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Historical Record Check - How to prevent errors from misregistration?


goodchild

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There have been a few posts regarding the steps that different institutions take to check a patient's history and how it's documented.

 

At our institution when we receive a specimen there are various identifiers to guide us for our history check. The blood type shows up in bold red on the header. We see antibody/antigen history as a large red AB/AG on the header. Special transfusion requirements are indicated by a large red M. Any other typing discrepancies or serological problems are indicated by a large red C (for freetexted comments). Patient's with previous transfusion reactions have a large red TXRXN. When an associate receives a specimen and sees these mnemonics they are guided to check the "BBK History" section of the LIS where the exact information is outlined. We use Meditech 5.65.

 

Like many other institutions this act is documented in the specimen itself by a result line in the Type and Screen test under History Check - "Previous History" or "No Previous History." When "No Previous History" is entered a free test is reflexed for a Retype (second specimen to verify the patient's blood type).

 

Here's the problem:

 

Using this system as our history check relies on the ability of the registrars to correctly identify the patient and register them as the correct medical record number upon encounter. What is to prevent a registrar from entering a new medical record number for the patient with anti-K & anti-Jk(a)? To continue in this thread, when you do your history check you see No Previous History, reflex your retype, your ABS is either negative or only identifies anti-K and the patient is transfused inappropriately.

 

What does your institution do to prevent a situation such as this? This is something that we're looking at now.

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A solution we're looking at is to use the same interface we look through when someone from a different hospital calls us to get blood bank history.

 

In our LIS we have a "BBK History" section where you can click Inquiry.

 

Type in either the MRN or a part of the patient's name, hit enter and it loads a window where you can choose to also define gender & birthdate.

 

A screen will load that lists the patient's who match or closely match the information you've entered. You can even enter * as a wildcard.

 

This is great and all, but is it realistic to use for every single "No Previous History" patient? We get 400-600 per month.

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We have an e-mail distribution list for duplicate medical record number issues.  I get at least 2 or 3 notices per day and keep them all in a three ring binder.  If there is no blood bank history for either number, then I just let registration take care of it however they take care of those things.  If there is a blood bank history on one of the numbers, I send a specific e-mail stating that this patients records MUST be merged into one.  Unfortunately, they will not do so until the patient has been discharged from their current stay.  If there is a clinically significant history on one number, I add it to the other number with a comment.  (We also have Meditech)

 

But like R1R2 says, you can only deal with the information you are given.

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Our policy is to check pt. history using only the patient name and as a filter DOB and we have to check multiple accounts if the name and DOB match or if the DOB is off by a digit. But as everyone has said you can only do your best, we have had pts. registered under new MR#s with thier names spelt differently or the middle name is now the first name.

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We check by name and match birthdates (where are multiple names the same). Pick up an aamazing number of duplicate MRN's. Once we have a name and birthdate match, we match the SSN. We have to do this,e ven beyond the duplicate MRN issue, because we are a 5 hospital system with 2 of them using different MRN's. I don't think the duplicate problem is going to go away anytime soon, esp since pts give differing info many times. Sometimes they give a middle name, sometimes use maiden name as middle initial and who knows what else. Good luck, we all just do the best we can.

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I was able to attend a registration task force meeting yesterday which I found very illuminating. Our current struggles with registration issues as well as national benchmarks were discussed and I was very surprised to hear how prevalent these issues are.

 

I totally agree with the statement: "you can only deal with the information you are given," however I think what you do with that information determines your compliance with the AABB/CAP standards (5.13.5 & TRM.40300). I don't believe that history checking by MRN is adequate and we will likely move forward with a BBK History inquiry by name that matches DOBs, similar to what others have described.

 

Thanks everyone!

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Time for a little philosophy.  I have often described healthcare as an upside down pyramid with everything balanced on it's weakest part.  Generally speaking, and I really intend no disrespect here but, our entire system is at the mercy of the lowest paid, least educated areas with the highest turn over rate.  You will rarely encounter a career admissions clerk.  Their training generally consists of "see one, do one, teach one".  Granted this is based on my limited personal experience but it is what I and my wife have both seen in our careers in healthcare.  As to a solution, I'm sorry to say that I don't have one that is very palitable in the current climate of financial restraint.  (How is that for attempting to be PC!)  I have found over the years when ever the opportunity to educate those folks responsible for obtaining patient information on why it is so critical, from a blood bank perspective, to get it right they were quite surprised and became much more diligent.  Which brings me to another of my favorite axioms, "If they don't know why they can't or won't comply!"

 

Ok, I'm done.  Have a nice day.  :rolleyes:

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We search the database first by medical record number. If no match, then a search is conducted by last name and look for same date of birth. We then check with the registration department to correct/merge if applicable. There is still the chance of a patient coming back with a different name and a different medical record number assigned but we can only do what we can do.....

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We fill out a white BB record card on all patients who have antibodies. When we receive a patient's sample for Crossmatches we check the card file by using the patient's name. (If a card is found, but the Medical Record Number or the Birthdate do not match, we investigate as much as possible to determine whether it is the same person or not.)

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Our system will bring up those it thinks may make a duplicate entry.  It uses Names, DOB, MR, SSN, so any combinations that match or are say one digit off as in SSN it will bring up and ask us if this is a duplicate.

 

We check by name and match birthdates (where are multiple names the same). Pick up an aamazing number of duplicate MRN's. Once we have a name and birthdate match, we match the SSN. We have to do this,e ven beyond the duplicate MRN issue, because we are a 5 hospital system with 2 of them using different MRN's. I don't think the duplicate problem is going to go away anytime soon, esp since pts give differing info many times. Sometimes they give a middle name, sometimes use maiden name as middle initial and who knows what else. Good luck, we all just do the best we can.

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Our system will bring up those it thinks may make a duplicate entry.  It uses Names, DOB, MR, SSN, so any combinations that match or are say one digit off as in SSN it will bring up and ask us if this is a duplicate.

 

The registration system does this or the blood bank LIS does this? What system is that?

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Very common problem.  The best we've found to do is to search using Social Security number or Name, DOB.  It is not just a blood bank problem.  Allergies and Special nursing notes are attached to medical records as well.  If that patient is given a new MRN, Nursing staff won't have those important warnings.  I see this problem magnified with a national medical database.  Imagine how many times a person can be duplicated on a nationwide scale. :o

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In reviewing this information I was able to find a report in Meditech (we're at 5.65 upgrading to 5.66) that compiles data for merged blood bank history files, which can give information towards how often this is happening at your institution. I was only vaguely aware this report existed until now.

 

Depending on how IS has set up Meditech for you:

 

It's under BBK History Desktop -> Mg/Umg/Sw Log

And/Or it's under BBK History window -> Reports -> Merge/Unmerge/Switch Log

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All too common. We had one just last week. We had a registrar put in a known sickle cell patient with a new MR#, left off her middle initial and changed her DOB by one digit. There was just enough different in all of the identifiers, so the system did not alert us to a potential match. She was given a unit of blood before it was caught. So frustrating...

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Our history check procedure requires a search by name if performed for a sample to be used for compatibtility testing.  We review all patients with matching name and MRN to identify patients with duplicate registration.  We also look for a DOB that is "close", possibly one was a typographical error.  We see patients with duplicate registrations frequently and sometimes the other registration has clinically significant anitbodies, important comments or transfusion requirements.

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Ah, one of my favorite topics (and a process I have had to change at various Institutions I have worked at; also something I cited a Hospital on that we inspected this year because their idea of fulfilling the requirement to search for a historical blood type and antibodies was to enter the MR# and see if the patient came up......and in my mind, that is an accident just waiting to happen). 

 

First, I can tell you that having worked at a number of Institutions in my career, this is (unfortunately), a common problem with Registration.  I think it has to do with how they look up patient histories.  For example, where I currently work, they must find 3 unique identifiers that ALL match in order to link a patient to that name/number in the computer.  Another issue might be the kind of identification the Registration Dept. in any Hospital, requires to register a patient.

 

Here is "what" I do and "why:"

  1. First, Search by LAST NAME only.  If you put in even a First Initial, you have already limited your Search and may miss what you can find by Step 2 below.  Depending on how common the Last Name is, it may take awhile to bring up all of the patients; but "patience" is the key.  Then scroll down until you find the patient(s) with the First Name you are looking for.  Look to see if there are 2 or more patients with the same First and Last Name and maybe a Date-of-Birth is just off by 1 number (could have been a clerical error at entry).  Or maybe a patient where 1 letter of the First Name is different.  If I find that, I go into the Hospital system and look at things like SS# or Address to see if it looks like it "might" be the same patient.  Then I notify Registration that there may be a patient with a Duplicate MR#.  You can also see if you have the "other" patient in your Blood Bank computer system (maybe you have blood types or antibodies on both of these patients and can either determine immediately that they are in fact 2 different patients, or, that they may be the same).
  2. Going back to the beginning of Step 1 above where you typed in LAST NAME only....after you look at the name just before and after the First Name of your patient, I then sort the Date-of-Birth field.  That will catch patients with interchangeable names (i.e. Robert and Bob; Rebecca and Becky; etc.; there are plenty of them).  So you see that if you used even the First Letter of the patient's First Name in step 1 above, you would not catch this problem (and it does occur; 1 time the patient comes in and says their name is Robert and the next time they say their name is Bob; and again, just depends on how your Registration Dept. looks up patients).  So when you sort the DOB; if you find >1 patient with the same DOB, see if the names might fit this category.  Another thing to look for here would be a middle initial; so maybe they came in as John F. Smith 1 time; then Frank (middle name) Smith the next.

Just some thoughts based on problems that I have seen at other Institutions.

 

Brenda Hutson, CLS(ASCP)SBB

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  • 2 weeks later...

We fill out a white BB record card on all patients who have antibodies. When we receive a patient's sample for Crossmatches we check the card file by using the patient's name. (If a card is found, but the Medical Record Number or the Birthdate do not match, we investigate as much as possible to determine whether it is the same person or not.)

We check our computer system using the patient's medical record number. We also keep a card file on all patient's with antibodies or special transfusion requirements. We check that as well and would investigate any possible matches or discrepancies. I know a card file may seem out of date but it is great for downtime and registration errors.

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Searching by last name has its limitations as well. I am at a Children's Hospital and we have more last name changes than we have duplicate MRNs. Searching by either MRN alone or Last Name alone will miss patients with historical records. You can choose one criteria for your first search and if no history is returned, search by the second criteria.

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Checking your computer by entering the MR# only, will not catch these registration errors. If there "was" no error and that is the only MR# for that patient, then fine; you can look at their historical blood type and antibodies. But that would negate the reason for this post....

Brenda Hutson

We check our computer system using the patient's medical record number. We also keep a card file on all patient's with antibodies or special transfusion requirements. We check that as well and would investigate any possible matches or discrepancies. I know a card file may seem out of date but it is great for downtime and registration errors.

 
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If the Last Name has changed, you are at the mercy of Registration. You can only hope that in their discussion with the patient, the patient told them that they had been there before, but under a diferent name; so that they find the "correct" previous MR#.

Brenda Hutson

Searching by last name has its limitations as well. I am at a Children's Hospital and we have more last name changes than we have duplicate MRNs. Searching by either MRN alone or Last Name alone will miss patients with historical records. You can choose one criteria for your first search and if no history is returned, search by the second criteria.

 
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Ah ! The pain in the butt issue. Tear your hair out - rant and rave,

Occurs everywhere I think. Let's microchip everybody at birth with a unique No. and have readers at Admissions.

No seriously, when we find a previous number on checking our database, we contact records/admissions and insist that all records are merged to the new number. This creates a lot of work for them, but the alternative is to correct the records to the old number, which means that we would have to issue new armbands, medical record (hard copy), new sheets of identifier labels etc. When we merge, any with antibodies are automatically updated with the new number in our antibody register. We don't issue Ab Cards, so no issue there. The old Medical Record Number is still searchable and directs to the new number, so traceability is covered.

Cheers

W Eoin

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