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.

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.

At HMC the patient’s risk for falling is identified by a Morse Fall Scale (MFS). A score of 55 or greater represents a high risk for falling.  As always, individual nursing assessment of patient and environmental variables may, in the nurse’s judgment, indicate fall risk even if the MFS is less than 55. JCAHO attention to fall prevention includes a focus on staff awareness of medications that have been associated with fall risk.  The Morse Fall Scale can identify side effects of high risk medications such as confusion or balance difficulty if they occur consistently. However, it does not typically identify transient changes or potential for side effects. 

Although not all studies agree on specific medications, those most frequently associated with patient falls include:

• Benzodiazepines
• Anticonvulsants
• Neuroleptic agents
• Serotonin reuptake inhibitors
• Tricyclic antidepressants
• Class 1A antiarrhythmic agents
• Diuretics, cathartics and laxatives
• Narcotics

 The above medication types may particularly contribute to risk of falling if they are new prescription for the patient or if they are receiving more than one agent. In these situations, carefully evaluate patient response to the medication. Consider reviewing medications with the pharmacist to evaluate alternative choices.  If choosing to add fall risk to a patient’s problem list when MFS is < 55, indicate the reasons for risk identification in the problem statement and shift assessment note.

Example:  Problem statement: “Patient at risk for falls due to multiple high-risk medications”.  Case note: “Good pain relief from current narcotic dose but occasionally sleepy after med given.  Patient describes feeling of urgency after diuretic given – does not always call for assistance despite reminders.”

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