level one trauma center and previous history

[LIMPER55]

We are a level one traum center-all our "does" are assigned a medical record number -we

use this as a patient identifier -

If the Doe is assigned a name later--we still use the medical record number for previous history check

oh oh--now we have a patient that we gave 9 units of blood --she has developed anti-Fya and anti-Jka

and we find out she was previously identified with a different medical record number and had anti-Fya!

We have resolved to look every patient up by both name and medical record number now

Is that how you all would handle this problem?

[David Saikin]

There is not much you can do with "Does" 'cuz you don't know who they are. How are you going to look a "Doe" up by name or MR# - they are both going to be different every time the person comes in as a "Doe", aren't they? It would seem that once the patient is identified, you should be able to merge them with their "real" mr#. That will not help with a "Doe" admission, but at least all the Doe stuff will be attached to the "real" identity.

[jalomahe]

We are a level 3 trauma center but we do get our fair share of "Does".

Our admitting registration of a Doe patient is the same as yours. When they come in they have they are assigned a medical record number along with the Doe name.

Obviously there is no point on doing a history check at this point since we know that a) the MRN is new and the Doe name is not the patient's real name.

Once the patient is identified by registration (anywhere from a few minutes to several hours later depending on the situation) the blood bank staff performs a history check on the patients actual name.

If a significant history of an antibody is found as in your case we immediately notify the physician caring for the patient at that time and our medical director of the situation.

With any luck, if the patient was bleeding profusely, they'll have bled out most of any antigen positive units that were given and we can "fill them up" with antigen negative units as they get the bleeding is under control.

Once we have identified a that we have multiple MRNs on a patient with previous blood bank histories on file, our LIS (Sunquest) allows us to "link" the MRNs together so that the information is available to the blood bank staff from that point forward no matter which MRN is being used.

[Brenda K Hutson]

First, that is always the risk a Trauma Center has until they know the real name. If they knew the real name, I assume they would have also pulled up the real MR#, correct? So that would not help. Without a name, Admitting cannot search for a previous history either. I would just say that as soon as you are given their real name and MR#, do your History Search as usual . It sounds to me from your post (and maybe I am reading it wrong), that you probably had this patient's correct name, way before you discovered the 2 antibodies? So I am wondering why no none searched for a previous history, "at that time?" That would be dangerous. Also, just as an aside: Having worked a number of places in my career, I have seen more admitting errors than I care to see. Because of that, a "normal" History check (in my mind; though not all computers will support this), involves searching by:

1. Last Name only (to see if there are 2 patients with the same First Name; then look at D.O.B.; this will catch those patients that Admitting did not catch, and for whom they gave a new MR#).

2. Then take that Search and Sort by D.O.B. (that will catch the patients with interchangeable names like Robert and Bob; Elizabeth and Beth; etc.; names that will not be caught alphabetically).

And believe me, both scenarios happen way too often!

In summary, the minute you are given the patient's real Name, search by Name. Once you do that, you should have pulled up the previous MR# also (though I would assume that if you found the patient by Name, you would have found the entire record??).

Brenda Hutson

I have seen

We are a level one traum center-all our "does" are assigned a medical record number -we

use this as a patient identifier -

If the Doe is assigned a name later--we still use the medical record number for previous history check

oh oh--now we have a patient that we gave 9 units of blood --she has developed anti-Fya and anti-Jka

and we find out she was previously identified with a different medical record number and had anti-Fya!

We have resolved to look every patient up by both name and medical record number now

Is that how you all would handle this problem?