Center for Phlebotomy Education says new requirement is step backward for patient safety
When The Joint Commission recently changed the patient identification requirement for drawing a blood sample, one national phlebotomy leader considered it a step backward in patient safety.
“Per a revised policy issued by The Joint Commission, it is no longer required for the phlebotomist or person drawing the blood to actively involve patients by, for example, asking them to state their name,” commented Dennis Ernst, MT(ASCP), the long-serving Director of the Center for Phlebotomy Education. He’s one of the leading observers of phlebotomy trends and he’s concerned about what this means to patient safety.
“Having a patient state their name before a blood collection is a very important step in patient identification,” declared Ernst. “The Joint Commission now finds it acceptable for the phlebotomist to use the identification bracelet alone, which we all know can end up on the wrong patient. That’s disturbing to me because it’s taking a chance with a patient’s life. I think any time you dilute the requirements for patient identification, you create a possible scenario that is not favorable to anyone seeking healthcare.”
“There doesn’t seem to be any logic that supports lessening the patient identification requirement,” said Ernst, who worries that not requiring phlebotomists to verify that the person about to be drawn matches the information on their wrist band will lead to unnecessary mistakes. “It’s reported that 160,000 adverse patient events occur every year in the United States due to patient or specimen identification errors involving the lab.
“Given the frequency of these errors, it seems that asking someone to confirm their identity is a simple, positive requirement,” he added. Ernst queried The Joint Commission over this issue. He says that a representative from The Joint Commission informed him that their clients feel that it is “burdensome and unnecessary” to ask a patient to confirm his or her name.
“Given how often the wrong ID band is put on a patient, this creates a situation where patients can be misidentified and the individual performing the blood collection can be completely compliant with the Joint Commissions’ requirements,” Ernst said. “From the perspective of a laboratory, I would recommend it follow a procedure that is one step higher than the requirement of The Joint Commission for positive patient identification.
Ernst also pointed out a difference between The Joint Commission’s requirement and the protocols provided by the CSLI standards. “Where hospitals and laboratories adhere to the CSLI standard, they will automatically ask a patient to say their name. But the problem is that the CLSI standards are voluntary standards.”
There’s another interesting perspective concerning The Joint Commission’s revised new requirement for patient identification. In laboratories which use Lean and quality management methods organized around “system of prevention” concepts, it is likely their work flow requirements do require the phlebotomist or person collecting the blood sample to ask the patient to verbally say their name. After all, that simple step provides one more important safeguard against a patient identity error.
Letter from Center for Phlebotomy Education to The Joint Commission on the Changed Requirement for positive patient identification
Commentary by Center for Phlebotomy Education about the Changed requirements for positive patient identification issued by The Joint Commission
Safety protocols for drawing blood published by The Joint Commission
The Dark Report Joint Commission Recent News
The Joint Commission said (from your link)
“…it was determined that the EP was rendered not surveyable or enforceable through the accreditation process. This is the reason behind the deletion. We continue to support active patient involvement in the identification process as a best practice and will encourage organizations to use such an approach when it is reasonable to do so.”
So they are encouraging it, but not requiring it?? The rule was not enforceable, so they removed it? Seems like that sends a mixed message.
What does “when it is reasonable” mean? When you feel like doing it? When the patient can speak?? This is confusing…
Fortunately, the CAP does require that the patient being drawn for compatability testing be asked to verbally verify his/her identity see below). It is a phase II or mandatory requirement. I too concur that patients, when able, should be asked to state their name – it is only when this process is inverted by asking the patient to agree with the name we state that serious misidentification errors can occur – if a patient whom we ask to state his/her name gives a different name than expected, this would be a trigger for further investigation. In fact, as both a physician (provider) and consumer of the healthcare system it has become routine that prior to any significant procedure on me to be asked to state my name and birthdate – thus, why this is being removed from one of the most serious error prone procedures in the hospital, seems out of synch with other aspects of healthcare.
TRM.40235 Phase II N/A YES NO
Is the patient asked to verbally verify his/her identity, whenever practical, at the time of specimen collection?
NOTE: When a translator is needed, verbal verification is not required if obtaining a translator would delay specimen collection.
One correction to the above, my name should be Roslyn Yomtovian, MD
Asking a patient his/her name and DOB is the first and last line of assuring positive sample and patient identification.
The JC needs to ask and adhere to the opinion of the the experts on this topic; laboratorians. We train our phlebotomists, the i.v. team and nursing on correct patient identification and specimen labeling. If JC steps backward and drops this requirement, it’s a significant blow to patient safety.
It is true that patient identification errors account for 160,000 adverse events per year. Time and again those in health care attempt to find reasons to not use proven auto-identification technology in place of the “tried and true” that have producded the 160,000 incidents cited. Every application of auto-ID in healthcare and other industries has shown positive results, whether they use technologies like bar coding or RRID. They have reduced human errors and improved productivity. Today, devices with FDA 510(k) approved software for transfusion verification that record all salient vitals and activities while forcing compliance with SOPs are more effective then manual systems. Otherwise, auto-ID would not be gaining support for medication administration, specimen collection, transfusion verification and being use in conjunction with many new point-of-care testing devices. JCAHO ought to be praised for there action and encourged to mandate the use of auto-ID technology. Technology has been a favorable development in the clinical arena and can be useful in areas such as transfusion verification.
AS a medical technologist with over thirty years of experience many in a prestigious US Medical Center I have seen the downward trend of the quality of specimen labeling and integrity with the advent of “phlebotomists only” and nursing staff taking the responsibility of blood draws.
Yes, the hospital saves money by multitasking overburdened nurses and using H.S. grads for the important task of blood draws while holding down the salaries of the most qualified and competent staff to perform this inital step- the medical technologists.
I have worked in Blood Banks for many years and at many hospitals. I was trained to identify and draw the patient specimen. Then I crossmatched that patient. From Womb to tomb so to speak. To rely on others for the specimen i-d made me very uneasy at the least and worrisome most all of the time.
I urge you not to delete the verbal name requirement. It is free.
And this could save yours or your family member’s life.
I would like to know what purpose this will serve. Laboratorians need to have a specimen drawn from the correct person otherwise the phrase “garbage in garbage out” rings true. Laboratories are finally getting others to recognize real patient identification as asking the patient their name and now it becomes burdensome? Isn’t it burdensome to complete payment information or insurance information? Can I count on the Joint Commission to do away with them? I am a blood banker for many years and I recognize that laboratorians are one of few professions that continually fight for proper patient identification, especially when we see how other professions do it. Where are our pathologist leaders????
I have been a phlebotomist for 10 years. I have been a phlebotomy supervisor for 2years. Last week i entered a room to collect blood samples from a patient and to my dismay right patient wrong ID band. The patient care tech asked the patient: how long have you had this band on? she replied, since last night it’s 11:00am. My point is whatever test she had or meds she was given before 11:00am no one checked the ID Band. This is a very important step and is life threatening to skip it. I urge all hospital staff to ask the patient to state their name and date of birth.