John/Jane Does

[LynK]

Hey, fellow BBers,

What is your protocol when you receive a BB tube labeled for John/Jane Doe, and the patient is later identified? Do you relabel the tube, redraw the tube? At our hospital, John/Jane Doe would be given a bogus DOB, and a MRN. When pt is identified, there may already be an existing MRN, and the accounts later get merged.

HELP!

[Mabel Adams]

We all love those, don't we? Our old policy said to use the account number as an identifier on these anonymous patients but we don't then use it to track the blood back to the patient so that seems bogus. We are now rolling out a new policy to get a new sample as soon as reasonably possible. We will allow correction of the specimen and BB band to the real ID in limited circumstances, but a new specimen is going to be our preference. Otherwise, nurses learn to ignore the name & DOB on the BB band pr people think that it is ok to correct anything on a band or specimen. Our current computer doesn't allow merges until the patient has been discharged so that keeps the MRN from changing. That may change with a new system in another year or so. Sigh.

[Brenda K Hutson]

As long as they keep the MR# the same for now (give new MR# to old name also; but will merge records upon discharge), then we would still accept that specimen with the MR# that matches. Some places I have worked at, would attach a comment in the computer stating AKA (also known as....). We might then also write AKA on the specimen (with their known name) and/or any products labeled with paperwork under the Doe, John/Jane name. Just so we start thinking of the 2 interchangeably during that admission. Because for some interval, you may receive correspondence from other departments (i.e. to pick up blood products; OR) with either name. Do don't want new staff coming along to spend time trying to figure out the "discrepancy."

Brenda Hutson

[Barbarakym]

I just re-wrote a policy. This policy covers John Does/ Disaster ID (Different in our hospital/ AND those pesky admitting errors, and VIP hidden id's. Where name is incorrect and/or double MR # assigned.

Basically what it says is that Original Admitting information must remain visable on the chart, dummy name, medical record, etc. That BOTH new info and old info will be required on pick up slip (what they bring down to id patient), That THEN we ASSIGN AN AKA on PT BB record for that 3 day period. Either name/mr can be used as long as it is matched up. If any of this fails (old id is removed for example). Pt must be redraw and reworked. At the end of the regular expiration date for the specime it must also be redone to only the correct information. We get quite a few of these and so far the policy appears to be working.

[webersl]

We are a very active Level I trauma center. We had a terrible paper-based system. We are switching to this:

In advance, fake names are registered in the computer and they also get a Med Rec Number. A sheet of ID labels prints out. Labels are placed on several requisitions, specimen containers, nursing flow sheets, blood pick-up form, armband, etc. This is all placed in a large ziplock bag. 25 are made up in advance. When the trauma (or unidentified) patient arrives, a trauma pack is selected. The armband is placed on the pt giving him this fake ID. Everything else also has the fake ID (name and MRN). This is used during the first 24 hours, even if they find out the patient's real ID before that.

At the point the pt's real ID is discovered, an e-mail is sent to BB so we can check pt history under the real ID. Twenty-four hours later, an e-mail is sent to BB to tell us that the name has either been CHANGED in the computer to the real name - or - for a returning patient, that the fake record has been merged to the real record. No changes to the fake ID are allowed until after 24 hours. At this point, the pt gets a new armband with real ID.

Upon receipt of the 2nd e-mail, BB staff scan the barcode of the specimen (that is labeled with the fake ID) and do a label reprint. This label shows the real ID and the original accn number and is placed over the fake ID on the specimen (but does not obscure the fake ID or accession number). Cerner erases the demographic blood type after a merge, so the tech also adds a "ABORH historic" test to the accn number and results it with the pt's type, and where they found the type (what computer screen, for example). Then, if there are still units crossmatched to the pt, the tech reprints the crossmatch tags (via the real MRN and the unit barcode) and the tags print out with the real ID.

Go live is Monday!

[tbostock]

John Doe doesn't work if you have a dozen victims coming in at once. It is better to register the patient with a new MR# and a fake name. We use the Typenex band number, so their name would be "ABR1234,Trauma". This name goes in the HIS under an AKA name field, and then they put in the real name later. The Typenex band stays on them for the entire admission, to serve as a cross-reference. If they have been to the hospital before, we link them in our BB LIS, then merge them later after discharge. Works well, and no redraws needed.

[AMcCord]

We also use the Typenex band number for the name of the patient and the band must not be removed until dismissal. When the patient is ID'd with true name, we start using the name and MR# and the Typenex band number becomes our 2nd BB ID. No redraw required.

[Bill]

Webersl--nice procedure!!

[kate murphy]

We all struggle with this. We are a very busy level 1 trauma center. We require a new spec any time a name or MRN changes. I believe many standards require that the specimen is labeled and compared to the wristband at the time of drawing. Relabeling later is not allowed. And if the name/MRN on the unit tag is different from the spec, how certain are you that the intended recipient is correct? Joint Comm standards require that 2 unique identifiers be used for transfusion (and other things). Usually it's name/MRN. Since "John/Jane Doe" or "Unknown Male" is not unique, many times transfusion happens with only the MRN and account number. Though I do know nurses that will hang a unit on the "gunshot in bed 1". Hard to adequately identify the patient specimen and during transfusion when you have 3 "Unknown Male" patients in the OR at the same time. Or worse, post op in SICU.

[Joanne P. Scannell]

We also use the Typenex band number for the name of the patient and the band must not be removed until dismissal. When the patient is ID'd with true name, we start using the name and MR# and the Typenex band number becomes our 2nd BB ID. No redraw required.

Ditto! Keeps it simple! Plus, we are now using the bands that have ONLY the unique BB# so the 'name/number doesn't match the name/number on the BB Band' questions don't exist anymore. BB Band# is our primary ID#.

[Brenda K Hutson]

And to clarify from what I said....I do not consider writing an AKA on a specimen (leaving previous information intact), to be relabeling. But that being said, I never did it unless the Hospital computer system listed them as AKAs. Just can't always get a new specimen on a trauma patient, just because they now have an identity. And I definitely wouldn't do it in a situation where ALL of your trauma patients are called John or Jane Doe. Where we did this, we had unique Trauma Names.

But I would contrast that for example, to things I would never allow:

1. Labelling an unlabeled specimen

2. Placing a correct label over an incorrect label

3. Adding information to an incomplete label

In fact, I am known for being very rigid in specimen requirements when it comes to the Blood Bank.

Brenda Hutson

We all struggle with this. We are a very busy level 1 trauma center. We require a new spec any time a name or MRN changes. I believe many standards require that the specimen is labeled and compared to the wristband at the time of drawing. Relabeling later is not allowed. And if the name/MRN on the unit tag is different from the spec, how certain are you that the intended recipient is correct? Joint Comm standards require that 2 unique identifiers be used for transfusion (and other things). Usually it's name/MRN. Since "John/Jane Doe" or "Unknown Male" is not unique, many times transfusion happens with only the MRN and account number. Though I do know nurses that will hang a unit on the "gunshot in bed 1". Hard to adequately identify the patient specimen and during transfusion when you have 3 "Unknown Male" patients in the OR at the same time. Or worse, post op in SICU.

[Kathy]

We require everything to match our specimen (name, DOB, MR#, blood bank#). The doctor attending to the patient must determine that the patient is stable before giving the go-ahead to change the patient's trauma (alias) name to the real name. Once the name is changed, they need to give us a new specimen if more blood is needed. If blood is needed and the name has been changed, we will give the crossmatched blood as long as the patient retains the armband with the trauma identification on it and they bring down a request with the trauma identification on it. We tell them to draw a new specimen ASAP. If the trauma armband has been cut off, we will issue uncrossmatched blood until we get a new specimen. Bottom line: everything has to match.