Dr Madhav Madhusudan Singh
Introduction
Patient identification is a crucial aspect of healthcare delivery, and it is important to have a proper system in place to ensure accurate patient identification. In this essay, I am going to discuss the patient identification process and the use of two identifiers in hospital settings, as per the guidelines of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and Joint Commission International (JCI). Patient identification is a critical aspect of healthcare, and its importance cannot be overstated. The use of patient identifiers helps in accurate and timely diagnosis, treatment, and follow-up care. In India, the healthcare industry has been grappling with patient identification challenges due to various reasons, including inadequate infrastructure, lack of standardization, and patient mobility across various healthcare facilities.
Patient Identification
Patient identification is the process of verifying the identity of a patient before providing any healthcare services. It is an important step to ensure that the right patient receives the right treatment. There are different methods for patient identification, including visual identification, asking the patient to state their name and date of birth, or using identification wristbands.
Two Identifiers
NABH and JCI recommend the use of two patient identifiers to ensure accurate patient identification. Two identifiers refer to using two pieces of information to confirm the patient's identity. The two identifiers may include the patient's full name, date of birth, unique identification number, or any other unique identifier.
Rationale for Using Two Identifiers
The rationale for using two identifiers is to minimize the risk of patient misidentification, which can have serious consequences, including medical errors, delayed treatment, and even death. Using two identifiers can help reduce the risk of errors by providing an additional layer of confirmation that the right patient is receiving the intended treatment. It also helps to ensure that patients are matched with their correct medical records, and their care is documented accurately.
Implementation of Two Identifiers
The implementation of two identifiers involves several steps, including staff training, patient education, and the use of appropriate technology. Here are the steps to implement a two-identifier system:
1. Develop policies and procedures: Develop policies and procedures for patient identification and two-identifier system. These policies should include the use of two identifiers, where to place identification wristbands, how to manage patient information, and how to handle any discrepancies.
2. Staff training: Train all staff members on the importance of accurate patient identification and the use of two identifiers. Staff should also be trained on how to check and confirm the patient's identity, how to handle any discrepancies, and how to properly document any patient identification issues.
3. Patient education: Educate patients on the importance of accurate identification and the use of two identifiers. Patients should also be informed about the type of information that will be used to identify them, and the location of identification wristbands.
4. Use of technology: Use technology to support the two-identifier system. This may include electronic health records, barcode scanners, or other technologies that can help verify patient identity.
20 of the most common problems faced by hospital staffs in patient identification:
1. Incomplete patient data: Patients may not provide all necessary information during registration, making it difficult to correctly identify them.
2. Name variations: Patients may use different names or spellings of their name, leading to confusion in identification.
3. Similar or identical names: Patients with similar or identical names may be confused for each other, leading to incorrect identification.
4. Missing identifiers: Patients may not have or may forget to bring their identification documents, making it difficult to verify their identity.
5. Language barriers: Patients who do not speak the same language as hospital staff may have difficulty communicating their identification information.
6. Lack of standardized procedures: Hospitals may not have consistent identification procedures across departments, leading to confusion and errors.
7. Human error: Hospital staff may make mistakes in entering or verifying patient identification information.
8. Technical errors: Electronic systems used for identification may malfunction or produce incorrect information.
9. Illegible handwriting: Handwritten patient identification information may be difficult to read, leading to errors.
10.Time pressure: Hospital staff may feel rushed to complete patient identification procedures, leading to mistakes.
11.Inadequate training: Hospital staff may not be properly trained in patient identification procedures, leading to errors.
12.Incorrectly entered data: Patient identification information may be entered incorrectly, leading to errors.
13.Patient refusal: Patients may refuse to provide identification information or may provide false information, leading to errors.
14.Patient unconsciousness: Patients who are unconscious may not be able to provide identification information or confirm their identity.
15.System incompatibility: Hospital systems used for patient identification may not be compatible with each other, leading to errors.
16.Inadequate record-keeping: Patient identification information may not be properly documented, leading to errors.
17.Patient transfer: Patients may be transferred from one department or hospital to another, leading to confusion in identification.
18.Outdated identification documents: Patients may have outdated identification documents, leading to errors.
19.System security: Hospital systems used for patient identification may be vulnerable to security breaches or hacking, leading to errors or fraud.
20.Lack of patient participation: Patients may not actively participate in the identification process, leading to errors or confusion.
Quality and Patient Safety Related Benefits of Patient Identification
Patient identification and the use of patient identifiers have several quality and patient safety benefits that are recognized by NABH and JCI.
1. Prevents medication errors : One of the most significant quality and patient safety benefits of patient identification is the prevention of medication errors. In healthcare, medication errors are a common problem that can result in adverse events, such as drug toxicity, allergic reactions, and even death. Patient identification helps to prevent medication errors by ensuring that the right medication is given to the right patient. For example, if a patient is incorrectly identified, they may be given medication that is intended for another patient, which can have serious consequences. By using patient identifiers, such as the patient's name, date of birth, and medical record number, healthcare providers can ensure that the correct medication is given to the correct patient.
2. Reduces the risk of wrong-site surgeries : Another quality and patient safety benefit of patient identification is the reduction of the risk of wrong-site surgeries. Wrong-site surgeries occur when a surgical procedure is performed on the wrong body part or on the wrong patient. These types of errors can have serious consequences for patients, including permanent disability or even death. Patient identification helps to reduce the risk of wrong-site surgeries by ensuring that the correct patient is identified before the procedure. By using patient identifiers, such as the patient's name, date of birth, and medical record number, healthcare providers can ensure that the correct patient is in the operating room and that the correct surgical site is marked before the procedure.
3. Improves patient outcomes : Patient identification and the use of patient identifiers can also lead to improved patient outcomes. When patients are correctly identified, healthcare providers can ensure that they receive the appropriate care and treatment for their condition. For example, if a patient has a particular medical condition or allergy, healthcare providers can identify this information using patient identifiers and adjust their treatment accordingly. By providing the right care and treatment, healthcare providers can improve patient outcomes and reduce the risk of adverse events.
4. Enhances patient satisfaction : Patient identification and the use of patient identifiers can also enhance patient satisfaction. When patients are correctly identified, healthcare providers can address their concerns and provide personalized care that meets their specific needs. Patients are more likely to feel valued and respected when healthcare providers use their name and other personal information to address them. By enhancing patient satisfaction, healthcare providers can improve patient engagement and encourage patients to take an active role in their care.
5. Facilitates communication and collaboration : Patient identification and the use of patient identifiers also facilitate communication and collaboration among healthcare providers. When patient information is accurate and up-to-date, healthcare providers can communicate more effectively and make informed decisions about patient care. For example, if a patient has a particular medical condition or allergy, healthcare providers can use patient identifiers to communicate this information to other members of the care team, such as nurses and pharmacists. By facilitating communication and collaboration, healthcare providers can ensure that patients receive coordinated and comprehensive care.
Legal issues in Patient Identification
The Indian legal system has played a vital role in addressing these challenges and providing guidance on the use of patient identifiers in healthcare.
1. National Legal Services Authority vs. Union of India (2014) : The National Legal Services Authority (NALSA) vs. Union of India case is a landmark judgement by the Supreme Court of India regarding the recognition of the transgender community and their rights. The case also emphasized the importance of ensuring accurate identification of patients in healthcare settings. The judgement directed all government and private hospitals to create separate wards for transgender people and ensure that they are not discriminated against in any form. The judgement also highlighted the importance of patient identification and directed hospitals to use proper identification methods to ensure that patients receive proper treatment.
2. Achutanand Mishra vs. State of Bihar (2019) : The Achutanand Mishra vs. State of Bihar case is another important judgement related to patient identification. The case dealt with the issue of identifying victims of sexual assault and ensuring their privacy and safety during medical examinations. The judgement directed hospitals to use unique identification methods to ensure that victims' identities are protected, and their privacy is maintained. The court also directed hospitals to use pseudonyms instead of the victim's real name during the medical examination and treatment.
3. Kunal Saha vs. AMRI Hospital (2013) : The Kunal Saha vs. AMRI Hospital case is a landmark judgement related to medical negligence in India. The case involved the death of Dr. Saha's wife due to medical negligence in a private hospital in Kolkata. The judgement emphasized the importance of proper patient identification and the use of patient identifiers in hospitals. The court directed all hospitals to use patient identification methods such as barcoding, RFID tags, or biometric identification to ensure that patients receive proper treatment and medication. The judgement also highlighted the need for standardization in patient identification methods and the need for hospitals to maintain accurate medical records.
Conclusion:
Accurate patient identification is critical for patient safety, and the use of two identifiers can help minimize the risk of patient misidentification. NABH and JCI recommend the use of two patient identifiers, and the implementation of this system involves staff training, patient education, and the use of appropriate technology. By using two identifiers, healthcare providers can ensure that the right patient receives the right treatment. patient identification is a critical aspect of healthcare, and its importance cannot be overstated. The Indian legal system has played a vital role in addressing patient identification challenges and providing guidance on the use of patient identifiers in healthcare. The above-mentioned cases highlight the importance of proper patient identification, the use of patient identifiers, and the need for standardization and privacy protection in healthcare.
Dr Madhav Madhusudan Singh MBBS, MHA , MBA , Ph.D.
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