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Patient Identifiers

The number one goal of The Joint Commission Standards Improvement Initiative for 2009 is to improve the accuracy of patient identification. One of the main ways that hospitals are improving their standard of care for compliance is through the use of bar coded wristbands.

Before giving any treatment or exchanging any HIPAA protected information, the nurse should use two patient-specific identifiers. The first could be the patientís date of birth. This is the most commonly used, as it is already on the wristband and difficult to misinterpret. The second is the wristband itself with the patientís printed name. If the patient is able, the nurse should have him or her state the name aloud and verify it against the armband.

The patient wristband has been in use for years now. The difference with the new bands is the bar code that can be scanned by handheld devices such as glucometers and medication administration wands. The nurse has a code that is scanned to identify who she is to the computer. After scanning her own code, she scans the patient and then is able to administer the treatment ordered. The computer can alert the nurse to any errors in the five rights of medication administration. This does not negate the responsibility of the nurse to know what she is administering to her patient and why. A computer scanner does not take the place of critical thinking and observation. Medication errors occur in nearly 1 of every 5 doses (1).

Difficulties with this system are becoming apparent. One is patient comfort. Many bands require the nurse to move the patientís arm to be able to scan the code. If a patient is sleeping, this can be an annoyance to them. Another problem is the band becoming wrinkled and unreadable by the scanner. Getting a new band for the patient is the solution, but this can be time-consuming on a busy floor. This may result in unsafe shortcuts by nursing staff. The bands and scanners are only as accurate as the user makes them. The last issue is loss of the band. Patients may work them off, they may come off due to the patient losing weight, or be cut off by a family member concerned about constriction. Proper application of the band can prevent these three issues. If you notice a band becoming tight, be sure to get a new one made right away. This is about patient safety and comfort, two areas that are the nurseís responsibility.

(1) Barker KN, Flynn EA, Pepper GA, PhD, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med 2002;162:1897-1903.


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