Is this Safe? Census: 45 / ID Bands: 0 / # of Nurses: 1

[carriebarton59]

Is this Safe? Census: 45 ID Bands: 0 Nurses: 1

I started a Per Diem RN position and was surprised to learn that none of the patients wear ID Bands. The accepted method of patient identification for medication administration is (1) a Photograph from the Med Pass Book (no computers here) or (2) to "ask the aides" who is who.

The most prevalent diagnosis in this population is dimentia and many patients cannot tell you their own names. So I'm wandering through the dining room with a photo in one hand and medication in the other. Or, after dinner, I'm trying to identify patients as they wander through the hallways. The Med Pass typically takes the seasoned nurses on this floor from 6 to 7 hours.

When I asked why the patients wear no ID Bands I was told that it had nothing to do with HIPPA but rather, it is a matter of "Patient Dignity" and that the bands get wet in the shower.

Eventually I will get to know all the patients but in the meantime, is this safe? And, is it standard practice?

[VANurse2010]

It's not safe, and it's one thing that residents should *not* have the right to refuse. It is their home, but it's really not the same. Safety comes before dignity.

[psu_213, BSN, RN]

Safety comes before dignity.

I don't know that I agree with that as a blanket statement. I could rationalize a lot of indignities by saying they are 'in the name of safety.' I'm sure it is a challenge to identify residents if you are not regularly at the facility...however, this is not the fault of someone living there. Creative solutions need to be found--and forcing residents to wear bands is not that solution.

[VANurse2010]

Wearing a name band is a common, accepted practice in a medical facility - which is what a nursing home is even if it's also a person's home.

[psu_213, BSN, RN]

Wearing a name band is a common, accepted practice in a medical facility - which is what a nursing home is even if it's also a person's home.

In the ER I don't think I have ever seen someone come from LTC with a hospital style name band on (the white plastic ones with a snap). With all the things LTC facilities don't do before they send pts to the ER, I would doubt that a nursing home would take the time to cut off the bands before transfer.

The only style of bands I have seen from LTC are the clear plastic bands that are hollow and contain a small strip of paper in them with the resident's name printed. The two ends of the band connect in a solid plastic piece that fits in the hollow plastic to 'seal' the band on the arm. When I was an aide in LTC, our facility went to these types of band to hold the little metal sensor (I'm sure it has a more technical name) that we aides scanned with out PDAs to then chart the resident's ADLs. The problem? Residents could take them off and throw them away. In other cases, a resident would see one lying on the ground, pick it up and put it on...etc, etc. Point is, some residents did not have theirs on; others had someone else's on. Not exactly a good system if you are trying to safely identify the residents.

[VANurse2010]

The clear plastic ones are the ones I'm talking about. They can go missing, certainly, but I never, ever saw the wrong one on a resident.

[VBRNJD99]

In the facility where I work, we use the sleeve kind with the paper in the middle. The new connectors are very tight and the bands usually have to be cut off when a resident leaves. Everyone wears one. The paper strips are color coded as well, pink for DNR, white for everyone else. I believe safety trumps dignity in this case. The bracelet is small, discrete, can be placed under a sock if troublesome but is there for identification in case of emergencies or new staff. I have worked in the facility 6 months and know the residents but sometimes w 5 Mary's in the same building, the band helps. In addition, an argument can be made that watch mates or wanderguards or locked dementia units are not home like and take away dignity, but if it was my family member, I would want safety first.

[Fngrpntsnotasin]

I don't know what state you are in but there are regs for how many residents per nurse/aide you can have depending on the shift. I work 7p-7a and have 44 residents (this is at an 88 bed facility with 2 wings 44 beds apice). As for the OP I would say sure, sounds okay. We don't have name bands either and I know all 88 residents first and last names. It is somthing you will get faster with with time, just like that dreaded med pass.

[SnowboardRN]

I have worked in two LTC facilities and neither used ID bands. I quickly learned the residents names, and always asked the other staff if I wasn't sure. Working the dining room really helped to know who was who

[MomjessB]

In LTC dignity is very important. The CNAs know the residents better than anyone. They are your eyes and ears in LTC because they do all the bathing, changing, and feeding for the most part. Nurses help, but mostly it is the CNAs.

[CapeCodMermaid, RN]

If I have to live in a nursing home and you put a name tag on my leg, be prepared to be kicked every time you try to look at it. Dignity is everything.

[amoLucia]

Just FYI - I did ACTUALLY have one resident with a WRONG bracelet on!!! It was the lab tech doing early morning phlebotomy who knew both residents well, so she knew the name band DID NOT MATCH!

It happened to be one of those clear tubular plastic-type bracelets that obviously slipped off a wrist as it was HUGE - it had not been cut to fit the slender wrist of the right pt. The other pt must have found it and just absent minded-ly slippped it on. Fortunately, both ladies were in their right beds (no AWOL!) and were both loooong-time familiar residents so we believed no med errors were made (also NO CRAZY meds!).

But Thank-You-God that the lab tech DID HER JOB and caught the error that prevented another potential catastrophy!

Bracelets are a god-send when new pts are admitted. At one place, it was dinner time in the dining room, and East Wing staff thought a new lady was from West Wing. West Wingers thought she was from East Wing. A CNA went to help toilet her after bingo and noticed an ankle bracelet under her pants leg, but, we didn't do ANKLE bracelets!!! Turns out, she was a wanderer from an ALF a few blocks away.

As for pictures, they need to be clear and reasonably close-up to be accurate. They should be updated periodically. Pictures are usually part of protocols for residents who go missing/AWOL/wandering, so accuracy is crucial, and duplicates are needed for the police.

To UMs, supers, DONs one last thing - please ensure that there are sufficient spare bracelets avail so pts have one on when they go out to the hosp 911. I've had to send out staff to local hosps to identify pts (with a bracelet) so the hosp would proceed. As super, I had my own supply of bracelets that WERE needed at times.

Personally, I agree that there HAS to be an easy quick ID system. I've given meds too many times to unfamiliar pts, so I have the greatest sympathy for newbies, floaters, and Agency. I guess that's part of the reason my med passes are soooo slow. So unless we tatoo their names on their foreheads....

[caldwellwenda]

I would rather have you kick me everyday that to give you the wrong med and do serious harm to you.