Applying National Patient Safety Goals-Patient Identification

Rules apply.

Recently I reviewed the medication administration practices at a small city jail. The nurse had been there many years and was able to complete the delivery of medication on 3 floors of inmate cells very quickly. In the unit common area she called out the names of the inmates. Inmates would present themselves and a soufflé cup of pills was poured into their open hand.  This was happening so quickly that I could not always see whether the inmate was tossing the medication into his mouth or his pocket. Neither nurse nor officer did an oral check. No inmate had a wrist band or other identification.

Can you name all the safety issues of concern in the described process? I hope that patient identification was high on your list of concerns along with medication diversion and hoarding risk…..but I’ll leave those last two for another discussion. “Wrong Patient” medication and treatment errors are frequent in health care delivery. They are a top concern for The Joint Commission (TJC) and are high on their list of National Patient Safety Goals again this year.

Times of particular concern for “Wrong Patient” errors are during medication administration, blood draws, blood transfusions, and surgical procedures. For the correctional setting, medication administration and blood draws would be most common.

Improve patient safety by applying these TJC recommendations:

  • Two methods of identification: Two forms of patient identification in corrections may include verbal name check (first and last) and inmate ID#. Photo ID cards or wristbands are ideal. Some computerized systems are able to access digital photos.
  • Involve the patient: Patients should know their meds and ordered lab tests. If there is a question about a medication or test, double-check the order. Patients can often help avoid an error.
  • Label in front of the patient: Label lab tubes in the presence of the patient. This can help avoid tube mix-up.
  • Include patient identification in orientation and training: Don’t leave patient identification processes to chance. Be sure all staff follow safety processes by learning them at orientation and through reinforcement during management rounds.

I shared my concerns with health care administration that day at the city jail described above and made recommendations for how they could improve their medication administration process to include 2 forms of patient identification.

What is your process for patient identification in medication administration at your facility? Share your procedure in the comments section of this post.

Read more about Patient Safety in Chapter 4 from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

Photo Credit: © creative soul – Fotolia.com

2 thoughts on “Applying National Patient Safety Goals-Patient Identification

  1. Great article Lorry, thank you. One alternative that is being used for patient ID in prisons is biometric identification. Since many prisons now use biometric identificaiton systems for prisoner ID during intake and outtake, they are extending the deployments to include medication distribution for safety and security. Prisoners can’t fake their biometric identity and the technology is extremely accurate.

    Just an alternative for prisons to consider.

    Like

    • Interesting concept. Sounds very high tech in a commonly low tech environment. Do you have an example of a prison system using biometrics on intake and/or for medication administration? I have not seen it to be the case in any jail or prison I am familiar with.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s