patient identification

Crocuta, RN · Jul 19, 2006

Use of two patient identifiers is a Joint Commission National Safety Goal and if you're the only staff member using them, your facility is going to get a major ding on the next JCAHO inspection.

At my facility, we acutally have nice 8x11 posters that are in each patient room explaining the two identifier rule and letting patients know that they have the right to have those identifiers used for their own safety. In addition, our follow up patient surveys include the question "How often did your health care providers ask for your name and birthdate before administering medications?" These results are provided to us quarterly along with many other indicators of the care we provided. You could present your findings to your management team and ask that patient identifiers be made a priority patient care issue.

I've had the same response you've heard. I tend to use humor to smooth things over. "Yup, you're still you!" I also freely let my patients know that I'm administering medications to 8-10 other patients and being human, it's best to make sure that I haven't walked into the wrong room by mistake! Cut them off before they can object - "I know that we just did this an hour ago, but can you tell me your birthdate again?" Frankly, I find that most patients appreciate you taking extra care. Once, I told a patient, "Yeah, I'm kinda anal." Make em laugh.

Your best bet is to help move your facility into compliance with JCAHO standards and then it won't be as much of an issue.

Hope this helps.

Trauma Columnist · Jul 19, 2006

When JCAHO made the two-identifier rule, our hospital also posted many, many signs about it in order to educate patients. I worked in a large, level one trauma center and found it easy to comply by looking at a name band and then asking for the name and date of birth (as compared to the name band). Rarely got any flack.

Your facility needs to ensure they are all compliant.

HappyNurse2005, RN · Jul 19, 2006

I tend to use humor to smooth things over. "Yup, you're still you!"

i do the same. as i am scanning their bracelet, i say "lets make sure you are still you". they think its how i charge them for the meds.

luvmy2angels · Jul 19, 2006

There weren't many nurses at the hospital I worked at that ask for the identifiers either. They were supposed to, but never did.

sister--* · Jul 19, 2006

Yep, it happens like that nearly all the time. Humor gets me through.

KRVRN, BSN, RN · Jul 19, 2006

So is it required to ask the pt to state this info? Is it not proper to check the name band? Name on band matches name on pharmacy label on med? And double check with the birthdate or the pt's MR number on the band? (I work NICU so that's how we do it)

perfectbluebuildings, BSN, RN · Jul 19, 2006

For this we are supposed to make sure everyone has their armband on (not cut off or fell off or mom is wearing it, which can happen...) which has the 2 identifiers of name and e-number. If the pt has lost a bracelet then we have to have their parents verbally verify their identity. That is in theory; it is not always the case in practice.

Crocuta, RN · Jul 19, 2006

So is it required to ask the pt to state this info? Is it not proper to check the name band?

I haven't seen anything in writing to indicate that the patient needs to actually verbalize the information, but I'm willing to be corrected if I'm mistaken. Personally, I always have them do so if they are awake or if this is the first time I have administered anything to this patient today. I'm not going to assume that the band was properly applied to the patient in the first place, so I'm just going to verify that first. Sometimes pt's remove the band and attach it to the bed, and they always get a verbal verification.

I just look for two identifiers on the band if the patient is sleeping and I am giving routine IV meds or fluids that 1) they've been getting already and 2) have little risk of side effects or adverse reactions. i.e. I'm not going to wake them up to hang the next bag of TPN. That's just mean. I won't administer something new without waking the patient and talking to them about it anyhow and I want them awake to monitor for adverse rxns.

TheCommuter, BSN, RN · Jul 20, 2006

Any suggestions about how to make this "annoying" identification process any easier on the patients AND me?

I am an LVN who has two jobs: one at a nursing home that is not JHACO-accredited and another at a JHACO-accredited psychiatric hospital.

The psychiatric hospital uses two patient identifiers: the patient's name and a very recent picture of the patient on the medication kardex. These two identifiers enable me to avoid asking the patient their name or birthdate. In addition, many psychiatric patients are not in 'their right mind' and won't provide a dependable answer to my questions anyway.

EDGRADNURSE · Jul 20, 2006

Thanks for all of the responses.

I guess I asked pt to state her name/birthdate because it was only my 2nd shift on the unit and I'm a relatively new nurse with a lot of patients. Still getting used to the place..........

Of course, I could have checked the armband and started doing that, especially after her reaction. I was just shocked at the reaction from the patient and also shocked that no one checked ID (armband or by asking). She was irritated even when I checked her wristband. Ah, but that's a different topic!

I'm not going to make waves at this point but I do think it is a REALLY good idea to educate the patients (i.e.-posters, handouts,etc) about this practice.

Also, I'm not going to stop checking just because other nurses don't.

Thanks

CritterLover, BSN, RN · Jul 20, 2006

so is it required to ask the pt to state this info? is it not proper to check the name band? name on band matches name on pharmacy label on med? and double check with the birthdate or the pt's mr number on the band? (i work nicu so that's how we do it)

exactly....this is what i do. is there something in the jcaho rule that the patient must state their name/dob? i usually just check the arm band. plus, our facility wants us to use the account number as the second identifier, rather than the dob, and it is not like anyone would know what their account number is.

i, too, usually ask the patient their name the first time i see/medicate them (if they are able to respond) in addition to checking the arm band. but after that i usually just check the band.