DOB as Routine 2nd Identifier

[Dee]

Our Nursing Administration wants to change from using Medical Record Number to Date of Birth as the primary identifier in addition to the patient name. Blood bank will still need to use the MRN to look up patient information since there are many patients with the same DOB. They are being told by a consultant that the move to DOB is a major move nationally. Are you guys seeing this?

[cindyk]

Why the change, I wonder? A patient's DOB is not really a "unique" identifier because, as you said, patients can and do have the same on. Did nursing give you a reason why? We still use the name and MR number.

[Cliff]

While I don't support the idea of using the name and DOB as unique identifiers, consider how the patient was assigned their MRN. Was it by their name and DOB? At our facility we also use their SSN, even in our donor center a SSN is required. Even then we've had situations where a SSN is duplicated.

[GilTphoto]

Our hospital has also changed to DOB and name, but we have made no changes to the BB policy of name and billing number. For some strange reason, our hospital never used MR# which stays the same. Billing number changes with each admission.

[Malcolm Needs ☆]

Over this side of the pond, we require three identifiers.

We require a full name (forename and surname, both correctly spelled), a full date of birth (age or year of birth is not sufficient) and hospital number or Accident and Emergency number or Major Incident number oraddress or National Health Service number. You be amazed, given all that choice, how many samples are sent in with the third identifier entirely missing and/or the first two incorrect (particularly as all of our samples at the Reference Laboratory pass through the hands of the Hospital Blood Bank before they are sent to us).

The NHS number is, of course, not available in countries other than the UK, I fully acknowledge that, but I do still wonder at the fact that only two identifiers are required.

That having been said, I agree with Cliff's comment about how the numbers are assigned.

[AMcCord]

I would ask nursing service for reference/source material as to why the change and the rationale for the change. Could be something very valid. OR Could this be a case of "Well, everybody else is doing it!" like your kid whining to go to the big party and in reality nobody else (or very few) are doing it?

[Marilyn Plett]

Using the name and DOB has one advantage. Information about unexpected antibodies can be shared between institutions more readily. The medical record number is unique to a hospital or possibly to a hospital system. Some facilities are no longer using SSN's because of privacy issues.

I think Cliff has the right idea. My husband was admitted to the ER with a mispelled name. Because I'm a neurotic blood banker, I made sure everything was corrected before samples were collected, but I'm sure I'm in a minority. Most patients and hospital admitting personnel don't understand how vital correct patient identification is.

[adiescast]

We have also had nursing move to name and date of birth as the primary identifiers. We lost the social security number as an identifier over a decade ago when there was a huge fuss about not using social security numbers (SSN) because the information could be stolen and used falsely by others. That was when our hospital went to using arbitrary medical record numbers. We also had several occasions when people used other people's SSN as identification for admission. We still require that the medical record number is on the sample, but the labels are printed now rather than hand written, so there is no way to tell whether anyone actually checked the patient identification when they labelled the sample.

[tbostock]

I believe one of the reasons is the Joint Commission's goal of involving patients in their own care. We now use DOB as our 2nd "official" identifier (we also use name, MR#, and Blood Bank ID band #), so that we can ask our patients to "please tell us your full name and DOB". Most patients don't know their MR number.

I agree though that the DOB is not unique at all. But we used to think that our MR# was unique until we merged to another hospital, now we have duplicates...which explains why we go a little overboard using so many identifiers.

By the way, my father and brother have the same exact name and DOB because my brother was born on the same day (different years of course)...what was my mom thinking???

[Malcolm Needs ☆]

I believe one of the reasons is the Joint Commission's goal of involving patients in their own care. We now use DOB as our 2nd "official" identifier (we also use name, MR#, and Blood Bank ID band #), so that we can ask our patients to "please tell us your full name and DOB". Most patients don't know their MR number.

I agree though that the DOB is not unique at all. But we used to think that our MR# was unique until we merged to another hospital, now we have duplicates...which explains why we go a little overboard using so many identifiers.

By the way, my father and brother have the same exact name and DOB because my brother was born on the same day (different years of course)...what was my mom thinking???

She was probably thinking, "Thank God that's over!!!!!!!!!!!!!"

:rolleyes:

[Packer Banker]

We just started that at our hospital about a year (or two? time flies with 3 kids...) ago. I thought it was the most ridiculous thing in the world at the time. But after much thought, we do have a blood bank band ID# which is of course unique as well. Our medical record numbers are 6 digits, just like a BD, their old system (therefore still used all the time!) was to separate the numbers with 2 dashes, just like a BD. You can imagine, that some are JUST like a BD, and therefore get mixed up with birthdates.

Anyway, I think we have far fewer errors in filling out blood bank bands, as well as when collecting info to issue products. I agree with one of the previous posts, that the patient is much more likely to notice an error too, with a BD rather than MR#.

[Stoogiesfreak]

I have not heard of any push to use DOB for a blood bank identifier. Over my 35 years I have seen patients with the exact same name and same birthday. So, the DOB is not foolproof. We also use the MobiLab system for all blood collections. MobiLab combined with our Meditech system forces the phlebotomist to barcode the armband and a second identifier of your choice at the time of collection. We do not use DOB and have no plans to do so. We do not use billing numbers either as they change for each hospital visit. We keep our identifiers as MR# and name as these are the constants that do not change.

Good luck!

John

[webersl]

Level I trauma center in USA.

Our hospital switched to Full Name and DOB as "dual identifiers" (for TJC) so that they could ask the patient to participate by stating both (which is good). But then they tried to say that Blood Bank specimens (drawn by nursing) would be labeled with name and DOB (only) and wanted to nix the Medical Record Number. We are currently "in discussion" with nursing because of CAP TRM.40230 (unique identifier) and 41300 (hospital number). In the end, we control what we will and will not accept into the Blood Bank. As of this moment, Name and MRN (among other things) are still required on BB specimens. Our MRN's are assigned in sequential order and are not based on name, MRN, or SSN.

[Lecia Guill]

I am new to my facility. We currently use name, MR#, DOB, and Blood Bank armband number during the process of issuing (releasing) blood. All these checks makes the issuing process laborious and time-consuming. Our plans are to omit one of the identifiers, either the MR# or DOB in the issue process. DOB is required hospital-wide as a second identifier, but as with the previous post, name and DOB do not always guarantee a unique combination.

Name, MR#, and armband number are our unique identifiers for specimens. In the Blood Bank, we don't utilize the DOB in historical record checks. However, it does print out on the Crossmatch/Transfusion Record form and is therefore available during the clerical checks at the bedside.

[Stoogiesfreak]

I did forget to mention that we also use the Hollister armband system in addition to the name and MR#. We totally take the DOB out of the process. We have had no issues with CAP over our last 4 inspections using this process. We have our Crossmatch/Transfuse cards and Issue card all are also printed without the DOB.

John

[rsammis2]

We just updated our blood product administration protocol recently and are now requiring 3 identifiers on the BB specimen (full name, DOB and MRN) before processing can take place. When the nurse comes to get the blood, she/he must also tell us the blood bank band number before they receive the blood- that way we know the nurse went to the bedside to check patient ID before coming of their blood. It's worked great so far and no incidences of duplicate numbers when you use all three.

[Stoogiesfreak]

rammis2 - I like that procedure. It adds one more level of security. When I was a student - many years ago - I witnessed a reaction due to an ABO discrepancy caused by a lack of checks of MR#, DOB and other factors. The patient died. I never want to witness or go through that again. Even though I was a student and witnessed the events it has left a lasting impression of just how important our labeling and issuing blood bank procedures can be. Thanks - you have given me some food for thought!

John

[adiescast]

We just updated our blood product administration protocol recently and are now requiring 3 identifiers on the BB specimen (full name, DOB and MRN) before processing can take place. When the nurse comes to get the blood, she/he must also tell us the blood bank band number before they receive the blood- that way we know the nurse went to the bedside to check patient ID before coming of their blood. It's worked great so far and no incidences of duplicate numbers when you use all three.

I hate to rain on the parade, but there is not an assurance that the nurse went and actually looked at the armband when she/he brings you the number unless you absolutely can prevent them from having the number anywhere else (I don't know of a sure fire way to do that). Our nurses always manage to get the armband number onto the chart no matter what we do. It's almost like they are avoiding looking at the patient!

[L106]

"Our nurses always manage to get the armband number onto the chart no matter what we do. It's almost like they are avoiding looking at the patient!"

[rsammis2]

To Adiecast and L106, I know people are always finding ways to get around the right way to do things. However I'm not sure you can ever find a system that would be 100% foolproof, but if you do, would you please share it with me!!!!!

[L106]

Nope!! I'm not going to share it.....I'm going to market it and make a fortune!!!!

[rsammis2]

Good luck L106- guess I'll have to buy it instead!!

[bjwhite]

Like most of you, where I work went to name and DOB several years ago. In the Blood Bank, we still use full name and MR#. I will fight to the death if they try to change us to DOB as I met someone many years ago with my same name (exact first, middle and married last) and exact DOB. Our husbands even have the same first name. We do print the DOB on the transfusion slips so nursing can use that at the bedside. It works well for us and no one complains. The nurses do get confused at times since glucometers use the account number and we use MR. Guess it is rocket science trying to remember when to use DOB, account and MR.