
- Direct thermal printers are simple to operate compared to most other print technologies, with no ink, toner or ribbon to monitor and replenish.
- Because direct-thermal printers don’t use ribbons, they protect patient privacy, which helps comply with HIPAA.
- With no supplies to replace other than the material to be printed, long-term maintenance costs and total cost of ownership remain low.
- Direct thermal enables batch or single label printing with virtually no waste.
- With recyclable materials available, direct thermal printers offer environmental economy.
- Direct thermal printing is sensitive to environmental conditions such as heat and light. Long-term exposure to fluorescent light can reduce bar code quality. However, top coated media is available to mitigate these effects, and direct thermal labels are usually fully capable of meeting medication marking needs.
- Thermal printers accept roll media and cannot print 8 1/2- by 11-inch documents.
- Laser printers are good at producing bar codes on plain-paper documents.
- They can print high-quality text and graphics on paper documents and can double as a document printer when not being used to print bar codes.
- Bar code density and resolution are also quite high on laser printers, resulting in high-quality symbols.
- Laser printers can be wasteful because they cannot produce single or small labels. A minimum of half a page of media is typically required for the printer to maintain control of the sheet. Unless the label is at least that size or multiple labels are needed at once, the remainder is wasted.
- Laser printer label adhesives must be carefully selected to ensure stability under the heat and pressure of the fuser. Otherwise, the adhesive may seep onto the printer mechanism, where it will capture stray toner, or may cause the labels to curl at the edges.
- Because of the pressures used in the image transfer process, many laminated label materials are not compatible with laser printing. Those materials that are compatible may not always be available in the sheet form necessary for laser printing.
- A laser-printed paper label has limited durability. Laser printers cannot produce chemical- or water- resistant labels and images.
- With laser printers, toner, drum and supply costs can skyrocket when printing bar codes instead of typical text. While text printing requires only about 5 percent black toner, bar code needs can exceed 30 percent to ensure proper contrast between dark and light elements. Toner costs alone could be six times higher when printing bar codes rather than text.
- Laser printers are too large to be carried or worn. They require a cart and a plug-in power supply.
- Desktop ink jet printers are inexpensive to purchase and easy to replace.
- Sheet-cut adhesive label material for desktop ink jets is readily available from office supply stores and catalogs.
- Many hospitals already have ink jet printers for document printing.
- Many desktop ink jet printers can only print labels by the sheet, resulting in waste and inefficient handling required for loading and handling label material.
- Processing variable data and formatting bar codes significantly slows print speed. Productivity suffers when operators must wait for labels to come out of the printer.
- There is limited bar code and label design software support for desktop ink jet printers.
- Media options are limited to paper, which is insufficient for many sample tracking environments.
- Durability and reliability are limited when desktop ink jet printers are used in non-office environments. Desktop ink jet printers are not designed to withstand dust, dirt, vibrations and other environmental conditions common in shipping areas, which leads to increased maintenance and reduced lifespan.
- Ink jet printers are too large to be carried or worn. They require a cart and a plug-in power supply.
Label Quality Matters
Label media works in concert with the printer and is a major variable in the image quality and durability. The finished label includes a substrate material, adhesive, and often a protective coating. Each element must be care- fully selected for the specific usage environment and checked for compatibility with the specific make and model of mobile printer. Otherwise, print quality and longevity problems can result.
It’s fairly easy to find substrate, coating and adhesive combinations that work well at the bedside. The challenge is finding label media that will maintain excellent print quality throughout the life of the sample and withstand all test and storage conditions, even if exposed to blood, water, xylene, disinfectants and UV light.
General-purpose, commodity-type labels may seem suitable because they can easily affix to the specimen container when the sample is taken. However, the labels may fall off if the adhesive isn’t specifically formulated to withstand cold storage, sterilization, centrifuge and other conditions. Even if the label remains on the container, the bar code and text may become unreadable if moisture causes smudges or tears, or if air pockets form between the container and the label.
Thermal printers are compatible with a variety of label materials engineered specifically for use in laboratory environments. Hospitals and labs should consult with a supplies specialist when specifying specimen tracking labels, because of the many variables involved and the many product options available.
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