How likely are staff to misidentify patients?

JCAHO calling for two patient identifiers

If asked, "How do you ensure patients are not mistakenly identified before medications are given?" during an accreditation survey, would every nurse in your facility be able to answer the question? During your next survey, you’ll need to show compliance with the requirement for two patient identifiers whenever medications or blood products are given and whenever blood samples and other specimens are brought for clinical testing. The requirement is a national patient safety goal from the Joint Commission on Accreditation of Healthcare Organizations.

Surveyors probably will ask staff about patient identifiers, says Kathleen Catalano, director of regulatory compliance for Provider HealthNet Services in Addison, TX. "They will then observe the care given to see if staff adhere to policy."

To comply, use the following practices:

Use acceptable identifiers.

According to the Joint Commission, the intent of the two identifiers is twofold: first, to verify the correct patient for the intended procedure and second, to match the service or treatment to that patient. The two patient-specific identifiers must be directly associated with the patient, and the same two identifiers must be directly associated with the medication, blood products, or specimen tube.

Acceptable identifiers are the patient’s name, an assigned identification number, telephone number, or other person-specific identifier such as age or Social Security number. Bar-coding that includes two or more person-specific identifiers is acceptable, but patient room numbers cannot be used. "The patient’s armband can be used if it has two to three identifiers such as patient name, account number, age, and medical record number," says Catalano.1

At New Britain (CT) General Hospital, prior to registration, the patient’s name and date of birth are used as identifiers, and after registration, name and medical record number are used, reports Robert G. Flade, RN, director of the ED.

Get information directly from the patient when possible.

"We are using the birth date and the Social Security Number as identifiers. We have the patient identify themselves and give us the information if able, in addition to checking the identification bracelet," says Kathie Carlson, RN, MSN, CEN, ED manager at Sentara CarePlex Hospital in Hampton, VA. When the patient is awake and alert, a verbal response as to who they are will work as one identifier, explains Carlson. "I personally like to ask the patient to tell me their name and Social Security and birth date," she points out.

If the patient is comatose, Carlson recommends using the information contained on the armband or barcode and having family members identify the patient if they are present. If an unidentified patient is unresponsive and unable to communicate, use identifiers such as the temporary name assigned, and an account number or medical record number, Catalano advises. "These same identifiers should be matched against specimen labels, medications ordered, or blood product labels," she says.

Address any problems with electronic documentation.

At Sentara CarePlex’s ED, electronic charting is used. "Our only problem currently is that we do not have two identifiers on our discharge instructions which are part of the medical record. Currently, only the patient’s name is on there," says Carlson. The vendor is fixing the problem, but meanwhile, a patient label is placed on the discharge instructions containing all the information on the patient’s armband, to comply with the two-identifier requirement, she explains.

Make identifiers accessible if the patient’s chart is unavailable.

"One of the biggest concerns is that nurses also must bring the paperwork into the room with the medication," says Flade. The facility is planning to switch to paperless charting in about two years, but currently uses paper charts, he explains. "So if the physician should happen to have the chart, the nurse cannot do treatments such as starting intravenous lines or administering medications without a piece of paper with the patient’s name and date of birth," says Flade. To address this problem, nurses use labels that are printed with the patient’s name and medical record number, he reports.

Consider using three identifiers.

"We do use three identifiers to identify patients," says Carlson. "This is done for all lab tests." The specimen is left in the patient’s room, and the person who does the collection initials the label that this is the correct patient by looking at the armband and speaking to the patient if possible, explains Carlson. A second staff member then comes in, if not already in the room, and does an independent second check.

"In our system, a label is printed for each specimen required, so all labels must be matched to the armband and patient interview," she says. The three identifiers are name, medical record number, and birth date or Social Security number, says Carlson.

By using the new identification process, the staff have discovered incorrect birthdates and the wrong Social Security numbers such as the husbands instead of the wife’s, she reports. "We interact with the patient when possible, to elicit information directly from them," Carlson notes. "We are very careful because we want to avoid mis-IDs.’ We just want to be cautious to make sure it is the right patient for the right test."

Reference

1. Joint Commission on Accreditation of Healthcare Organizations. 2004 National Patient Safety Goals — FAQs. Updated 3/9/04. Web: www.jcaho.org/accredited+organizations/patient+safety/04+npsg/04_faqs.htm#goal1.

Need more information?

Kathleen Carlson, RN, MSN, CEN, Operations Manager, Emergency Department, Sentara CarePlex Hospital, 3000 Coliseum Drive, Hampton, VA 23666. Phone: (757) 736-1031. E-mail: kecarlso@sentara.com.

Kathleen Catalano, Director of Regulatory Compliance, Provider HealthNet Services, 15851 Dallas Parkway, Suite 925, Addison, TX 75001. Phone: (972) 701-8042, ext. 216. Fax: (972) 385-2445. E-mail: Kathleen. Catalano@phns.com.

Robert G. Flade, RN, Director, Emergency Department, New Britain General Hospital, 100 Grand St., New Britain, CT 06050. Phone: (860) 224-5626. E-mail: RGFlade@nbgh.org.