Identifying the right patient is something we are taught from day one when training as a medical professional, to ensure that the right procedure is carried out on the right patient at the right time.
Mistakes can and will happen, which is why correct identification and procedure matching is crucial for minimising risk and keeping our patients safe.
Communicating for Safety is the 6th standard from the recently updated National Safety and Quality Health Service Standards.
It’s about the clinical governance and quality improvement necessary to support effective communication and ensures that ‘systems are in place for effective and coordinated communication that supports the delivery of continuous and safe care for patients.’
Standard 6.5 is specifically focused on correct patient identification with ‘systems to maintain the identity of the patient are used to ensure that the patient receives the care intended for them.’ These include:
- The definition of approved identifiers for patients according to best-practice guidelines
- Requiring at least three approved identifiers on registration and admission, when care, medication, therapy and other services are provided, and when clinical handover, transfer or discharge takes place
- That the hospital/organisation specifies the processes to correctly match patients with their care
- Documentation of information about the processes used to correctly match patients with their planned care
Processes for Correctly Matching a Patient with their Procedure
When we fail to identify a patient correctly and match them with their intended procedure, the results can be disastrous including the wrong procedure being performed on the wrong person, wrong side or site; medication errors, blood transfusion errors and incorrect diagnostic tests being performed.
It is important to consistently check the patient’s identity and match it with their intended care throughout their hospital stay and ensure this has been correctly documented.
Identity Checking at Admission and Registration
As soon as the patient enters the ward or surgical suite, it is crucial to check that they are the expected person for the planned procedure or care.
Clinical registration or hospital admission policies need to clearly document how to identify the patient using three of the approved identifiers.
How this information is obtained should include:
- Checking their appointment letter against the patient list
- Asking them to confirm key identifiers – typically name, address and date of birth
- Ensuring that all documentation, medical notes and electronic systems used match the patient in front of you
- If the patient has been transferred from another department ensuring that all paperwork is present and identifiers match
Asking the Patient for Identifier Information
This is the best way to ensure that the correct patient is in front of you and expecting the same procedure that you have listed.
Mistakes can happen when appointments are made, letters dispatched or transfers between departments. Unless cognitive function is impaired, the patient knows themselves and what they’re expecting best.
Although it is important to bear in mind that some patients’ anxiety will prevent them from processing information correctly, meaning that they may nod and agree with something that’s incorrect, using open-ended questions along with checking the identity band against their notes is the best way to ensure a positive match.
There will be some situations where the patient is unconscious and unable to provide the information required.
In these instances, every effort must be made to identify the correct patient, but identifiers may be limited to medical number and gender without the patient able to confirm their name, address and date of birth.
Therefore, prior documentation of the patient’s identity is important and confirmation that clinical handover at every stage has been handled correctly.
What Information Must You Record and Document?
You must ensure that the approved identifiers have been recorded, and how that information has been obtained is documented.
There should be a clear policy and process in place for this at your organisation including where and how to document the information.
Remember that if it hasn’t been written down, you cannot prove you’ve done it so take care with your notes and be sure they’re accurate.
What are the Approved Identifiers?
There are six approved identifiers used to ensure the right patient is matched with the right procedure. These include:
- Patient name (family and given names)
- Date of birth
- Medical record number
- Individual healthcare identifier
Three of these must be used every time a procedure is being discussed with the patient or about to be carried out, to safeguard against medical errors or breach of confidentiality.
Why are Three Approved Patient Identifiers Required?
Studies in the USA have found that the risk of false matching decreases dramatically from a 2-in-3 chance to a 1-in-3500 chance when the first and last name, postcode and date of birth are used to identify a patient compared to last name alone.
With some names being common, it is not unusual to have two patients in the same ward with the same last name (or both names), in which case it is vital that other identifying information is used before carrying out the procedure.
ID Band Specifications/Standards
The patient identity wristband is consistently used to check the approved identifiers throughout their hospital stay and at each stage of treatment.
Whether it uses barcode technology or printed details, it is paramount that all details are correct for the patient so that positive identification can be confirmed.
The Australian Commission for Safety and Quality in Health Care developed specifications for a national patient identification band to ensure standardised best-practice across the country.
Based on the principle that the primary purpose of the identification band is to identify the patient; the Commission believes that black text on a single white band with the core patient identifiers is the safest and most reliable way to present the information.
That means coloured wristbands to denote allergies or specific wards are no longer considered appropriate, and that the identity band should only contain the following information:
- Date of birth
- Medical number/healthcare identifier
Family and given names should be clearly differentiated to prevent misidentification, this is done by having the family name appearing first in upper case letters followed by the given names in title case. i.e. DOE Jane.
It is important to remember that the wristband isn’t always right.
Errors can occur when inputting the information into the computer system that aren’t immediately spotted so always ensure that you’re checking the wristband with something else such as the medical notes and your patient, where possible.
What Happens at Clinical Handover?
Where a clinical handover is needed at the end of a shift or for patient transfer, it is critical that both medical professionals check the identity of the patient using three of the approved identifiers, ideally with the patient involved.
Clinical handover often happens in the staff room or another area of the ward large enough for all team members to gather, but this can lead to confusion where several patients and procedures are discussed at the same time.
Bedside handover using the identity band and patient’s confirmation is the best way of ensuring that patients safety.
What Happens When Misidentification Occurs?
According to the Productivity Commission’s report on government health services, there were 82 ‘sentinel incidents’ nationally in 2015-16 of which 5 were where ‘procedures involving the wrong patient or body part resulted in death or major permanent loss of function’ compared to just 1 in 2014-2015.
Patient safety incidents like these and near misses that are associated with incorrect patient identification is a recognised problem internationally and has been identified as a key patient safety goal by agencies around the world.
Medical errors that might occur due to patient misidentification include:
- The wrong procedure being performed
- The wrong site
- The wrong side
- The wrong patient
It is important to mention that these mistakes often harm two or more patients, such as two patients with similar names receiving the procedure meant for the other, or the implant reserved for one patient being used on another meaning their procedure is cancelled.
The World Health Organisation introduced the Surgical Safety Checklist in 2008 where identification and safety checks are carried out at pre-anaesthetic induction, before skin incision is made, and before the patient leaves the operating theatre.
A review of the use of the checklist found a reduction in patient mortality and inpatient complications compared to non-use.
Patient identification errors can occur anywhere within the healthcare process and at any healthcare facility which is why the NSQHS standards are important in keeping mistakes to a minimum.
Ensuring you know the policies and processes of your organisation and following them with every patient is the best way to keep your patients safe and receiving the treatment intended for them.
- Australian Commission on Safety and Quality in Health Care 2017, National Safety and Quality Health Service Standards, NSQHS, viewed 22 May 2018, https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
- Australian Government Productivity Commission 2018, Report on Government Services 2018, viewed 22 May 2018, https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/public-hospitals
- Government of Western Australia Department of Health 2014, WA Health Patient Identification Policy, viewed 22 May 2018, http://www.health.wa.gov.au/circularsnew/attachments/842.pdf
- Australian Commission on Safety and Quality in Health Care 2012, Standard 5 Patient Identification and Procedure Matching Safety and Quality Improvement Guide, 22 May 2018, https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard5_Oct_2012_WEB.pdf
- Australian Commission on Safety and Quality in Health Care, Specifications for a standard patient identification band, viewed 22 May 2018, https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/FAQ-PatID-Band.pdf
- World Health Organization 2007, ‘Patient Identification’, Patient Safety Solutions, vol. 1, no. 2, viewed 22 May 201, http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution2.pdf
- World Alliance for Patient Safety 2008, WHO surgical safety checklist and implementation manual, viewed 22 May 2018, http://www.who.int/patientsafety/safesurgery/ss_checklist/en/
- Treadwell, JR, Lucas, S, Tsou, AY 2014, ‘Surgical checklists: a systematic review of impacts and implementation’, BMJ Quality and Safety, vol. 23, pp. 299-318, http://qualitysafety.bmj.com/content/23/4/299
- Agency for Healthcare Research and Quality 2017, Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery, viewed 22 May 2018, https://psnet.ahrq.gov/primers/primer/18/wrong-site-wrong-procedure-and-wrong-patient-surgery