Trauma Name Changes

[BankerGirl]

Help!   I am in need of a concensus concerning trauma identification.  Our Radiology department is insisting that our trauma names need to be merged (not just records updated) ASAP because it is causing problems in their imaging (PACS) system.  I have said from the begining that Standards require the patient's order and the label on the specimen match exactly, not to mention if they merge the records, NOTHING will be the same afterwards.  According to the information obtained from three other trauma centers in our state, two merge the patient and apparently use the merge trail to trace back to the previous identification(?), and one does like we do and requires a new specimen if the demographic info changes.  Our trauma director wants to go the oposite direction and not update anything for 24 hours.

 

For any who accept the merged patient info and don't redraw, how do you get aroung Standard

5.11.3 that states "...all identifying information on the request is in agreement with that on the sample label."?

[jojo808]

If we get a "code 500" specimen the name will either be a Jane or John Doe. If the identity gets corrected by the time our unit tag prints out then the blood band will say Jane (or John) Doe and the tags will have the correct name. In those cases we enter a unit tag comment as "AKA Jane Doe" Our hospitals LIS system automatically updates/changes the name as it gets corrected. We try to draw a new specimen the nextday or as soon as the critical episode subsides.

[Andersli]

_{I may need more clarification on what you mean by "merge".  Our system has a group of trauma names that are 'pre-registered' with an account number.  When a trauma patient presents, our admitting department (PAS) quickly assigns the patient a MRN with an alias name (i.e., Athens, Athens; Evans, Evans) are a few of the ones we had yesterday.  Once they obtain a 'real' patient name, PAS is given the ok to make a name and DOB update.  This MRN stays with the patient for the entire length of stay.  Also, there is an audit trail that captures the alias name in the hospital system and when the lab is made aware of the change, we also put the alias name in our system when we update the name.} 

 

_{For our blood bank samples, we use an additional blood bank armband with a unique number so we really have 3 identifiers (i.e. Name, MRN and R#).  So when the name changes, the MRN and R# that print on the transfusion forms match the blood bank armband and the sample collected.  In addition, once the name is updated, nursing replaces the hospital armband with the new name so that band is checked against the transfusion forms if the name has been changed.  The blood bank armband is not removed until another sample is required or it expires (72 hours).}

 

_{For the merging of records.....so if the trauma patient already had a previous MRN in the hospital system, these 2 records are not merged until the patient is discharged.  Once discharged, then the merge occurs and we can track this in the system.  They are not to merge anything while the patient is still in house.}

 

_{Hope this helps!}

 

_Lisa

 

_{(PS - edited for font size)}

Edited September 18, 2014 by Andersli

[BankerGirl]

When I said merge, I indeed meant merging the Trauma registration into their actual MR number.  We have pre-registered trauma IDs as well, and they are given the name of Trauma, Julie or Trauma, Samuel with a brand new MR number.  Our registration folks keep merging the trauma registration into the patient's previous MR number so nothing stays the same...not the MR number, name, DOB, except MAYBE the visit ID.  I still have a problem with issuing blood knowing that the specimen I performed the crossmatch on has none of the same information as the request that comes to issue the blood, even when it happens an hour after I am done and I know what happened.  There is that pesky Standard I mentioned.  Our computer system (Meditech) obvioulsy has a trace of what happened with the records as well, but it isn't possible to see that from our side if there wasn't a previous BB history file on that patient.

[pbaker]

We also have Meditech but can't count on the admitting department correctly entering everything in for an accurate audit trail.  If any identifying information changes (name, MRN, DOB), admitting MUST call the blood bank before changing.  If there is a blood bank specimen, we do an armband verify where a blood bank staff member physically watches the old armband being removed, comparing to the current specimen and watching the new armband being reapplied with a corresponding new label attached to the specimen.  If we find an armband has been changed or records have been merged without contacting the blood bank, we start all over with a new specimen. If it is an emergent situation, they now get uncrossmatched O=.

[tbostock]

You need an "AKA" or "alias" name field in your HIS where that original name can reside and will always be there for crossreference.  In Meditech at one of hospitals, the registration dept puts the alias name in the BAR section of the registration area.  Also, they built a test in the Meditech Blood Bank section that can be added on so that your alias name is contained right in the Type and Screen test results.

 

We need to get our computer systems working for us, so that there are no unnecessary patient delays with having patients redrawn.

[BankerGirl]

You need an "AKA" or "alias" name field in your HIS where that original name can reside and will always be there for crossreference. 

Terri, while that would help, would that be adequate if all of the patient info is changed?  This is what happens with a records merge.  I have actually decided to ask AABB.  Maybe I am interpreting the standard wrong and once testing is complete, the ability to track the merge would be acceptable.  I'll update when I get an answer.

[Andersli]

I agree with you that if the sample you have doesn't have any matching identifiers to the current name and MRN, then a new sample would definitely be needed. I have heard our nurses in the ER complain about not being able to see previous records when the patient is currently admitted as an Unknown. Even once they update the name though, they still have to search by name to get all the records because we do not merge until the patient is discharged at our facility.

Lisa

[Mabel Adams]

We don't allow merges while the patient is admitted so that headache is gone.  When a name gets changed we get a new specimen as soon as possible after the crisis has passed.  I felt that if we left a BB band on the patient with wrong name and DOB then nurses come to think it doesn't matter if the info matches the units or not.  Before the dust settles, the OR and PACU nurses probably understand about the name change, but 2 days later it just seems like it sends the wrong message.

[kate murphy]

We do much the same as everyone else for merges - get a new spec ASAP.  If the need is urgent, we will continue with emergency release and make the doc sign.

The hospital wants to merge - there are bigger requirements than ours.  Joint Comm has a requirement to check past records for allergies, drug histories and diagnoses.  So we need to think of the big picture and fit ourselves into the puzzle.

[Mabel Adams]

We could deal with even merges as long as they don't do it in the middle of a massive transfusion, they communicate that they are going to do it and they leave a documentation trail.

[kate murphy]

I agree - in the middle of a massive or while the patient is on the table in the OR is a bad time.  We've successfully lobbied Admitting to wait till the patient is in a bed on the floor (usually SICU) and merge ONLY after speaking with the bedside people.  Small concession - but the impact could be large downstream.  Since most of these traumas end up in SICU, we've got them trained now to draw a new BB spec when they put the new armband on.