I would appreciate input from other hospital blood bankers out there on how you maintain patient identity during traumas. My hospital merges the trauma identification number to a historical medical record number ASAP. When this merge happens, without a new specimen, we really do not have a good means of maintaining patient identity. We ask for a new specimen when them merge happens, but this is not always immediately apparent to us and we get a lot of push back and often no repeat sample. We have asked the other parties involved to delay the merge during the massive transfusion event. They would still be able to access the historical information, but we would be able to better maintain patient identity if they delayed this process. This request was not well received as the clinical team is anxious to access the patient history and allergy history and may not completely understand the patient safety issue on the blood bank side of things. We also use "R numbers" for red cell transfusion, which sometimes confounds the process. Any advice would be greatly appreciated. Thanks.

We insist that the records are not merged until discharge (unless they can get a sample to us) - if that means the patient has two records then so be it. We also insist that we are notified of any merges on the system so we can identify if they have an 'in use' BB sample and arrange a repeat.

In the UK this is the guidance from the MHRA.

We also use "R numbers" for red cell transfusion, which sometimes confounds the process. Any advice would be greatly appreciated. Thanks.

I am assuming that this indicates a unique blood bank identification band? If so, is there any reason this band could not remain on the patient throughout the stay as the safety identifier for blood bank? That is the process we adhere to for the duration of the stay after a trauma admission without identity. The hospital identification band is a separate item and can be changed to serve the other purposes you list. Maintain the blood bank band with the numbers associated with blood bank and you should be fine. Once the patient is discharged a merge could occur without interruption of service.

I am assuming that this indicates a unique blood bank identification band? If so, is there any reason this band could not remain on the patient throughout the stay as the safety identifier for blood bank? That is the process we adhere to for the duration of the stay after a trauma admission without identity. The hospital identification band is a separate item and can be changed to serve the other purposes you list. Maintain the blood bank band with the numbers associated with blood bank and you should be fine. Once the patient is discharged a merge could occur without interruption of service.

This is similiar to our process. We have convinced the hospital to not merge patient info until discharge, however, they do update the patients name to the real name when known. We use the spearate blood bank armband and this way we have our two unique identifiers still in place, Medical Record # and the number from the blood bank armband.

Trauma patients at our facility are being identified with a trauma name plus a Medical Record Number plus a visit number. We also use a blood bank armband number. When the patient name is changed to their real name we still have MRN, visit number and BB armband number, i.e. 3 identifiers to match at transfusion. Currently, if the patient had a previous MRN, the new trauma MRN is merged in to that one after discharged. In the near future, MRN mergers are going to happen prior to discharge. The agreement is that the merger will not take place until the patient is stable. Our plan is to re-collect a new Blood Bank Specimen with new BB band and repeat testing once the merger happens, because otherwise we would be down to only one identifier the BB armband number.

We use the BloodLoc system; as long as the BL code remains attached to the patient we can deal with any "merges" that occur. If the pt armband (and hence the BL code) is removed a new specimen is necessitated. In emergent situations we can transfuse with the BL code alone if necessary (barrier).

We have both the pre-identification information (Trauma ID) and the correct patient ID, BOTH must remain on the chart so these 2 things link the 2 patient identifiers. As long as BOTH identifiers are on the chart (must be documented by BB Tech talking to nurse) per hospital policy AND the BB Band is on the patient and is true to one of these IDs we accept whichever way it is ordered and list the alternative name as an AKA. If any of these things is not true (once had someone remove all Trauma id (with all corresponding lab results) then we have to start over and if they want blood in the meantime they get uncrossmatched and have to sign for it.

We use this procedure for ALL merging (Admitting mistakes, disaster id, etc.)

This is similiar to our process. We have convinced the hospital to not merge patient info until discharge, however, they do update the patients name to the real name when known. We use the spearate blood bank armband and this way we have our two unique identifiers still in place, Medical Record # and the number from the blood bank armband.

This is what we do, too.

We also received friction when asking that trauma patient not be merged until they are out of surgery. What we do if they merge is give them oneg uncrossmatched until we receive a new specimen. They have been pretty good about waiting since we did that.

Barbarakym, do you change the ID on your specimen, bag tags, transfusion records and the BB armband or do you leave them since they agree with at least one of the identifiers in the chart. Also, are you using paper charts? I am not sure how our EMR could keep two IDs at once--at least not anywhere that someone later could see them.

We have in the past gone directly and asked the patient -after all this is going to be the most accurate result you could ever have. It's how they are supposed to label the samples after all.

We have in the past gone directly and asked the patient -after all this is going to be the most accurate result you could ever have. It's how they are supposed to label the samples after all.

I wish that I could agree, but my own mother is slipping gently into senility, following a fall lat last year, and will often answer that she is someone completely different to who she is.

This is also often true when patients are confused, following a head injury.

This is one ongoing, nasty situation for us too. We have a policy (seldom followed by Admissions) for Unidentifed pts (sometimes actual traumas). The policy calls for Admissions to label the pt with a distinct BB ID band and use that number as the pt name for the start of the trauma. The Medical Record number and the Encounter (visit) number are assigned by the computer. We have adjusted to part of Admission's perceived need to have the pt's real name in the computer by asking them to put in the pt's name as they learn it, but also leave the BB ID band # in the name field too. Then, if they find an earlier MR # too, they are asked to wait until the pt is in an In-patient room (not OR) before merging and we will get a new specimen as soon as the emergency abates. The Admissions # remains the same for the whole visit, so that tends to give us 2 identifiers at all points of the process (if!!!! the process was ever used correctly by the Admissions Dept to begin with!!). Practice would help a complex process like this go better and constant training for the high-turnover depts like ER Admissions would help too, but we get so little trauma here that Admissions and ER both always struggle with the process. The BB ID band # remains our constant identifier of choice until we can get the pt ID settled down. I can't imagine handling these problems without some kind of separate and distinct BB ID (the barrier/barcode methods would help too).

Best of luck coming up with a process that works for your facility.