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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 30-33

The survey of degree of observance of positive patient identification standards in university hospital


1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Services Management, Student Research Committee, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
3 Health Management and Economics Research Center, University of Medical Sciences, Isfahan, Iran

Date of Web Publication25-Jun-2014

Correspondence Address:
Vahideh Rostami
Health Services Management, Student Research Committee, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.135352

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  Abstract 

Context: Misidentification of patients is a common problem that many hospitals face on daily basis and is one of the resulting causes of medical errors and medical malpractices. Ensuring correct patient identification prior to any medical intervention is necessary at all times. Aims: The present study was conducted to assess the degree of observance of correct patient identification standards in One of the biggest teaching hospitals university hospital. Subjects and Methods: The present descriptive study was carried out cross-sectional in autumn of 2013, in One of the biggest teaching hospitals university hospital. Data were collected by a valid and reliable researcher who made checklist through observation (documents and patient identification process) and through interview with 150 patient and staff that were randomly selected. The data was analyzed using Statistical Package for the Social Sciences (SPSS) statistical software and descriptive statistical methods. Results: The results of the present study indicated that correct patient identification process when prescribing medication with a mean score of 85.7% was evaluated 'good'. The correct patient identification process before blood transfusion (73.5%), the general principles associated with the correct patient identification process (71%), correct patient identification during laboratory (70.7%) and correct patient identification before imaging (50%) were evaluated average in studied hospital. Correct patient identification before surgery and correct infants identification process with score of 43.7%, 45%, respectively were evaluated 'poor'. Overall, hospital in the implementation of the principles associated patient safety identification process with a mean score of 62.8 was evaluated 'average'. Conclusions: Given that the importance of patient identification process in patient safety and considering that patient safety is the required infrastructure for clinical governance and accreditation program. Thus, the use of proper patient identification systems should be placed at the head of the patient safety program.

Keywords: Medical errors, patient identification, patient safety


How to cite this article:
Shams A, Rostami V, Javadi M. The survey of degree of observance of positive patient identification standards in university hospital. Int J Health Syst Disaster Manage 2014;2:30-3

How to cite this URL:
Shams A, Rostami V, Javadi M. The survey of degree of observance of positive patient identification standards in university hospital. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2024 Mar 29];2:30-3. Available from: https://www.ijhsdm.org/text.asp?2014/2/1/30/135352


  Introduction Top


Patient safety is a critical component of healthcare quality. Patient safety means to avoid and prevent any injury to the patient during healthcare delivery. In addition to unpleasant consequences for the patients and their families, unsafe health care causes psychological stress on the healthcare employees and individuals in society and finally exerts a heavy economic cost on healthcare system. [1]

In order to improve patient safety, the Joint Commission, in the United States of America introduced correct patients identification as the first of its National Patient Safety Goals in 2003, and this continues to be an accreditation requirement. [2] Accurate patient identification is an essential stage in the performance of including blood and drug administration, surgery, diagnostic procedures, laboratory medicine and the discharge of infants to the families. [3]

Between November 2003 and July 2005, the United Kingdom National Patient Safety Agency reported 236 incidents and near misses related to missing wristbands or wristbands with incorrect information. Over the period, February 2006 to January 2007, 24,382 reports of patients being mismatched to their care. It is over 2,900 in relation to the identification and application of wristband. Fortunately, results reported of the causal analysis on more than 100 cases of mistakes in the process of correct patients identification Confirm the effectiveness of interventions and strategies in effective reducing the risk of patient misidentification. [4]

Misidentification of patients is a common problem that many hospitals face on daily basis. Patient misidentification is one of the resulting causes of medical errors and medical malpractices. It has been recognized as a serious risk to patient safety. [5] And in some cases, lead to permanent and irreparable damage and injury or even death to patients. [6] Addition to the patient mistrust to Service Provider system Litigation costs also increase for hospitals.

Given the losses and injuries resulting from misidentification patient, reducing and, where possible, eliminating errors in the lack of proper identification of patients should be central point to improve patient safety in hospital. [4]

In recognition of the increasing threat to patient safety, it is important for hospitals to prevent these medical errors from happening by adopting a proper patient identification system that can improve current safety procedures. [5]

To describe in more details the scope of the patient misidentification problem, consider the following case scenarios. [5]
"A young lady in her late twenties was going to surgery the next morning. She was on "nothing by mouth." Due to error of misidentification, a tray was inadvertently given to the patient on the morning of surgery. Perhaps the patient thought it was okay, so she ate her food and said nothing. Later that morning, she was taken to surgery. During the procedure, she threw up and aspirated her vomits. She had a cardiac arrest and was later revived. It was too late because the sensory nerve damage had occurred. She sustained brain damage and became paralyzed.

The hospital took good care of her for a couple of years as part of the settlement. One day she was left unattended in the x-ray department while waiting for a procedure, and she was later found dead. Correct identification before issuing a food tray to the patient going to surgery could have prevented the tragedy.

In a hurry, a nurse picked up medication for one patient and inadvertently administered it to a wrong patient. In a hurry to do her work, she misidentified the patient supposed to receive the medication. Although the "five rights" are supposed to help double-check medication before it is administered, in a hurry, deviation and short cuts may occur leading to tragic errors. The right medication for the right patient through the right route, with the right dosage, at the right time is the standard in many hospitals. This should help to decrease medication errors."

Ensuring correct patient identification prior to any medical intervention is necessary at all times. The present study was conducted to assess the degree of observance of correct patients identification standards in university hospital.


  Subjects and Methods Top


The present descriptive study was carried out cross-sectional in autumn of 2013 in one of the biggest teaching hospitals university hospital.

The study populations included staff and all patients who were hospitalized or had surgery in the hospital in autumn of 2013, of which 150 patients and staff were captured through random sampling.

The research tool in this study was the checklist that adopted patients correct identification instruction the hospital in 2013 and Iranian Ministry Health and Medical Education Positive Patients Identification guidelines. The checklist was designed in seven domains. The first part of the checklist consists of 21 questions of the general principles associated with the correct patient identification process. The second part is the criteria for the correct infant identification process, which consists of 10 questions. The third part consisted of five questions of the correct patient identification process before blood transfusion. The fourth part consisted of five questions of the correct patient identification during laboratory. The fifth part consists of two questions of correct patient identification before imaging. The sixth part consists of four questions of right prescription of medication to right patient standards, and the seventh part including eight questions of correct patient identification before surgery. Correct patient identification process was evaluated through observation of patient identification process, reviewing different documents and having interviews with patient and staff.

Reliability of the checklist was confirmed by calculating Cronbach's alpha greater than 80% and its validity was approved by five healthcare experts in the area of ​​patient safety.

Questions was scored based on three-point Likert scale, yes, to some extent and no, which scores agreement (2 = yes, 1 = some extent and no = 0). The data was analyzed using Statistical Package for the Social Sciences (SPSS) statistical software and descriptive statistical methods. If the percentage score associated with each domain was less than 50%, the status of hospital was poor in that domain; if it was between 50%-75%, the status of hospital was average in that domain; and if it was more than 70%, the status of hospital was good in that domain.


  Results Top


The results of the present study indicated that correct patient identification process when prescribing medication.

With a mean score of 85.7% was evaluated good. The correct patient identification process before blood transfusion (73.5%), the general principles associated with the correct patient identification process (71%), correct patient identification during laboratory (70.7%) and correct patient identification before imaging (50%) was evaluated average in studied hospital. Correct patient identification before surgery and correct infants identification process with score of 43.7%, 45%, respectively was evaluated poor.

In the correct patient identification process when prescribing medication domain, (i) Check the medicine label with medication order contained in medicine card when preparing medicines, medication given by nurses with mean score of 100% and (ii) accordance medicine card with medication order contained in clinical records at the time of implementation of the new drug dosage or change the dosage to the patient with mean score of 92.7% had the highest score. Patient identification at the time of giving medication using self-expression patient or his relatives and compliance with patient identification wristbands with a mean score of 46% was poor.

In the patient identification process before blood transfusion, correct patient identification using identify wristbands and verbal questions from their relatives about unconscious patients or infants before blood transfusion with a mean score of 100% had the highest score and label specimen tubes/bottles straight after the sample is placed inside, before leaving the patient's bedside with a mean score of 46% received the lowest score.

In the general, principles associated with the correct patient identification process domain, issuing identification wristbands for inpatient, emergency and unknown patient, physical characteristic of wristband and standardsizing identifiers contained on wristband with a mean score of 100%, had the highest score. Asking patient or their caregivers to read the details on the identity wristband and confirm the correctness on admission, educate patients or their caregivers on the importance of wearing and caring of identity wristband on arrival of patient to ward, and install warning labels on bed patient in nominal similarity with a mean score of 0%, 14.3% and 15.4% respectively, had the lowest score. In the correct patient identification during laboratory domain, label specimens on the wall of the sample container tubing and matching, test request forms with patient's father's Name and patient name with a mean score of 100%, had the highest score and labeling of specimen tubes/bottles straight after the sample that is placed inside, before leaving the patient's bedside, with a mean score of 42.9% had the lowest score.

In the correct patient identification process before imaging, asking the patient (where possible) to state their name, last name and date of birth, and checking these details against the identity wristband and the imaging request form and the correct identification of patients who are unable to tell their name by asking the patients relative had mean score of 50%.

In the correct infants identification process domain, specify the number of twin if they are twins or triplets on identification wristband, check the baby's identification wristband daily by the nursing or Midwifery staff in ward, check the baby's identification wristband prior to commencing the clinical activity/procedure had a mean score of 100% the highest score and Issuing two identification wristbands for infants immediately after birth.

Issuing identification wristband if one of the two identification wristbands missing and staff awareness about the steps that must be performed if there is any uncertainty or contradict on the baby's specifications with a mean score of 0% had the lowest score.

In the correct patient identification before surgery domain, checking identification wristband of all candidates for surgery, asking the accuracy of the information contained on the wristband and name surgery from patient or relatives in the entrance of operating room with a mean score of 100% had the highest score and compared with the specifications contained on identifying wristband with patient's record and self-expressive of patient prior to being anesthesia and comparison of the specifications contained on identify wristband with patient's record and self-expressive of patient when patients entering the operating room with a mean score of 0% had the lowest score. Overall, hospital in the implementation of the principles associated patient safety identification process with a mean score of 62.8 was evaluated average.


  Discussion Top


Decreasing medication errors, improving patient safety and increasing the accuracy of clinical procedures are important contributing factors to reduce healthcare costs and enhance the quality of healthcare. The use of patient identification systems positively impacts these factors and significantly ensuring safer and higher quality service delivery. [7]

The analysis of findings of this study on various aspects of patient identification depicts that hospital was poor in the field of Correct infants identification and Correct patient identification before surgery as the studies have shown within all kinds of surgical adverse events, wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events are the most devastating, unacceptable, and often result in litigation. [8] Ludwick studied the Joint Commission on Accreditation of Healthcare Organizations Goals for reducing wrong-site, wrong-patient, wrong-procedure events and stated that according to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards of all healthcare facilities are required to implement established patient safety goals. Facility needs policies that required staff to ensure that all surgical procedures are done on the right patient and at the right location and that the correct procedure is performed. [9] The results of study indicated that general principles associated with the correct patient identification process before blood transfusion, the correct patient identification during laboratory, and the correct patient identification before imaging were average in studied hospital. Overall, the hospitals' implementation of the principles associated patient safety identification process was average in studied hospital. In a study by Chung, which aimed elimination of medication errors through Positive Patient Medication Matching showed that Medication error reduction can be readily achieved with the use of "positive patient medication matching" protocol. [10] A study conducted by Jenna, et al., revealed that patient identification errors as a root cause of medication, surgical, dietary, and other medical errors. And the most frequent error leading to a fatal outcome was blood transfusion to the wrong person. [11] In Huygens's study, use of the bar coding and positive patient identification initiative is introduced for patient safety improvement. These results are supported by a study carried out over 18 months. [12]

According to Christian et al., problems in communication and information flow, patient misidentification and workload and competing tasks were found to have measurable negative impact on team performance and patient safety. [13] The results of these studies are consistent with our study. Correct patient identification is considered as crucial factor in reducing medical errors in all of them given that the importance of patient identification process in patient safety and considering that patient safety is the required infrastructure for clinical governance and accreditation program. Thus, the use of proper patient identification systems should be placed at the head of the patient safety program. Conduct research to analyze the root causes of patient misidentification, preparation and distribution of brochures and pamphlets about the importance of correct identification of patients between healthcare personnel. Equip hospital to bar code readers' devices, reveal statistics that patient misidentification result in occurrence of the error or near miss and motivating staff in order to improve correct patient identification is recommended.

Limitation of the study

Impossibility of direct observation in some process by the researcher, conservatism some of the staff and Supervisors to exposure information is the main limitations of this study.


  Acknowledgments Top


The authors would like to thank the hospital authorities for permission to conduct this research. They are also grateful for all staff and patient for their sincere cooperation in conducting the research.

 
  References Top

1.Abdi J, Maleki M. Staff's Understand of security culture sickness in the selected ospital of Tehran University of Medical Sciences. Health Sci Res Cent Jehaddaneshgahi 2011;19:411-9.  Back to cited text no. 1
    
2.Patient identification, WHO Collaborating Centre for Patient Safety Solutions. Available from: http://www.who.int/patientsafety [Last accessed on 2007 Feb 13].  Back to cited text no. 2
    
3.Murphy MF, Kay JD. Patient identification: Problems and potential solutions. Vox Sang 2004;87:197-202.  Back to cited text no. 3
    
4.Deputy treatment, Patient safety unit. Mostofi F. Correct patient identification guidelines for Inpatient and Outpatient ward, blood transfusion, medication, surgery, laboratory measures to reduce the occurrence of health care adverse events. Ministry of Health and Medical Education; 2009. [Last cited on 2013 Jan 25]. Available from: vh.tums.ac.ir.  Back to cited text no. 4
    
5.In: Aguilar A, van der Putten W, Kirrane F, editors. Positive patient identification using RFID and wireless networks. 11 th Annual Conference and Scientific Symposium (HISI), Dublin, Ireland.  Back to cited text no. 5
    
6.Lucas A. Policy for the positive identification of patients January 2010. Available from: http://www.ruh.nhs.uk/about/policies/documents/clinical_policies/blue_clinical/Blue_775_Patient_Identification_Policy [Last accessed on 2013 Mar 28].  Back to cited text no. 6
    
7.Garcia-Betances RI, Huerta MK. A review of automatic patient identification options for public health care centers with restricted budgets. Online J Public Health Inform 2012;4.  Back to cited text no. 7
    
8.Su CJ. Improving patient safety and control in operating room by leveraging RFID technology. IEMS 2009;8:37-46.  Back to cited text no. 8
    
9.Ludwick S. Surgical Safety: Addressing the JCAHO Goals for Reducing Wrong-site, Wrong-patient, Wrong-procedure Events. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005.  Back to cited text no. 9
    
10.Chung K. Elimination of medication errors through "Positive Patient Medication Matching". 2001. [Last cited on 2013 Feb 13]. Available from:www.avantetech.com.  Back to cited text no. 10
    
11.Jenna L, Philip L, Tuan A, Megan M, Donald L. Efficiency,Thoroughness, and the Patient Identifi cation Process. [Last cited on 2013 March 10]. Available from: ioe.engin.umich.edu.  Back to cited text no. 11
    
12.T H, Heelon M, Siano B, Douglass L, Liebro P, Spath B, et al. Medication safety improves after implementation of positive patient identification. Appl Clin Inform 2010;1:213-20.  Back to cited text no. 12
    
13.Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery 2006;139:159-73.  Back to cited text no. 13
    




 

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Abstract
Introduction
Subjects and Methods
Results
Discussion
Acknowledgments
References

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