Patient identifiers on BB samples

[Christy Spence]

Our blood bank policy states to use 2 patient identifiers on our blood bank samples; med rec number and full name. We use the Typenex system with pre-printed labels (chart labels that match our hospital bracelet stickers) that adhere to the patient's blood bank bracelet. Policy requires the person drawing the patient to verify name and DOB in addition to the med rec number prior to draw. The label on the actual tube is generated from our computer system- Cerner. It does not include the DOB but it does include full name, MRN, and accession number.

Our interim director is extremely concerned that we do not have  DOB on the actual sample. It's my understanding that full name and 2 unique identifiers, MRN and Typenex number, meets accrediting requirements. Does anybody else require more than the standard 2 patient identifiers on their samples? Am I missing a significant CAP/TJC/AABB requirement for DOB?

 

[Malcolm Needs ☆]

Certainly, within the UK, there is a requirement for a full (and correctly spelled) forename and surname, a hospital number, a full date of birth (not age), the date of the sample and the signature of the person who has taken the blood.  This must all be hand written, UNLESS the printed label is generated immediately at the time of the venipuncture (e.g. at the bedside).  Pre-printed sticky labels are forbidden.  It seems to work, in most cases.  It is fairly fool proof, but NOTHING is idiot proof!

[klsmith]

Malcolm,

Do you guys use Blood Bank armbands over there?

[Malcolm Needs ☆]

Well, yes and no (I realise that is not helpful, so I will expand!).

The patient's do wear arm bands that have both eye readable identification (full name, hospital number, date of birth, etc), but also a bar code that can be read by a scanner, with the same information (at least, if not more).  The bar code can be used to produce sticky labels at the bedside that can be used to label sample tubes for blood bank - but no pre-printed sticky labels are allowed.  The blood bank also can produce labels for the units of blood/blood components and blood products, and so these can be scanned at the bedside (against the arm band) before administration.  This is the "yes" bit!

Having said all that, the arm bands are not exclusive to blood bank; they can also be used to identify the patient for the administration of, for example, medication, to ensure correct patient identification.  Therefore, the arm bands are not exclusive to the blood bank.  This is the "no" bit!

[John C. Staley]

3 hours ago, Malcolm Needs said:

Having said all that, the arm bands are not exclusive to blood bank; they can also be used to identify the patient for the administration of, for example, medication, to ensure correct patient identification.  Therefore, the arm bands are not exclusive to the blood bank.  This is the "no" bit!

I have never seen a need for an exclusive blood bank arm band.  If the universal hospital arm band provides the needed info and is used appropriately then why needlessly complicate a process with a blood bank exclusive arm band? Complicating process never makes it better. 

To answer the original question we required Patient's full name, DOB, and MR # along with the phlebotomist's initials and date/time of the collection.  Utilizing the biologics arm band system (pre barcode tech) the 1st three were provided on the label made directly from the patient's armband.  The last 3 were hand written by the phlebotomist.  I'm certain the technology has changed but I'm confident the bar code systems function very much the same.  

As far as regulations go I believe that CAP or maybe JACHO required 3 identifiers and 2 of them had to be full name and DOB.  I may be mistaken in this but that's what I seem to remember.    

[SMILLER]

The difference between a BB armband and having only a hospital armband is significant only if the Lab is responsible for specimens drawn under the BB armband.  One needs a strict policy regarding the use of BB armbands to make them effective for avoiding things like mis-labeling and lost armbands.

Scott

[jojo808]

We also use the Typenex banding system and hand write full name and med rec#. From our experience pre-printed labels are asking for trouble. If you work at a busy hospital then more so. Because written on, our Phelps will add DOB 90% of the time, there is more than enough room for that. Hope you find a painless resolution.

[AMcCord]

Blood bank specimens here require 2 patient identifiers plus a sticker from a blood bank armband that is directly attached to a patient appendage. Our required identifiers for inpatients are full name and MR#. The labels that print at bedside include the birthdate, but birthdate is not a required identifier. We do, however, use birthdate as one possible patient identifier for outpatients. Specimens from outside clinics for reference work (prenatal panels) are acceptable with the name and a birthdate.

We've stuck with our blood bank armbands because we've watched how some patients have gotten armbanded on the floor...staff member walks into room and slaps on band OR staff member walks into room, says 'Are you Fred?' and slaps on armband OR any other similar variation. That is definitely not policy, but it is human behavior. Blood bank specimens are lab draw, with some exceptions from the OR. We have a very strict policy about the removal of blood bank armbands - only we cut them off, or give permission for them to be cut off, unless the patient is being discharged. We've been doing that for long enough that we lose almost no bands. We have the full support of Quality to enforce the armband policy.

 

[Patty]

I believe you are suppose to ask the patient to identify themselves if at all possible.  Using the name and DOB are two things each patient is likely to know. If it is not on their label or armband how are you suppose to know what you are checking is accurate?  I doubt patient's know their MR# or Accn#.

[AMcCord]

19 hours ago, Patty said:

I believe you are suppose to ask the patient to identify themselves if at all possible.  Using the name and DOB are two things each patient is likely to know. If it is not on their label or armband how are you suppose to know what you are checking is accurate?  I doubt patient's know their MR# or Accn#.

Exactly - patients should self identify, whenever possible, and that would be full name plus birth date. (We have had a few frequent flyers who would rattle off their MR#s when asked to identify themselves, but I think that was more about being a touch exasperated w/ our constant requests for them to tell us who they were rather than anything else.) And I agree that the birth date should be on the armband and the order for ID purposes. We do have it on the labels that go on our specimens, but it is not 'required' as an element of specimen ID.

The CAP requirement for patient specimens is: "All blood samples used for compatibility testing are labeled in the presence of the patient with:1. Patient's first and last name2. Unique identification number3. Date of collection4. A method to identify the phlebotomist."

AABB Stds say:

"Requests: Requests for blood, blood components, tests, tissue, and derivatives and records accompanying samples from the patient shall contain sufficient information to uniquely identify the patient, including two independent identifiers. The transfusion service shall accept only complete, accurate, and legible requests."

"Patient Samples: Patient samples shall be identified with an affixed label bearing sufficient information for unique identification of the patient, including two independent identifiers." They further say that the completed label has to be placed on the sample container at bedside; it has to identify the date/time of draw and the person(s) who collected the sample; that specimens have to be completely, accurately, and legibly labeled; and there should be a policy to reduce risk of misidentification of pretransfusion samples.

I believe that Joint Commission recommends following AABB guidelines.

So, as far as I know, the birth date is not 'required' on patient samples, but it is also not precluded from sample labeling. You can choose what your independent identifiers are and you can always have stricter requirements than standards in order to meet your needs. We choose to use full name, MR# and a separate armband ID for inpatients, giving us 3 independent identifiers - not required, but we've chosen that protocol to meet our needs.