Currently we use an R number, as well as the name and MRN. We treat pre-op patients as we do our inpatients and outpatients. The thing is, the patient is drawn in pre-op. The band is put in the patient's chart. When the patient is admitted, he/she gets banded at that time. What bothers me is, the person who drew the initial sample isn't necessarily the same person who will band the patient when the patient returns. This is part of the reason I'm not a big fan of a 3rd identifier, or at least a separate bb identifier. I think you can use the DOB as a third identifier if you really feel you need one. I also would like to propose involving the patient (as long as the patient is conscious) by having them say their name and give their birth date. In addition to checking the wrist band, you can add the patient's response as another safety check in the transfusion process. I also think (I'm on a roll now!) getting the patient to participate is important from the patient stand point, they can free confident that the phlebotomist/transfusionist is being extra careful with their medical treatment.