patients with the same name

[jorjaRN]

What is everyone's experience with facility policy on patient with the same name? The last place I worked every effort was made not to even have patients with the same last name on the same floor, but if unavoidable, they were put as far away from each other as possible so that thier meds would be on different carts, etc.

Last night I had a patient, let's call him John Patient, in room 5, and about halfway through the shift, we got an admission with the name John Patient. Exact same name, first and last. And they put him in room 7. Our charge nurse informed the coordinater that we already had a patient with the name, but I think her reaction was pretty much, "oh well, deal with it". I wasn't assigned the new patient, but obviously when I went to get meds out of the Pixis the names were right next to each other, and their med drawers in the cart were literally on top of each other. I just felt like it was an accident waiting to happen.

This is a pretty small hospital, with only a couple of med-surg floors, and it hasn't been rare to have patients with the same (common) last names on the floor, but I thought this was pretty extreme. I'm wondering if the hospital would have had any responsibility if an error were to occur, since I feel like it would be in part a systems error if someone pulled the wrong med or something. Obviously that's why we check more than one patient identifier, but we all know that mistakes unfortunately happen even under the best circumstances.

In any event, I'm hoping at least one of them will be discharged before I'm back on the floor in a couple of days.

Just wondering what your thoughts/experiences were.

[Penelope_Pitstop, BSN, RN]

Can't say that I've ever had a patient with the same first AND last names on the same floor, but my hospital is similar to yours in that we try to space patients with the same or similar surnames out on the floor if we cannot move one to a different department.

It sounds like a recipe for disaster. Remember your TWO unique identifiers. If everyone does that, potential errors are reduced quite a bit, but I worry about what happens when people call to speak to "the nurse for Mr. Parent," ("Which Mr. Parent?" "Oh, Mr. John Parent." "Hmm, WHICH Mr. John Parent?") whetn doctors pick up the wrong chart, when (God forbid), one dies...

There must be some way to get one of those gentleman on a different floor! Even swaps exist for a reason, even if they're an inconvenience. (I've got a COPD'r over here, can we trade for one of YOUR COPD'rs?) Safety is more important!

[gtoko]

As the previous poster stated, remember your two unique identifiers. Also, a name alert.

Good idea about swapping pats also.

[brownbook]

We have bright yellow name alert bracelets the patients wear, in addition to their regular bracelet, and yellow stickers that say name alert we put every where on their chart, door to their room, etc.

[bill4745, RN]

We put up signs in appropriate (eg med room) but private (watch HIPAA!) areas that warn staff of similar names.

[Meriwhen, ASN, BSN, MSN, RN]

The record on my unit is 4 patients with the same first name--2 of those shared the same last initial. This got confusing since on the outside of the charts and on the boards, we list them by first names only. We used a lot of name alert tags and asked for birthdates at every med pass. Never had someone with two entirely identical names though.

Maybe your two patients have different middle intials--if they do, you can use that to help tell them apart.

[tewdles, RN]

I have never had it happen in the hospital but when I worked in community health we frequently had patients who had the same first and last names and often the same middle initial. We had 3 young boys, all with the same first and last names AND 2 of them even had the same birthday. Given that we were working with the migrant hispanic community, we used the mother's maiden name to ID them.

No matter what, you have to have at least 2 unique identifiers...dangerous possibilities...

[JulieCVICURN, BSN, RN]

It's happened to me recently too, and to make matters worse, I work in a CVICU, so not only did they have the same name but also the same diagnosis, were only 2 years apart in age, and had the same primary physician AND cardiologist. Both were scheduled for the exact same test at different times the next day. I had both patients, simply because I was called in to take them both as admits and they had come in to the ER at relatively the same time. Before we realized they had the same name we almost made them roommates because our floor was so full, but ended up moving a patient just so we could split them up! It was a hairy night for me, and in the morning we made sure to split them up and give them to two different nurses. And of course, we put stickers on the charts and everything that said "NAME ALERT".

[SouthernPoint]

i have personal had to deal with this as a charge nurse and floor nurse. here is how i would deal with it.

as charge nurse:

1 - i will try my hardest to have the patients as far away from each other as possible (that is, if i am giving the bed to the house supervisor).

2 - i will never give a nurse both of these patients. there were many times i have came into work and the night charge nurse assigned both patients to the same nurse. if i am not able to switch things around. then i will take the patient and i have a handful of times.

3 - put a note (name alert) on the medication cart/pyxis or what ever delivering system your work place has. this way it draws attention and everyone will notice.

4 - make sure you let both nurse's know about the double patient name's. have them always double check everything given during their shift. i know it's a pain in the butt, but so are writing up incident reports.

as a floor nurse.

1 - i will make sure that there is a note in the medication room/pyxis.

2 - i will get with the nurse who has the other patient and talk with them about having 2 patients with the same/almost the same name.

3 - i will double check everything i am giving to my patient with either another floor nurse or the charge nurse.

4 - without violating any type of hippa issue's. i talk with my patient and explain that it's very important, but i am going to have to ask them their date of birth (our mar's have the patient's dob on them) each time they are to receive medication or testing. i have never had any issue's with this, and many patients state they are grateful that i am taking that extra step for safety.

i hope this might give you some idea's on how to handle issue's like this.

[jorjaRN]

Thanks so much for all your responses! If they're still both there the next time I work, I'll definitely make sure that some of these steps are in place.

I personally check name, date of birth and record number when I give meds on any of my patients, and I'm sure that the other nurses on my floor will be extra careful with these two patients, but I'm wondering, if something were to happen, would the hospital have any additional liability for creating this situation in the first place? There were definitely places in the hospital that the second patient could have been put.

Thanks!

[cherrybreeze, ADN, RN]

i have personal had to deal with this as a charge nurse and floor nurse. here is how i would deal with it.

as charge nurse:

1 - i will try my hardest to have the patients as far away from each other as possible (that is, if i am giving the bed to the house supervisor).

2 - i will never give a nurse both of these patients. there were many times i have came into work and the night charge nurse assigned both patients to the same nurse. if i am not able to switch things around. then i will take the patient and i have a handful of times.

3 - put a note (name alert) on the medication cart/pyxis or what ever delivering system your work place has. this way it draws attention and everyone will notice.

4 - make sure you let both nurse's know about the double patient name's. have them always double check everything given during their shift. i know it's a pain in the butt, but so are writing up incident reports.

as a floor nurse.

1 - i will make sure that there is a note in the medication room/pyxis.

2 - i will get with the nurse who has the other patient and talk with them about having 2 patients with the same/almost the same name.

3 - i will double check everything i am giving to my patient with either another floor nurse or the charge nurse.

4 - without violating any type of hippa issue's. i talk with my patient and explain that it's very important, but i am going to have to ask them their date of birth (our mar's have the patient's dob on them) each time they are to receive medication or testing. i have never had any issue's with this, and many patients state they are grateful that i am taking that extra step for safety.

i hope this might give you some idea's on how to handle issue's like this.

it is our policy to ask for a patient's last name and birthdate every time we give a med, regardless. i do believe it will help in this case, but we would be doing that anyway.

thanks so much for all your responses! if they're still both there the next time i work, i'll definitely make sure that some of these steps are in place.

i personally check name, date of birth and record number when i give meds on any of my patients, and i'm sure that the other nurses on my floor will be extra careful with these two patients, but i'm wondering, if something were to happen, would the hospital have any additional liability for creating this situation in the first place? there were definitely places in the hospital that the second patient could have been put.

thanks!

i don't think that can be answered definitively. it would vary with every case. if it came down to a lawsuit, it would depend on the lawyers, the judge, the day. one judge/jury might find that the hospital itself had some liability in not placing them in different locations (but by saying hospital, you would still have to narrow it down....who would have made the choice not to split them up? it comes down to someone). another might find that even though they were close together, ultimately it is the nurses' responibility to make sure they are giving the correct meds to the correct patient, since they (obviously) should be doing that anyway. having patients with the same name does increase the risk of errors, but if staff is following the 5 rights, checking birthdates, etc, the risk should be minimized.

i think that it also would help to have the patients aware (if they are oriented enough) of what meds they take, and make sure the nurse bringing in their meds tells them specifically what they are giving them, as opposed to "your morning pills," "your evening pills," "your blood pressure pill," "your pain pill," etc. if the patient hears the name of a med they aren't familiar with, or know they haven't taken before, that would raise a flag as well. of course, i realize that not all patients are going to be capable of this, but for those that are, it could be useful. even giving the patient a written list of what meds they take and when, and updating it as things are added/removed, would aid in this process and not violate hipaa (as it wouldn't be posted anywhere).

[SouthernPoint]

thanks so much for all your responses! if they're still both there the next time i work, i'll definitely make sure that some of these steps are in place.

i personally check name, date of birth and record number when i give meds on any of my patients, and i'm sure that the other nurses on my floor will be extra careful with these two patients, but i'm wondering, if something were to happen, would the hospital have any additional liability for creating this situation in the first place? there were definitely places in the hospital that the second patient could have been put.

thanks!

jorjarn

what ever you do. do not let yourself get into that situation. trust me, if the pooh hit's the fan. it's gonna splatter and make one heck of a mess and the hospital will use you to clean up the mess.