JCAHO’s first of seven national patient safety goals is: “to improve the accuracy of patient identification.” JCAHO has mandated that hospitals use at least two (2) patient identifiers (neither to be the patient’s room number) whenever administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures. 

Harborview policy states that name and date of birth are to be used as the primary patient identifiers. Other acceptable identifiers are the patient’s medical record number (MRN), or social security number (you must match two). 

• Example: MRN is the second identifier used for blood transfusion specimens and blood transfusion. Patients who cannot be positively identified by name are given a “DOE” full name and MRN. 

Birth dates as second identifiers might pose special issues with our immigrant populations. Names may seem similar and countries that do not recognize birth dates are all given a common birth date of January 1, and the year of their immigration to the United State. Using a third identifier in these cases will ensure the right patient.

This is a HIGH RISK procedure and should not be considered a “routine” lab that is drawn with all other specimens. Whenever possible, make it a separate draw. Medical students and nursing students cannot be involved in this procedure. 

The following procedure can occur in ANY order, but there must be two licensed clinicians (RN, phlebotomist, MD, PA, and ARNP) present throughout each step of the entire process.

• Acquire the specimen tube, acquire the label (there can only be one; it may be a computer generated label or a pink blood bank label), and place the label on the blood tube.
• Validate the label with the patient’s armband and “Request for Blood” form. Ensure that the name and medical record number match exactly and ask the patient to state their name and date of birth. A second licensed clinician must be in the room to validate the blood draw and patient identification process!
• After drawing the blood, document your signature, title, date and time on both the “Request for Blood” form and label. A second licensed clinician must also sign that the patient’s identity matches the label on the tube and the “Request for Blood” form. The two signatures guarantee that the identification process has been followed precisely, that the information on the request form, specimen tube, and patient’s armband match exactly, and that the blood in the tube is from the same patient.
• If the process is interrupted at any time during the procedure, the procedure must start over. 
• If Transfusion Support Services determines that the blood specimen is mislabeled, a new specimen must be redrawn. Under no circumstances are labels or forms with changes to the patient name, medical record number, or draw time and date to be used.

If a provider is unable to participate in the identification process but is drawing the blood, two licensed clinicians may verify the patient identification, “Request For Blood” form, sign the labels, place the label on the tube, and fill the tube with blood when they witness the provider drawing the patient’s blood during:

• An angiogram procedure

• An emergency department “code yellow or red” trauma resuscitation (EMERGENCY DEPARTMENT ONLY)

• Procedures where the physician/provider needs to remain gowned and/or gloved
  (e.g., placing central venous access, drawing blood cultures, etc.)
• If a provider was witnessed by two clinicians to have drawn the blood, the provider’s first and last name must be handwritten on the label and the “Request for Blood” form.

For more information, see Nursing Procedures—“Blood Ordering Blood Components—Adult & Pediatrics,” and “Blood Ordering: Group O Uncrossmatched Red Blood Cells”.

 

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In compliance with JCAHO’s second safety goal, “improve the effectiveness of communication among caregivers,” the DO NOT USE ABBREVIATIONS list was implemented at Harborview in January 2004. The following abbreviations have been commonly associated with misinterpretation and are unacceptable for use in orders and other forms of patient-specific clinical documentation.

Any documentation involving medications or ANY order containing an abbreviation with which the reader is unfamiliar must be clarified with the author of the order.

Dangerous Abbreviations – Avoid Using

 Harborview implemented a “hard stop” where orders will not be accepted if prohibited abbreviations are used, except in a life threatening situation. The ordering provider will need to rewrite the order.

Another JCAHO safety goal is to improve the safety of using high-alert medications. High alert medications are drugs that have a “heightened risk of causing significant patient harm when they are used in error” (Institute for Safe Medication Practices, Dec 2003). Orders for high alert medications should trigger closer attention to indications for use, appropriate dosing, and possible complications, as well as the usual safety practices used for medication administration. Example: the nurse notes an order for continuous IV heparin in a patient less than 2 days post surgery, and verifies with the physician that the indication for anticoagulation outweighs the risk of hemorrhage.

 Those that are commonly prescribed in the hospital setting include: 

JCAHO’s safety goal includes taking an inventory of look-alike, sound-alike drugs. HMC has implemented a “Tall Man” lettering system in the Pyxis for the most commonly used drugs in this category. “Tall Man” lettering alerts the clinician to the risk of mistaking one medication for another.

Common Examples:

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