Positive Patient Identification for Patient Protection

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Positive patient identification (PPID) is an approach to avoiding patient misidentification for the prevention of medical errors, which include errors in medication, transfusion, and testing, as well as wrong-person procedures and the discharge of infants to the wrong family. Since the turn of the second millennium, healthcare accrediting bodies and the World Health Organization have emphasized the importance of tracking patients, medications, and data through PPID.

PPID has been described as a combination of computer systems, hardware devices, and printable products for the purpose of identifying a patient by matching historical records with current records.¹ Until recently, the costs associated with hardware and software were beyond the reach of the average hospital or laboratory. Today there are multiple vendors with devices that can easily be integrated into the information system of a facility. Some systems are better for small facilities, while others are better for larger institutions. It is important to compare each vendor with particular requirements, so that an informed decision can be made.

Prevention of Preanalytical Errors

Studies have shown that 31.6% to 75% of laboratory errors take place during the preanalytical stage.² Errors occur every day in every healthcare facility worldwide, and sometimes these errors prove fatal. How can a facility’s staff and administration prevent these errors? The technology is here with wireless, simple-to-use patient ID systems. The decision boils down to features and cost. So how do you determine which product works in your facility?

Evaluate the Existing Process

Donald Berwick, professor at the Harvard School of Public Health (Boston, MA) and patient safety advocate, says: “Understanding your process first can lead you toward choosing technology as a solution.” Two things to consider for process compatibility are the interface of a laboratory information system (LIS) with system management. A patient safety system should be able to interface with the existing LIS to update specimen collection information. A system that will generate a comprehensive management report will help assess the impact the system has on reducing collection errors. Knowing how your workflow operates is the first step in selecting a device that will capture the patient’s demographic information through the armband’s barcode. Some important questions to ask are:

• Does the employee’s ID badge have a barcode system to identify the person collecting the blood?
• Is the patient’s armband one that can be used for ID on an arm or leg?
• Does the handheld system use wired or wireless synchronization to communicate between the bedside unit and the server?
• Is end-user training included in the cost of the equipment on all three shifts, seven days a week?
• Does the product reduce collection time, and has this been documented?

Use a Unified Procedure that Includes the Specimen

Paula Santrach, MD, the director of phlebotomy at Mayo Clinic (Rochester, MN), notes: “Simplify procedures. Sometimes, ID procedures get complicated, or differ by location or department. We used to have two different procedures, one for blood bank specimens and one for other specimens. It helped us to simplify ID into a single procedure. You can harm a patient with a wrong blood draw for a chemistry specimen just as you can for a blood bank specimen.” To prevent these problems, a proper system is needed for the blood tube label. Some questions to ask are:

• Are the labels printed at the bedside?
• Do they have the proper barcode on them?
• Is there a mechanism within the system to prevent one patient’s labels being accidentally placed on another patient’s tubes?
• Is there a label design that allows labels to be placed correctly on the tube (vertically down the side as opposed to spiraling around the tube or attached like a flag waving in the breeze)?
• Does the laboratory staff have to relabel the tube when it arrives at the testing area?
• How much time and technician cost is involved in tube relabeling?

Educate Staff for Increased Compliance

Cecelia Wright, MBA, MT (ASCP), the group manager for phlebotomy and specimen processing at the ARUP Laboratories at the University of Utah Hospitals and Clinics (Salt Lake City, UT), found that communicating and reinforcing hospital policies and procedures on specimen collection was not enough to reduce the rejection rates of phlebotomy specimens obtained by nurses.

“You have to explain to nurses the reasons behind the procedures. Nurses and laboratory personnel have different mindsets and incorrect assumptions about each other,” Wright said. “The lab staff incorrectly assumes that all nurses understand the reasons underlying the order of draw and specimen rejections. There is better compliance with specimen collection policies and procedures when nurses and other specimen collectors understand why you need to do things a certain way.”

A consistent method of collection to which everyone adheres eliminates shortcuts that have been instilled into the staff culture over the years.

• CareFusion Corporation (San Diego, CA) offers a suite of Pyxis^® Point of Care (POC) Verification applications that employ barcode technology, perform positive patient identification, and have features pertinent to each particular application. The products include: Pyxis Med Administration Verification, Pyxis Nursing Data Collection, Pyxis Specimen Collection Verification, Pyxis Transfusion Verification, and Pyxis Infant Care Verification.
• Standard Register Healthcare (Dayton, OH) helps its clients standardize and manage communications across the continuum of care. It offers SMARTworks^® Clinical Enterprise, which automatically produces customized patient registration kits that contain wristbands, labels, face sheets, consents, and other pertinent documentation, with the patient’s photo, personal demographics, and barcodes integrated on each item.
• Bio-Optronics, Inc. (Rochester, NY) offers the Biopoint™ Patient ID Wristband System, which is a patient identification wristband software that utilizes color photographs, barcodes, color standardization, and warning indicators to ensure the proper synchronization of patients and treatment. The Biopoint Patient ID software fills all label identification needs, including chart, specimens, and medications. It is possible to interface with hospital enterprise systems and pharmacy systems, and Bio-Optronics can also develop custom interfaces.

References

1. http://www.easyasphg.com/positive-patient-identification.html.
2. Bonini, P.; Plebani, M.; et al. Errors in laboratory medicine. Clin Chem. 2002, 48, 691–8.

Please see our Laboratory Information Management Systems (LIMS) and Clinical Diagnostics Equipment and Kits sections to find manufacturers that sell these products