Enhancing Nursing Efficiency and Patient Safety: Barcode Scanning and Interoperable Devices for Enteral Feeding

By: Caroline Steele, MS, RD, IBCLC, FAND and Suzanne Smith, MS, RD, LDN, IBCLC

Introduction

While enteral nutrition (EN) is generally considered safe, it involves a complex process with potential risks, especially for vulnerable patients like premature infants and critically ill children who require customized feedings with added fortifiers and nutrients to meet their increased metabolic needs. Much like medication compounding, preparing and administering EN carries a significant possibility of error as practitioners may accidentally use incorrect, expired, or even recalled ingredients, potentially jeopardizing patient safety.

Barcode scanning technology offers a reliable solution by verifying EN components against the patient’s electronic health record (EHR) during preparation and administration. However, the adoption of this technology remains suboptimal.  A 2015 survey of nearly 1,500 practitioners showed that less than half consistently used barcode scanning to verify human milk before each feeding.1 While the practice of scanning human milk has become more common, it has not been widely extended to other crucial EN components, such as fortifiers, additives, and enteral formulas. This lack of comprehensive barcode scanning, along with frequent formula recalls, likely contributes to the underreported problem of EN errors. The potential consequences of these errors underscore the urgent need for increased adoption of barcode scanning technology across all aspects of EN preparation and administration.

Barcode scanning is the superior method for verifying EN accuracy. It surpasses manual two-person checks by being more efficient, less prone to human error, and minimizing confirmation bias.2-3 Research strongly supports the effectiveness of barcode scanning in reducing errors, while there’s little evidence that two-person visual verification is associated with any significant reduction in errors.4-7 By implementing this technology for EN, hospitals can ensure the correct and safe use of formulas, fortifiers, and human milk, while also identifying expired or recalled items. Additionally, barcode scanning helps track “near misses,” allowing for system improvements and learning from potential errors. Both the Institute for Safe Medication Practices (ISMP) and the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend reporting errors and near misses to enhance safety in nutrition support therapy.

Scanning Human Milk

Leading professional organizations, including ASPEN, the Academy of Nutrition and Dietetics, and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), recognize the importance of scanning human milk at the time of administration as a best practice to prevent errors.8-11 This is particularly crucial for newborns, who are at a higher risk of misidentification and potentially serious consequences from receiving the wrong expressed milk. The Joint Commission, acknowledging these risks, recommends implementing reliable identification systems, such as barcode scanning, to prevent such errors.11

Research has consistently demonstrated the effectiveness of scanning human milk in reducing errors at various stages, including feeding preparation, administration, and hospital discharge.2-3,12 The studies below highlight the significant impact of barcode scanning in improving the safety of human milk administration and reducing the risk of potentially harmful errors:

  • Prevented wrong-patient errors: In one study, scanning prevented the administration of the wrong human milk 8.3 times per 1,000 bottles when nurses prepared feedings, and 2 times per 1,000 bottles when dedicated human milk/formula technicians were responsible.12 Another study reported preventing 1,226 wrong-patient errors over a 7-year period.3
  • Prevented administration of expired human milk: Scanning prevented the use of expired human milk 84 times per 1,000 bottles when nurses prepared feedings and 8.9 times per 1,000 bottles when dedicated human milk/formula technicians prepared feedings in a 6-year study.12 Additionally, another study prevented the use of expired human milk 2,103 times over 7 years.3

Scanning Fortifiers, Formulas, and Modulars

Despite the potential risks associated with EN errors, the practice of scanning all EN products during preparation and administration remains inconsistent across healthcare organizations. This is concerning because administering the wrong formula or fortifier can lead to serious complications, including metabolic and electrolyte imbalances, allergic reactions, and gastrointestinal issues.3 Leading organizations like ASPEN and the Academy of Nutrition and Dietetics recommend scanning EN products to improve patient safety.8,10,13 ASPEN, for instance, highlights how barcode scanning supports safe practices for both nurses and other caregivers involved in EN administration.13

Recent studies underscore the need for consistent scanning protocols:

  • Fortification errors: Studies have found attempts to use incorrect additives when fortifying human milk occurred more frequently with nurses than with dedicated human milk/formula technicians.12,14
  • Scanning effectiveness: Implementing barcode scanning for all additives in human milk fortification prevented these errors from reaching patients.12,14
  • Error reduction: In a children’s hospital, scanning all ingredients for human milk fortification and formula preparation prevented 480 errors over 2.5 years.3
  • Improved documentation: A study found that scanning enhanced documentation, safety, and transparency for EN therapies.15
  • Medication-use process errors: Data from the National Center for Patient Safety revealed that a significant portion of EN-related safety events were linked to the medication-use process, with administration being the most common error-prone stage.16

These findings emphasize the value of barcode scanning in reducing EN errors and improving patient safety. By adopting standardized scanning protocols, healthcare organizations can minimize the risk of adverse events associated with EN administration.

Leveraging Barcode Scanning & Device Interoperability Empowers Nurses

Barcode scanning technology and device interoperability have revolutionized NICUs by streamlining workflows and enhancing patient care. Automating tasks like human milk administration and recipe calculations with barcode scanning reduces human error and ensures accuracy. Additionally, real-time data sharing between medical devices and electronic health records through device interoperability provides healthcare professionals with a comprehensive record of the infant’s nutritional intake contributing to better care coordination.17 This facilitates faster, more informed clinical decision-making, ultimately leading to improved patient outcomes and allowing nurses to dedicate more time to direct patient care.17 By simplifying complex processes, this technology has transformed the delivery of nutritional care in the NICU, setting a new standard for excellence in neonatal care. Investing in this technology not only improves efficiency but also boosts nurse morale by allowing them to see the direct impact of their work.17

At Timeless Medical Systems®, we offer evidence-based programs and resources to improve safety, enhance efficiency, and improve nurse satisfaction. Our Timeless Medical Nutrition Platform™ barcoding software leverages interoperability and can help safeguard your patients by:

  • Utilizing bar code scanning technology of human milk, donor human milk, infant formula, fortifiers, and additives,
  • Providing precise volumes and ingredient quantities via our enhanced recipe calculator thus forgoing any hand calculations and reducing the risk of miscalculations,
  • Performing the necessary tracking and documentation of lot/batch numbers in the event of a recall, and
  • Interfacing scanned feeding information directly into the electronic health record thereby saving time and improving the user experience.

For more information about the Timeless Medical Nutrition Platform™ or if you would like an on-site simulation, please visit our website at www.timelessmedical.com or email us at sales@timelessmedical.com.

References

  1. Institute of Safe Medicine Practices. Results of Survey on Pediatric Medication Safety – More is needed to protect hospitalized children from medication errors. 2015. 13:7.
  2. Steele C, Bixby C. Centralized breastmilk handling and bar code scanning improve safety and reduce breastmilk administration errors. Breastfeed Med. 2014;9(9):426-9.
  3. Steele C, Bixby C. Barcode scanning of human milk and enteral formulas improves efficiency and patient safety: a 7-year review. Nutr Clin Pract. 2022;37(4):921-8.
  4. Hutton K, Ding Q, Wellman G. The effects of bar-coding technology on medication errors: a systematic literature review. J Patient Saf. 2021;17(3):e192-e206.
  5. Thompson KM, Swanson KM, Cox DL, et al. Implementation of bar-code medication administration to reduce patient harm. Mayo Clin Proc Innov Qual Outcomes. 2018;2(4):342-51.
  6. Koyama AK, Maddox CSS, Li L, Bucknall T, Westbrook JI. Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Qual Saf. 2020;29(7):595-603.
  7. Konwinski L. Medication safety and the independent double check: a work system analysis and reliability engineering theory review. Proceedings of the 2020 International Symposium on Human Factors and Ergonomics in Health Care. 2020;9(1):119-20. ismp.org/ext/1375
  8. Pediatric Nutrition Dietetic Practice Group; Steele C, Collins EA, eds. Infant and pediatric feedings: Guidelines for preparation of human milk and formula in health care facilities. 3rd ed. Academy of Nutrition and Dietetics; 2019.
  9. Moro GE, Arslanoglu S, Bertino E, et al; American Academy of Pediatrics, European Society for Paediatric Gastroenterology, Hepatology and Nutrition. XII. Human milk in feeding premature infants: consensus statement. J Pediatr Gastroenterol Nutr. 2015;61(suppl 1):S16-9.
  10. Malone A, Carney LN, Carrera AL, Mays A. ASPEN enteral nutrition handbook. 2nd ed. American Society for Parenteral and Enteral Nutrition; 2019.
  11. The Joint Commission. National Patient Safety Goals effective January 2022 for the hospital program. Accessed January 24, 2025.
  12. Oza-Frank R, Kachoria R, Dail J, Green J, Walls K, McClead RE Jr. A quality improvement project to decrease human milk errors in the NICU. Pediatrics. 2017;139(2):e20154451.
  13. Boullata JI, Carrera AL, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr. 2017;41(1):15-103.
  14. Steele C, Alessi S. Evaluation of the use of dedicated technicians and bar code scanning technology for fortified human milk feeding preparation in a single neonatal intensive care unit to reduce risk of adverse events. J Acad Nutr Diet. 2024;124(5):559-63.
  15. Chew MM, Rivas S, Chesser M, et al. Improving administration and documentation of enteral nutrition support therapy in a Veteran Affairs health care system: use of medication administration record and bar code scanning technology. J Patient Saf. 2023;19(1):23-8.
  16. Citty SW, Chew M, Hiller LD, Maria LA. Enteral nutrition: an underappreciated source of patient safety events. Nutr Clin Pract. 2024;39(4):784-99.
  17. Anderson, E. Interoperability: The Missing Link to Combat Nurse Burnout. 2024. Accessed January 27, 2025. https://hitconsultant.net/2024/08/20/interoperability-the-missing-link-to-combat-nurse-burnout/

Learn more about Timeless Medical Systems

The Timeless Medical Systems bar code scanning system offers a variety of reports that can help healthcare organizations evaluate their near-miss data and turn that knowledge into process change. In addition, Timeless Medical Systems also offers preparation room consulting services. Our very experienced and skilled Clinical Team Members have 1st hand experience in creating and implementing centralized preparation rooms and processes in some of the largest most prestigious hospitals throughout North America and are experts in workflows designed to minimize risk of error. If you are interested in learning more about these consulting services, please contact sales@timelessmedical.com.
Learn More

The material presented in this blog represents the opinion of the author(s) and not necessarily the views of Synova Associates. Synova Associates does not endorse any specific products or organizations but strives to connect its industry partners with leaders interested in product/educational innovation.

Notify Me When The Book Is Available

This field is for validation purposes and should be left unchanged.
Name(Required)
Email(Required)

Book A Call

This field is for validation purposes and should be left unchanged.
Name(Required)
Email(Required)