Reduced Space Symbology can easily fit into labels with limited room.

The North American RSS/Composite Implementation Group, working with The NOSCO Printing Group (Carrollton, TX) and companies throughout the healthcare supply chain, has proved the commercial feasibility of bar coding medications in units as small as 2 ml. Bar coding down to the dispensed unit has the potential to reduce medication errors significantly.

Approximately 90% of all healthcare items can be coded using existing linear symbologies. The other 10%, which typically include unit-of-use and unit-dose items dispensed to the patient at the hospital bedside, are too small for linear symbology.

The Uniform Code Council Inc. (UCC), a not-for-profit voluntary standards organization, developed Reduced Space Symbology (RSS) for packages too small for traditional linear technology. Complemented with correct software, RSS can provide all the information available through UPC codes.

The group's efforts have shown that bar codes can be placed on virtually any healthcare product. The implementation group selected RSS Limited for items such as syringes and RSS-14 Stacked for items requiring a narrow symbol such as vials. RSS encodes the full 14-digit global trade item number (GTIN), meeting the basic identification needs of worldwide healthcare manufacturers, distributors, and suppliers. With appropriate software, RSS can be used to confirm that appropriate dosages are being administered and to track inventory and other information. (For a discussion on the different RSS versions, see the October 1999 PMP News editorial, "Cracking the Bar Code Quandary.")

RSS Limited is 70% more space efficient than an EAN/UPC character. Also, while a UPC-A symbol requires a nine-module quiet zone on each side, no quiet zones are required around RSS codes. They can also be printed as a composite symbol with the accompanying EAN/UCC 2-D Composite Component printed directly above the RSS linear component. (RSS encodes a linkage flag to indicate the existence of a 2-D composite component.)

Two package sizes, 3 ml and 5 ml, were selected for the first RSS test, one using RSS Stacked and the other, RSS Limited. After determining that the 0.5-mil bar-width reduction (BWR) was the most readable, The NOSCO Printing Group produced labels. Each label contained two symbols, one for ladder and one for picket fence.

In accordance with a test plan developed by Frank Sharkey of UCC, each BWR figure was verified successfully, determining the optimum BWR. The Diversco Inc. facility then produced both paper and film labels using both the rotary letterpress and flexographic printing technologies.

The labels were then shipped to a pharmaceutical manufacturer, who applied the labels successfully, and they were scanned 100% after application. The samples were then packed and identified and shipped to the UCC and to a healthcare facility for on-site testing.

Final testing was done at the St. Alexius Medical Center, a 300-bed facility in Bismarck, ND, known for its promotion and implementation of bar code identification technologies for healthcare products down to the unit of dose.

After determining the appropriate angle for the scan, St. Alexius personnel performed 30 successful first-time scans. Current linear technology often requires two scans, St. Alexius noted.

Because human-readable characters were often larger than the RSS itself, there was frequently not enough space to also print this information. But omission of human-readable characters was deemed practical because the new drug code number is printed on the pharmaceutical products in compliance with FDA regulation.