Patient Identification

1. Patient Identification Patient Safety Opportunities in Patient Access Services

2. Patient Identification • Patient Identification is a Clinical Process: JCAHO has patient safety goals for patient identification for both the inpatient and outpatient settings. • We are an integral part of those goals.

3. Medical Error • From the Institute for Healthcare Improvement Leadership Guide to Patient Safety • “Medical errors, also called ‘adverse events,’ include missed and delayed diagnosis, • mistakes during treatment, • delayed reporting of results, • miscommunication during transfers and transitions in care, • inadequate postoperative care, and • MISTAKEN IDENTITY”

4. Required Searches • Required searches and/or patient identifiers • Name • Date of Birth • Social Security Number • MRN • Phonetic • Address

5. Two Types of Patient Identification Errors • Duplicate MRN • Two different persons sharing one MRN • These two types of errors are not created equal..

6. Duplicate MRN • Patient has two medical record numbers: important clinical information is in different places; new MRN will be missing medication history, allergies, radiology results, etc. etc. from previous visits and admissions • This is not a good thing

7. Selecting the Wrong Established MRN • Two people sharing a single MRN • Someone else’s lab and radiology history, medical history, someone else’s allergies, wrong medication history • This is an urgent situation

8. Recent situation: • Patient had cancer surgery (very ill), discovered to be using a different patient’s MRN. The MRN actually belonged to a transplant patient with the same first and last name and same MI. Thus: the Transplant hx., meds, allergies, were in cancer surgery patient’s electronic record. New documentation on the surgical ca. patient was being entered on the tx. pts. Record. The surgical patient’s history, allergies, etc. were under his established MRN • What to do?

9. How to Resolve • We are developing a new policy and process • After appropriate notifications to all clinical departments, the Allegra encounter is moved from the wrong MRN to the correct MRN; • in Allegra it takes all the charges, etc. • Simultaneously, in PowerChart, it takes all the allergies, medications, notes, forms, from the incorrect electronic medical record to the correct electronic medical record. • Paper forms must be corrected with the patient’s correct MRN

10. An Ounce of Prevention is Worth… • When possible, verify patient identification according to the established process.. • Name • Date of Birth • Social Security Number • MRN • Phonetic • Address

11. If you have the opportunity to talk directly to the patient to verify, be grateful, and use the process. Secondary sources of information are often less accurate • Look and listen: does the patient appear to be the stated age? • Do not change personal demographic information in the record unless you are absolutely sure.. • Changing birth date, middle name, etc. should be a very, very, very red flag that something else is going on….. that the person in front of you is someone else.

12. When in Doubt • If you cannot verify the identity of the patient according to the procedure, create a new MRN • We expect more duplicates in situations where the patient cannot participate fully in the identification process