This isn't really just a BB question, but applies to the entire LAB. Also, it isn't just a CAP question (they have a standard about it), but also Joint Commission.

If the wrong patient is selected at time of registration, what processes do you have in place to make sure that the results are corrected properly?

Both CAP and JC have standards that require that corrections to reports are made in a way that shows there has been a correction.

So... Mary Doe is admitted but put under name Mary Roe. Lab work is done. The next day someone discovers this... now we have a problem. In Meditech, Medical Records/Adm Registration have a routine they can use to switch the account from one Medical Record to another (though as I understand it, this routine will not move everything, and some things, including some BB, sometimes is blocked) (what is moved and what is blocked is a little foggy for me).

This "switch" would seem to take care of getting all of the information onto the correct patient's chart, but it does not take care of the incorrect results that went out on Mary Roe and may have been viewed by a doctor remotely... may even be printed in the doctor's office. So we don't want them to move the account, because that means it has vanished from Mary Roe's record. (This is not to mention all of the other documentation that is incorrect.)

Sorry to be so long winded, but this seems to be a pretty complex problem.

Anyone out there have a great plan??

Linda Frederick

If a duplicate account is inadvertently created, it can be merged with the original. The computer tracks the merge for us. Otherwise, I've seen a variety of processes for correcting patient reports, but all are messy.

Our current process is to "correct" the bad results with the alpha "See comment", which places a huge footnote on the result (previoiusly reported ... as xxxxx) and reorder on the correct patient using our downtime restore procedure. We try to be careful with explanatory comments -- I particularly like the "nurse mislabeled specimen" comments that techs like to use.

All changes to verified records are considered incidents that are documented, investigated, etc. They are also treated as critical results, with call comments appended.

We have an audit to make sure are documenting everything correctly and consistently.

We do a similar appended report with verbiage that says "the above results do not belong to this patient". We are trying to keep the free texting standard and not point fingers at nsg staff.

We then fill out a hosptial occurrence report that goes to the Registration Director and into the hospital risk mgt database. We also have our own lab QA internal database and we code the QA's based on pre, post and analytical errors, wrong reg is one of the choices. We also do a verbal report and treat it like a critical value. Too much work, too many forms:cries:

As far as addressing and doing something about them we fall a little short here, it's an ugly mess and we are still trying to work out the kinks

Why not point fingers, Likewine? You can bet your booties the nurses sure say "the lab messed up". Read a chart sometime- I bet you will find in 1 out of 10 the comment "Lab Error". Until I was placed on the chart review committee, I had the same opinion as you. However, I have seen that "lab error" comment enough, and know that in most cases it is not true, to be driven to the dark side, where we tell it like it is.

BC

rcurrie I agree that we should point fingers, especially when someone from outside the lab collects a specimen.

The problem we were having was that our lab staff was entering external comments, which appears on the pt MR, and they weren't worded as professionally as they could have been.

We do place the blame squarely on the nursing staff but we are trying to get away from sniping at them through an external comment.

We are also trying to zero in on specific individuals who may not be following specific collection guidelines, but we have over 600 people in our hospital that collect samples and it's nearly impossible to keep track of it.

We do a similar appended report with verbiage that says "the above results do not belong to this patient".

Our computer system allows us to enter "TNR" (Test Not Reported) to replace the wrong patient result values. The report will then be noted as "amended" and you can add a comment stating the results did not belong to the patient.

I prefer making a change this way because of cumulative patient reports. I can just see a provider looking at a cumulative report and not noticing the footnote stating that the one set of results still appearing didn't belong to the patient!

We recently had this happen at our site. We removed the results from the erroneous record but we did not re-enter the results into what they were saying was the correct record. If we don't have specimen containers labeled with the correct patient name and number how can we be sure whose specimen it is? Does anyone else do this?

We also have a program that merges the results to the correct patient. The merge is tracked by the computer so that you can do an audit trail on it. When results cannot be merged, we do a correction that leaves the actual results and changes the interpretation to "test not performed" with a comment that states "is a correction of the results that were previously reported as [insert previous interpretation] on [insert date of previous result]." This is a mostly canned comment. Then we also order another test on the patient (CMRB1 for blood bank; CMR for lab) that allows us to enter information about the error (who was responsible, what was the primary cause, etc.). Only some of that information actually gets charted. The rest is used solely for QA purposes.