Patient Name or MRN changes

[BBKT]

We have recently moved from a stand alone blood bank computer system where we had complete control over patient information to a hospital wide system where Medical Records is now in charge of updating patient names and MRNs. I need input on how other institutions deal with issuing blood to a patient that has had patient information in the computer (for example when an assigned trauma name and MRN gets updated to the real patient name and different MRN) changed and your blood bank tube label no longer matches the patient information in the computer. I am "old school' and feel we need a new sample submitted on the patient labeled with the updated MRN/name. However, this poses typing problems if the patient has received uncrossmatched O negs, not to mention the fact that docs do not want to wait the additional hour for the new sample testing to be completed before they can have more blood. Plus, finance says we can't bill for the second Type and Cross. I am VERY uncomfortable with the idea of just accepting that Medical Records combined or updated the patient information correctly.

Help!!!!

[Bill]

I worked in two institutions where Medical Records had control of the MRN's and the MR coordinator was even more anal they I about patient identification before MRNs were changed, or before records were combined. I would suggest that you review medical records policy about the situation. Once records were changed--we added comment to all existing reports and then reprinted labels and reports with new name/MR#.

[pluto]

We have recently moved from a stand alone blood bank computer system where we had complete control over patient information to a hospital wide system where Medical Records is now in charge of updating patient names and MRNs. I need input on how other institutions deal with issuing blood to a patient that has had patient information in the computer (for example when an assigned trauma name and MRN gets updated to the real patient name and different MRN) changed and your blood bank tube label no longer matches the patient information in the computer. I am "old school' and feel we need a new sample submitted on the patient labeled with the updated MRN/name. However, this poses typing problems if the patient has received uncrossmatched O negs, not to mention the fact that docs do not want to wait the additional hour for the new sample testing to be completed before they can have more blood. Plus, finance says we can't bill for the second Type and Cross. I am VERY uncomfortable with the idea of just accepting that Medical Records combined or updated the patient information correctly.

Help!!!!

I would not be happy either - interestingly the MHRA who inspect blood banks in the Uk have issued the following clarification on a similar subject - patient merging

see http://www.transfusionguidelines.org.uk/Index.aspx?Publication=REGS&Section=23&pageid=1370

I agree with you new sample if different hospital No , better 1hr delay than to be dead through a transfusion mismatch

Edited May 7, 2009 by pluto
Link did not work

[L106]

BBKT -

I understand exactly what you are talking about. At our institution our Medical Records Department is in charge of patient information (but our Patient Registration Dept can also make name changes.) However, changes in patient names and Medical Records Numbers do NOT automatically cross into our Mediware Blood Bank computer system. Every morning our hospital computer system automatically spits out a report on a printer in the Lab that lists all significant changes in patient information that have been made in the last 24 hours (ie: changes in pt name, MRN, birthdate, sex, merges, etc.) I go through that report and make the appropriate changes in our Blood Bank computer and records.

Now, concerning the situation where blood has been crossmatched and then the MRN of the pt get changed: In our institution, once a patient is registered with a Medical Records Number, they KEEP that MRN throughout that length of stay. If it is discovered that the patient has other MRNs, they are mergered AFTER discharge.

In the situation where blood has been crossmatched and then the patient's name gets changed: The specimen collector puts a special Blood Bank wristband on the pt if a sample is collected for Blood Bank testing. Each BB wristband has a unique ID # with 3 alphabets and 3 digits, and the collector puts one of the sticky ID #'s on the crossmatch specimen (and this number prints out on our crossmatch paperwork.) So even if "John Doe's" name is changed in the computers a few hours later, that unique BB wristband ID # is our firm link between patient, BB specimen, and the crossmatched units.

So, the only problem we ever have is if nursing or surgical personnel cut off that BB wristband, which unfortunately does happen a few times a month.

[Jaimie Nicholson]

We in New Zealand also require a new specimen before we'll change the details. We frequently have such changes, and get notified of them, and we put a comment in the computer system about the new name, but if we have to issue blood, then it always has the same details as the sample.

[krichards]

Our facility merges "No ID" trauma patients with their old records only AFTER calling the BB. If the patient has a current sample, then they wait until the sample expires. If the patient does not, then we give them the ok to merge records.

[kcayson]

We have the same problem here. The lab has a different system from the HIS. We have name changes and etc all the time. We have a printer in our BB department that is in the print queue for the HIS so that when patient's are merged together, names are changed, etc in the HIS system, tht information prints on the printer in the BB. It provides patient demographics including the new name and the old name.

If there is a discrepancy at time of testing or dispense of unit to floor, we make a copy of the name change form and attached to the specimen or units as need be. This provides the name the department has and the new name the HIS will have. This paper explains the difference b/t the names. That is only done when the change doesn't update our system before the specimen is drawn.

[Dar]

We have the same type of problem; however, I feel better about our process. All trauma patients get a medical record number the starts with "800". A message prints on our printer once the patient is identified, if there is another MR#. Our computer system, SOFT, allows us to link the trauma patient with the old MR so that historical knowledge applies. The 800 MR# is not merged until discharge. Currently, the name does not change until they feel comfortable drawing a new sample. Of course, ICU wants the policy to change. My question is: Would you feel comfortable using the sample after the name has been changed, if you have the same MR# and a typenex number (2 identifiers that remain the same)? We do electronic XM, so most of the time, we are not even touching the sample once the T&S is complete.

[KLCarter]

I have worked at two institutions where Medical Records is in charge of patient information. At each facility, a name change meant a new sample was required for crossmatch testing. Medical Records has to notify blood bank prior to changing patient information. Also we tried to coordinate the information change with the expiration of a type and screen sample or after the patient was no longer in critical status. When the situation occurs that a name change can not wait (our OR would not do surgery unless all information was correct) we require a new sample and repeat TS and XM testing. Hope this helps!

[nsfirm]

is it also happens for Mr. X that changes to Mr.-with-a-real-name?

if we ask for a new sample to be sent, does it mean that we have to do the test with the new sample again? won't it cost the patient more than needed?

I know that it's for patient safety, but in my country money is also a big problem, that may go to the press -which is already happened for doing the TTI rescreening-.

[Liz]

We have recently moved from a stand alone blood bank computer system where we had complete control over patient information to a hospital wide system where Medical Records is now in charge of updating patient names and MRNs. I need input on how other institutions deal with issuing blood to a patient that has had patient information in the computer (for example when an assigned trauma name and MRN gets updated to the real patient name and different MRN) changed and your blood bank tube label no longer matches the patient information in the computer. I am "old school' and feel we need a new sample submitted on the patient labeled with the updated MRN/name. However, this poses typing problems if the patient has received uncrossmatched O negs, not to mention the fact that docs do not want to wait the additional hour for the new sample testing to be completed before they can have more blood. Plus, finance says we can't bill for the second Type and Cross. I am VERY uncomfortable with the idea of just accepting that Medical Records combined or updated the patient information correctly.

Help!!!!

If the "unknown" keeps the same MR # once he gets a name how would you proceed?

And: How is a new born without a name identified by name other than the MR #? and when he gets a name how do you proceed?

[Deny Morlino]

Liz

I will come back to the first question in a moment. For newborns at our facility they are identified with their last name, boy or girl (if twins boy A, boy , date of birth and medical record number. This remains unchanged through discharge. On any return visit the medical record is altered to include the patient's first, middle, and possible last name changes.

Here we use a blood band system. This along with the medical record number allow us to maintain the identity. The blood bank band remains the same for the duration of the admission and has the medical record number on the band as well.

[Mabel Adams]

Deny, do you change the name on the BB wristband when there is an update? Also, does your policy require that nurses check the name on the BB wristband when hanging blood or just the number? We have run into problems with nurses being used to name changes so not being concerned (or not even checking?) the name on the BB wristband when hanging blood even though it is part of our policy for them to do so.

[Deny Morlino]

The name remains the same on the blood bank band. Often a notation is made on the blood bank paperwork indicating that the patient was a "John Doe" with name change to their correct name to aid in the identification process. As we are a small hospital these patients are frequently transferred to another larger facility, so the length of time they are a patient is to our advantage. Yes nursing is to check the patient name on the blood bank band as well as the hospital ID band. This along with the above mentioned works well for identification purposes.