So... What if patient says that the wristband is not them?...

wish_me_luck, BSN, RN · Sep 12, 2012

You ask them what their name is. I was slightly confused as to whether you just said "Are you so and so?" or if you asked them and they told you and it was different from the arm band. If it did happen that they said something different, then I would consider their mental status (confused or A and O x 3) and check the medical record . If they were alert and oriented and the medical record matched what they said, then get a new arm band. If nothing matched and they were alert and oriented, I would go to charge nurse first for assistance. Definitely would want someone's second eyes (and ears) before doing anything; that's me anyway.

Since you are a student, instead of the charge nurse, you would go to your instructor for assistance. But first consider their mental status (especially since they said one thing and then another) and check it against the medical record. Then, get your CI for help.

When I was in clinical and gave medications, I always asked their name and date of birth to verify also. Use your pt identifiers to assist you.

That's the best I can tell you. If any experienced LPNs or RNs want to chime in, it would be appreciated.

allnurses Guide · Sep 12, 2012

Don't do anything until yu are sure who you are dealing with!

Get your instructor, look in the chart, see if the pt has photo, confirm the pt's ID with a staff who knows the pt.

Student2001 · Sep 12, 2012

yeah this was before giving medicine when i was doing my rights. The patient couldn`t talk because he was trached and vented .. and had a history of mental issues so that would have been considered.. but i`m wondering in general if they say that their name doesn`t match.. how can you make sure that its them.. i didn`t see any photo id in the med record and i can`t just take someone else`s word for it because what if a nurse before me thought he was who she thought he was didn`t check with him, didn`t verify, and is now my reference. I can`t ask my instructor.. well no i did ask him and he said "figure it out".. and i`ve been trying but i don`t see anything else to do except question patient more about id and mental status and look in the chart (for what I don`t know since theres no photo id anyways).. i`m so stressed out with this clinical ugh

wish_me_luck, BSN, RN · Sep 12, 2012

That's dangerous when a CI refuses to help a student and says "Figure it out". Was there any family? I am not keen on the idea of only asking family but you have to figure out for sure who this person is. Kudos for attempting to figure it out.

But a word to the wise. Even though a person has mental issues does not automatically make them "incapacitated" or "incompetent". Take it on a case by case basis. Good Luck!

eatmysoxRN, ASN, RN · Sep 12, 2012

If they said no, then yes, I'd take the opportunity to check their mental status. If they weren't able to verbalize, ask them if this month is (wrong month), and see what they say. Ask if George bush is the current president. Ask yes and no questions. If they are able to answer all appropriately, reask their name/dob and if they still say no, seek advice from your clinical instructor or charge nurse.

Esme12, ASN, BSN, RN · Sep 12, 2012

Not many times in your practice will someone say that they aren't so and so. Once they are admitted their identity has been established. Shame on your CI for such a poor response to your question.

In this setting I would ask the family if they are present. I would seek other staff members to see if they know who the patient is. If they cannot verbally respond I would assure that the name band matches what I am giving to whom I am giving it too. I would check the chart to see if this is a known behavior and seek the guidance of the charge nurse for witness that it is the patient who you are caring for is the right one.

In an Emergency room setting there are set rules about identifying patients and how they get identified. Two cases come to mind. One I know of personally (on the news) and one on the news.

I was supervising two facilities which meant I was off site for one of them......there was a house fire during the holidays where one mental giant in the room threw firecrackers in the Christmas tree causing a fire. One of the three expired, one got out, and the other severely burned. The staff never followed chain of command and allowed the mental giant, who threw the fire cracker, identify the burned and the deceased. They called me after the coroner was there and the burned sent out.....I called risk management to enlighten them on the potential for a problem in the near future. It was settled out of court for an undisclosed amount.

MONTHS later when the burn victim recovered and was extubated they discovered the burn victim was the one that was supposed to be deceased and the family who thought their family member survived now had to deal with their family members death.

The other was in Indiana with two college girls one lived with severe head trauma and the other deceased. It was months when they discovered the mistake as the girls were very similar in looks.

http://abcnews.go.com/GMA/tragic-mix-hospital-miss-signs/story?id=11257120#.UFEACMWYUw8

BuckyBadgerRN, ASN, RN · Sep 12, 2012

Well, the rule is "never ask a yes or no question". Phrase it so that it requires an answer. Of course, things will be different when a pt is on a vent and their speaking abilities may be compromised. Are they able to write their name on a white board?

What would you do if patient shakes his head when you ask if they are who they are? I`m on a med surg floor for clinical and everyone is on ventilator.. have mental issues.. and can`t talk. I asked my patient if his name and date of birth was right and he shook his head no .. i asked again and then he said yes.. but i`m just wondering what to do when they say no. Is there something in the chart.. do i go get the charge nurse.. what steps do i take to make sure of the person`s ID?..

KelRN215, BSN, RN · Sep 13, 2012

I have seen this happen before. Working in the hospital, once on a 3-11 shift, I picked up a patient who was a new admit. Let's call her Suzy Jones. I went into the room and looked at her wrist band and it said "Mary Smith." Her mother at that point saw it and said "that's not her." What happened, evidently, was that the nurse had asked the CNA to put a wrist band on the new admit and the CNA had done it without verifying with the mother that the information on the wrist band was correct. ALWAYS double check with the patient/family before placing a wrist band on a patient. I have also seen it happen that the ER delivered the wrong patient to the floor. We were expecting Joe Brown and the patient, introduced as the "new admit from the ER" arrives and then it is revealed that this is actually Bob Johnson.

As a general rule, if the patient says that the name on the wrist band is incorrect, you STOP. You don't want to give Mary Smith's medicine to Suzy Jones, especially not if she told you the wrist band was wrong.

Katie71275 · Sep 15, 2012

This is the reason to have pictures on the chart!!

BuckyBadgerRN, ASN, RN · Sep 15, 2012

LOL, yeah, in the perfect NCLEX facility....

This is the reason to have pictures on the chart!!

CP2013 · Sep 15, 2012

I have only ever seen pictures on charts in long-term care facilities or nursing homes, etc. where the patients are there for a long time, and because there are so many staff members.

I have seen pictures come in to the hospital if a patient is transferred from one of these facilities.

I can't imagine who would pay for a picture in a chart for a patient in a hospital, that seems like an expense insurance companies would gripe about.

I usually ask the patient for their name and date of birth, and have them tell me without any suggestion from me. If they disagree with me, then I ask them for the year, or for their favorite show and what time it comes on, or some other sort of technique to assess their orientation to place and time before identifying if they are oriented to person.

If they truly are not the person on their armband, contact the nursing instructor, who will probably get a staff nurse to verify, and then have a new armband issued and have the patient assessed to be sure no incorrect medications, treatments, or procedures were performed on the wrong patient.