Patient Identification Question

[catmontgomery]

What do you do in these cases?

One department, labor and delivery, draw our intial lab specimens (including a Blood Bank Hold specimen) at the time the IV is set up. This department has recurring problems with obtaining their medical record numbers/hospital armbands in time to draw/label their tubes and make out the blood bank armband. It was suggested they not wait for a hospital armband, just use the name and date of birth the patient gives you, but this becomes a problem when we have patients with the same name and date of birth. A current suggestion was to have the blood bank specimens drawn at another time when needed. The Nurses believe there is no time when a bleed or c-section occurs. In emergencies we would give them O Negative RBCs, etc.

The past year we have made great strides in assuring our patients who require blood products are identified by exact name and our hosptial medical record number. We do use a specific blood bank armband, recording the name and medical record number, date/time, and intials of person drawing on the label. The blood bank armband is checked against the hospital armband at the time of attaching to the patient and at the time of transfusion. I am concerned that the identification of the patient at the bedside may be compromised if the patient has not received their hospital armband before the specimen is drawn.

Does anyone have similar problems? Any suggestions?

[John C. Staley]

You are most definetly not alone. Much like the OR and ER, L&D seem to be the universal problem children. They like to think they function only in crisis mode and there fore should be exempt from all rules, regulations and policies. I actually had one L&D nurse tell me that it was impossible for her to transfuse the wrong blood to the wrong patient regardless of the status of any patient identification and she was serious. Just to help you understand my perspective, I'm married to a L&D nurse. She has no explanation why this particular group has such a difficult time truly understanding our fanatical obsession with proper patient identification. She understands but can't get the others to understand at anywhere close to the same level but then she's had me nagging her about it for 30 years.

One of the ways we (the hospital not the transfusion service) worked with this is to preadmit most of the L&D patients so the armband and everything is ready when they arrive. Another thing we have done was to work with admitting and get them to fast track the L&D admissions that are not preadmitted. The one thing we did not do is allow "work arounds" to circumvent the patient identification policies. Also, if a L&D patient come in in serious bleeding trouble they can use the same emergency identification/issue system we use in the ER.

[delvigo]

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[Mabel Adams]

John has the right idea--to solve the root problem--timely ID bands on the patients.

Here is a scenario: 2 OB patients, say named Christine and Christina Dodd. Christine delivers on Saturday and has blood xmd because she was a previa. All well, no tranfusion, discharged Sunday. BB still has units set up on Monday for Christine. No one working Monday realizes there were 2 patients with almost identical names. Follow it through and see what disasters await.

[Mabel Adams]

I guess I should say that Christina admits to deliver on Monday and phone calls to the BB asking if there is blood available for her by name only are answered Yes. Then lack of positive ID at request, issue and transfusion could be fatal. Everyone working cares about doing a good job, but not everyone understands the risks.

[delvigo]

Dear Mabel,

1) ID bands on the patient is a little step, but not solve the problem of human error........because there is the visual check.

2) When will be solve the problem of identity of patient, another big step, ....but in transfusion there are the different 8 groups of blood bag.

Solution ???

Medical device that check, by mechanical barriers, at first the identity group of patient and then the compatibility of this group.

I think if you look at Medical Device "Blood Safety" you'll find solution to solve problem transfusion ABO incompatible.

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Ciao

Pier Luigi

[cin]

We have the same problem, but rarely. If the specimen must be drawn before the patient is registered, then we use the name, dob, and then ssn in lieu of the medical record number. This way, we can verify the patient info in the computer system once they are registered.

[AMcCord]

You also have to hope that admitting correctly admits the correct patient. We had 2 women here with due dates within 1 month of each other. Their first and last names were the same - though one last name was spelled with an S where the other name had a Z. The birthdates were almost identical - same month and year, only 2 days apart. They lived in the same trailer park, so had the exact same street address, the box numbers were different by 2. Their husbands did have different names, thank goodness and we had a SS# on one. One was admitted as the other to deliver. L&D slapped an armband on for us, grudgingly - only because we get cranky about it and won't draw lab specimens without it. Guess what?!? The blood type didn't match our records for who we were supposed to have.

We (blood bank) figured out who was really in the L&D room upstairs by speaking with the patient's husband (language barrier) but then had an impossible time getting L&D and admitting to correct the admission error and get things straight!!! All the calls about who was who kept coming to me. L&D didn't think any of this was a problem that concerned them at all - they didn't see any need to talk to the patient or to assist admitting in fixing the problem. When the other patient with the same name came in 3 weeks later for some outpatient lab work, we discovered that the record had still not been corrected. We had to go to the head of admitting to fix the problem. We knew L&D wouldn't have if she had come in to deliver.

Bottom line...WE have to be vigilant cause there are far, far too many people who just don't get it!

[Mary]

Sad case............

[delvigo]

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[Liz0316]

Have you considered using a blood bank band, similar to how you would band a trauma patient? At our hospital, we use a banding system with a unique ID # in trauma cases. Why not apply the same theory to the L&D patients when time is critical? There is no need for the patient to be pre-registered, you don't even need a name...Jane Doe, XYZ123 - there are your 2 patient ID's.

I realize blood bank bands can be costly, but how often are you using them? If you are already using a banding system for traumas, get a secondary color for the L&D patients.