EXECUTIVE SUMMARY
Patients often are upset to be asked for demographic information repeatedly. Patient access counters dissatisfaction by educating patients that it’s for their safety.
- Tell patients upfront they’ll verify their identity multiple times.
- Encourage patients to ask clinicians to verify their identity.
- Ask patients to confirm the accuracy of information before placing wristbands.
Patients and family often are exasperated when asked for the same information over and over again. Registrars are usually the ones to bear their wrath.
“An average hospital patient probably has their ID verified anytime from 10 to 30 times a day. We need to do a better job of setting that expectation,” says Kathy J. Eichner, RN, MSN, CJCP, principal consultant at Joint Commission Resources.
The Joint Commission’s National Patient Safety Goal addresses the longstanding problems of misidentifying patients and not matching patients with the correct orders or procedures.
“Patient access has been dealing with this issue for many years, trying to get rid of duplicate and inaccurate medical records,” Eichner notes.
However, the problem is more difficult than it appears.
“Hospitals are incredibly busy places, and also very complex places,” Eichner says. “It’s very common for patients to move around the hospital system interacting with different departments.”
Patient access is the first step.
“Registration really has an opportunity to set the stage from the beginning and promote safety anywhere the patient goes,” Eichner says.
To put patients at ease, registrars can state, “I want to make sure I have all the information correct.”
“Other industries routinely ask for verification. We do it with banks and credit cards,” Eichner says. “In healthcare, it’s the same principle — to match up the right work with the right people.”
Stephanie Uses, PharmD, MD, JD, a patient safety analyst at ECRI Institute, recommends asking patients in an open-ended way, “What is your name and date of birth?”
“During the course of the admission, the patient may just start telling you their name and date of birth without asking,” she says.
Registrars often ask patients, “Are you Mr. Jones? And is this your date of birth?” This can elicit inaccurate responses.
“It encourages simple ‘yes’ or ‘no’ responses,” Uses explains. “This may mislead the clinician into thinking they have confirmation.”
Eichner offers this sample scripting: “It’s important to us at ABC hospital to make sure we are always providing you with the specific medications and treatments that your physician orders for you. We do that by always making sure that we match up your identity with the indications on the order. Because of that, whenever someone comes to give you medication or take you for a procedure or does a treatment, you can expect they will always want to validate your name and date of birth.”
“Just by setting that expectation, then the first, second, or even 10th time they’re asked, they understand you’re wanting to keep them safe,” Eichner notes.
Eichner says departments that struggle with satisfaction issues related to patient identification “may be the ones who don’t proactively set that tone.”
Patient access can partner with patients in these two ways:
1. Tell patients, “If somebody forgets to ask you, you should stop them. Ask them to verify your identity first.”
“This is the same thing we do with handwashing. We tell patients it’s OK to ask healthcare providers to wash their hands,” Eichner says. The same is true for asking healthcare providers to verify the patient’s identity.
2. Ask patients to read wristbands carefully to be sure the information is accurate and spelled correctly.
“That’s the last safety net to make sure we identify the patient correctly,” Eichner says.
Fix These Problems
Surveyors from The Joint Commission report these five common issues involving patient identification processes:
- Two identifiers are obtained, but they aren’t specific to the patient.
The Joint Commission’s National Patient Safety Goal requiring the use of two unique identifiers has been in place for about a decade, but there are still problems with compliance. Most often, this is due to the use of incorrect identifiers.
“The key there is unique,” Eichner says. “We are looking for identifiers that are as specific to that patient as possible — and two separate ones.”
This is to make sure patients with the same name are distinguished by a piece of information that’s unique to them such as date of birth or a medical record number.
“We especially guard against using the room, cubicle, or bay number, because patients do move around in hospitals,” Eichner adds.
- An order or test result doesn’t seem to go with the rest of the patient’s record.
“It could be that someone selected the wrong patient before they started charting. We see that a lot, actually — it’s not uncommon,” Eichner says.
There might be several Fred Johnsons, all related, even with the same address. It’s easy to imagine how a test result could get into the wrong person’s chart.
“That is a significant issue for patient access,” Eichner says.
- A roomful of people is waiting to register.
When the registrar calls out, “Mr. Johnson,” several people stand up.
“Clearly, we need more information about the Mr. Johnson we want to speak to,” Eichner says. “We need a process for figuring out how that’s going to happen.”
- A patient is quick-registered at the bedside, and goes up to a floor unit where a patient with a similar name is receiving treatment.
“If a registration person goes up to collect the rest of the patient’s information and there is another Mr. Johnson up there, we can run into confusion,” Eichner explains.
- A patient is pre-registered, but only basic demographic information is collected.
“Anytime there is a campaign trying to encourage people to pre-register, we need a good process to gather unique information on the patient,” Eichner emphasizes.
Explain that identifiers are for their own safety.
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