Name edits causing issue with labeling.

[Gerald]

We are having an issue at our hospital caused by editing of patient names by our Admissions Dept.

The usual scenario is our specimen label prints out with the patient’s name with no middle initial. We draw the patient matching the information on our specimen label to their hospital armband: full name, date of birth and med rec number. Admissions then edits the patient’s name by adding their middle initial. At this point in time the name on our specimen (no middle initial), the Typenex band and their hospital band does not match their registration (with a middle initial). Any crossmatch labels printed at this time will have the name with the middle initial.

We require everything to match 100% so we redraw the patient and complete a new crossmatch.

How would you handle this situation? Would you redraw the patient?

Thanks

[Bill]

What is the reason for entering the middle initial at a later time than the registration? Remember, by your own admission, two identifiers match--that is the national standard. Discuss the situation with registration and try to come to some arrangement about the middle initial, then have both departments adjust the SOP's to match what is decided to do. Personally, I would be very mad (and probably would not let them do it) if someone tried to redraw me because my middle initial was added to the paperwork.

[L106]

I agree with Bill.

Plus, do you do the repeat work at no charge (which is a loss of labor time & reagents for the Lab?) Surely you don't charge the patient for the repeat testing???

Frankly, I would want that middle name or initial on everything right from the beginning. We have a lot of patients who have similar names, and the middle name or initial helps us to differentiate them.

Donna

[Brenda K Hutson]

As anyone who has worked with me would agree, I am very strict when it comes to specimen labeling. However, in all honesty, I have to say that unless I had a different middle initial on a specimen label, from what was on the Order, I would not lose any sleep over it. We often receive Autologous Units from out supplier which have a middle initial. We do not enter the middle initial into our computer system when receiveing it because we do not want the computer to think there is a mismatch (or not find the unit when entering the specimen/order) because our Hospital computer system did not put a middle initial. In fact, if that is the biggest problem you have with your Admissions dept., I think you are doing well!

What I see all too often (everywhere I have worked) is that Admitting does not seem to have the same strict protocols for finding a previous record on a patient, as we do in the Transfusion Service. We perform a search 2 ways (both ways; everytime; every specimen; every order). First we enter only the Last Name. We then find our patient in the list that comes up and look at the name before and after our patient. If there is an exact match, we look at the D.O.B. (also shows in the field). If we have a birthday match, we look into the possibility that Admitting missed the previous record and have assigned a new MR#. With that same list still in view, we sort by D.O.B. That will catch the patient who likes to go by different names inbetween visits (just to make us crazy I think). For example, interchangeable names like Robert and Bob (obviously those would not come up next to each other in a Name search). Or maybe they use their first name one time; and give their middle name the next. All of which could be caught by Admitting if they searched as diligently as we. In fact, I had a patient just yesterday who had been given a new MR#. When I searched by Last Name, I only found 1 patient with that name. But when I then sorted that field by D.O.B., there was another patient with the same D.O.B. In this case, the first names were totally different. Upon further investigation in the Hospital computer system, I noted that the addresses matched. I called Admitting to let them know the patients would need to be merged (and they did confirm it was the same patient).

And of course all of this is critical in our field because there may be an important history (i.e. antibodies) under the previous name.

Anyway, sorry to go on....that addressed more than your initial question.

Brenda Hutson, CLS(ASCP)SBB

We are having an issue at our hospital caused by editing of patient names by our Admissions Dept.

The usual scenario is our specimen label prints out with the patient’s name with no middle initial. We draw the patient matching the information on our specimen label to their hospital armband: full name, date of birth and med rec number. Admissions then edits the patient’s name by adding their middle initial. At this point in time the name on our specimen (no middle initial), the Typenex band and their hospital band does not match their registration (with a middle initial). Any crossmatch labels printed at this time will have the name with the middle initial.

We require everything to match 100% so we redraw the patient and complete a new crossmatch.

How would you handle this situation? Would you redraw the patient?

Thanks

[David Saikin]

I agree with the consensus - I would not be concerned about the middle initial. You must have defined your 2 identifiers (if the name is one then you have a problem). I would think you could adjust your policy to accomodate the addition or lack of the MI.

[SMILLER]

I agree with most here. We do not worry about the addition of a middle initial when one was absent in the first place.

[Gerald]

I agree with the consensus - I would not be concerned about the middle initial. You must have defined your 2 identifiers (if the name is one then you have a problem). I would think you could adjust your policy to accomodate the addition or lack of the MI.

Our hospital has defined our 2 identifiers as Name and DOB.

Our lab and hospital are both Joint Commission inspected and they have indicated that if the middle initial is present on the registration it has to be on the specimen used for crossmatching. Their revised standard QSA.05.07.01 (effective 07/01/11) says that the following has to be on the label of a specimen used for crossmatching:

1 The recipients full name

2 The unique identifying number

3 The specimen collection date

[SMILLER]

Thanks for the standard reference, Gerald.

The requirement reads "full name". By this I believe the intent is to not use nicknames or initials for a first name, etc. If that is correct, then it seems like a "full" first and last name would satisfy the requirement. (Otherwise, an initial for the second name would not be considered "full" either!)

We routinely have to correct for Admitting adding a middle initial (or removing one). We DO NOT redraw/retest a patient for this. Only if a pre-existing middle initial is changed. We have never been cited for this and we have recently gone through a very thorough FDA inspection.

[Gerald]

Thank you everyone for your input. It's appreciated.

[John C. Staley]

"If the arm band on the patient used to identify the patient for the collection of the pretransfusion sample is removed from the patient, the sample is invalid for future use, to include the issue of any products crossmatched utilizing that original sample." This was the stance of the corporate transfusion services medical director at my previous employment. There were any number of reasons armbands changed and name changes was the most common.

Basically the theory was that if the armband was removed you no longer had absolute connection between the sample and the patient. Because of this a patient would occasionally be wearing 2 armbands until the original sample was no longer valid and a new sample could be collected.

Hope this makes sense. :explosion

[Likewine99]

I'm with everyone else and would not re-draw the specimen. A conversation with your registration department might help alleviate the problem.

If they are aware that is is causing you problems downstream they may be able to come up with a quick fix process change in their dept. Don't try to solve this in a vacuum, get all the players in the process involved and it might save you some time, money and the pt another stick.

[Malcolm Needs ☆]

On the other hand, you could shoot them.

[L106]

Do you mean shoot the people in the Registration Department?

[Malcolm Needs ☆]

Do you mean shoot the people in the Registration Department?

Exactly that Donna. As SMILLER said earlier, a middle initial can hardly be regarded as a full and entire name, so why are they changing it, unless it is to be pedantic (something, of course, nobody could ever accuse me of being!!!!!!!!!!!!!!!!!!!), but, at the same time, making life incredibly difficult for everyone else, including the patient.

[L106]

I am often amazed at how oblivious some departments within the institution are to the concept that what they do (or don't do) can have an impact upon other departments.

Donna

[Gerald]

I did involve registration all along but apparently not the one person in the dept I really needed to talk to. I was at a meeting today on a totally different subject and talked to him afterwards. I asked him why just recently they decided to require that the middle initial be added to the registration 100% of the time, even when it was in the middle of the patient's admission. I was somewhat surprised when he told me it was someone from the blood bank who said that's the way it has to be! So it appears I caused my own problem even though I never told anyone to do that. He was amazed that changing 1 letter could cause such a potentially big issue. He told me that they would no longer be adding or deleting any middle initials during an admission. That one's solved so now I 'll just wait and see what the next problem will be that I unknowingly cause myself. Thank you for all the comments.

[L106]

You didn't cause the problem, Geraki! Glad it's fixed! (And you didn't have to shoot anyone!!)