Patient Identifiers the Importance Term Paper

Pages: 10 (4119 words)  ·  Bibliography Sources: ≈ 21  ·  File: .docx  ·  Level: College Senior  ·  Topic: Healthcare

Non-compliance with existing patient safety guidelines represented 95.2% of all errors found, which suggests the vast majority of errors were preventable.

Misidentification during Medication Administration

During a study observing nurse-patient interactions in three hospitals in England, close to 7% of nurses failed to ask the patient's name when administering medication in an acute mental health care setting (Duxbury et al., 2010). The failure to positively identify the patient before administering medication violated the patient care guidelines set forth by the Nursing Midwifery Council. This was particularly troubling since two nurses made the medication rounds, with one acting as an observer. Medication errors are the most common source of preventable adverse events, and are believed to have led to the deaths of 1200 patients in England and Wales in 2001 (reviewed by Brady, Malone, and Fleming, (2009).

The Role of Automated Patient Information Systems

The implementation of barcodes to help lower error in identifying the correct medication to administer has reportedly reduced medication errors by 65 to 74% (reviewed by Marini, Hasman, Huijer, and Dimassi, 2010). The use of automated patient information tools lowers medication administration errors by helping to confirm the 8Rs:

Right medication

Right dose

Right patient

Right route

Right time

Right assessment

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Right reason

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The implementation of computerized physician order entry systems lowered the rates of medication administration errors by another 81%, due in large part to the elimination of handwritten prescriptions, and in some organizations by forcing physicians to provide more complete prescribing information (reviewed by Marini, Hasman, Huijer, and Dimassi, 2010). The use of patient ID wrist bands is also believed to have helped reduce patient identification errors (reviewed by Evans, 2009). Unfortunately, a one year study conducted at an Australian metropolitan hospital found the rate of patient misidentification approached 3% because in many cases patient ID bands were not being replaced after the completion of procedures (Tran and Johnson, 2010). The primary outcome of patient misidentification in this study was patients receiving unnecessary or inappropriate tests, thereby putting the health of the patients at risk, delaying appropriate treatment, and increasing the cost of providing care.

Although implementation of automated patient information tools have helped reduce errors dramatically, new concerns have arisen because some health care workers may be becoming complacent by relying too heavily on these tools to catch errors. The importance of combining the automated information tools with health care worker diligence was revealed when it was discovered in one hospital that patient wrist band barcodes were being misread by scanners at a rate greater than 1 in 84,000 scans (Snyder, Carter, Jenkins, and Frantz, 2010). Misread barcodes were attributed to faulty printers and scanners with unexpectedly high error rates. In addition, scanning error was found to be increased by poor scanning angles and damaged or wrinkled wristbands.

The better approximation of the true prevalence of patient misidentification was provided by an ingenious intervention program instituted at a major academic medical institution. Administrators at the UCLA Medical Center came up with a plan to employ student observers to record health care worker habits during the checking of patient identity before medication administration and handoffs to hospital escorts (Rosenthal, Erbeznik, Padilla, Zaroda, Nguyen, and Rodriquez, 2009). During the 2-1/2-year study period the frequency of checking two patient identifiers during medication administration went from about 60% to over 90%. The frequency of bedside verification of patient name and medical record number during handoffs to escorts went from about 20% to almost 90% during the same period. The use of student observers, and providing end-of-the-day feedback to charge nurses, was believed to be the primary factors contributing to improved patient safety policy compliance. The authors of this study pointed out that it took close to 14 months of observation and feedback to cause a noticeable shift in health care worker habits, which hints at the intractable nature of the old habits.

Legal Restrictions on the Use of Patient Identifiers

The Privacy Rule

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a mandate to protect the personal health information of individuals, and the task of developing the rules to fulfill this mandate fell to the Department of Health & Human Services. The final version of the Privacy Rule (Standards for Privacy of Individually Identifiable Health Information) was published in 2002 and has effectively changed not only how protected health information (PHI) is handled and controlled, but established a viable means for enforcement (Office of Civil Rights [OCR], 2003).

The Privacy Rule defines who must protect personal information generated, retained, and utilized as a result of providing health care. These 'covered entities' include health care providers, health plans, health care clearinghouses, and any contractors who are required to handle PHI (OCR, 2003). PHI personal identifiers, demographic information, health history, health condition, prognoses, treatments and services rendered, and financial transactions related to health services and care. Personal identifiers that fall under the Privacy Rule's protection include name, address, birth date, social security number, etc.…, the same information that's crucial to ensuring patient safety.

HIPAA lists 18 patient identifiers that should be protected:

2. Geographic location information smaller than a state, i.e., patient's address

3. Any date related to the patient, such as birth date, admission date, discharge date, date of death, and any ages over 89

4. Phone numbers

5. Fax numbers

6. Email addresses

7. SSN

8. Medical record numbers

9. Health plan beneficiary numbers

10. Account numbers

11. Certificate/license numbers

12. Vehicle identification numbers

13. Device identifiers and serial numbers

14. URL addresses

15. IP addresses

16. Biometric identifiers, including fingerprints or voice prints

17. Full face photographic images and any comparable images

18. Any other unique identifying number, characteristic, or code (excludes unique codes assigned by an investigator to code the data)

The information protected under the Privacy Rule can be used and released by covered entities under the following conditions (OCR, 2003):

To the patient

To treat and provide services to the patient

By verbal permission from the patient or patient representative, typically as part of efforts to provide care

Incident to a permitted use or disclosure, as long as reasonable safeguards were observed

When required by:

Law: judicial proceedings, law enforcement investigations, as evidence of criminal activity (abuse, neglect, or violence), when handling the corpse of a patient, military missions, and intelligence and national security activities authorized by law

Public health activities/emergencies

Oversight agencies

Tissue and organ donation procedures

Research purposes

Worker's compensation programs

Health information can be de-identified, or stripped of any personal information that could link health-related information to a specific individual (OCR, 2003). This can be done by passing the information through a covered statistician who converts protected health information into numerical quantities, or by stripping personal identifiers from the remaining health information. Information that's been de-identified is no longer PHI under the Privacy Rule.

Covered entities are also required to adhere to a principle of the 'minimum necessary'. This principle requires covered entities to only request and store the minimum amount of protected health information required to provide health care to the patient. Covered entities must also establish reasonable safeguards and procedures to protect personal health information (OCR, 2003).

Security Rule

HIPAA also explicitly mandated that covered entities that handle protected health information electronically take all necessary and reasonable precautions to protect and control this information (National Institutes for Standards and Technology, 2008). For health care workers, this will mean being given only the minimum level of access to electronic protected health information (EPHI) required to perform their duties and facing sanctions should violations of this rule occur.

Patient Safety and Quality Improvement Act of 2005

In continued pursuit of improving patient safety and privacy concerns in the health care setting, Congress passed the Patient Safety and Quality Improvement Act (PSQIA) in 2005. The final rule was published by the Department of Health & Human Services (DHHS) in 2008. This Act establishes a legal framework that provides a confidential and privileged route for care providers to report patient safety concerns to Patient Safety Organizations (PSOs). The purpose is to provide a way to track, assess, and institute policy changes to improve patient safety, without fear of legal liability.

Area of Greatest Learning

If the research literature can be used as a guide, patient misidentification threatens patient safety primarily during medication administration, transfusions, laboratory specimen gathering, and invasive procedures. Patient misidentification during these procedures risks the health and lives of patients, and costs hospitals billions of dollars a year in unnecessary or incorrect procedures, and liability settlements (WHO, 2005).

For patient safety to improve significantly though (Who, 2005), hospitals will have to institute and standardize the use of individual-specific identifiers as required for hospital accreditation by The Joint Commission (2010). Remedial interventions targeting individual health care workers because of their poor performance will only have a minimal impact on reducing patient misidentification error rates, when compared to instituting system-wide policy changes.

Recommendations for Change

Of the studies… [END OF PREVIEW] . . . READ MORE

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How to Cite "Patient Identifiers the Importance" Term Paper in a Bibliography:

APA Style

Patient Identifiers the Importance.  (2011, March 17).  Retrieved April 7, 2020, from

MLA Format

"Patient Identifiers the Importance."  17 March 2011.  Web.  7 April 2020. <>.

Chicago Style

"Patient Identifiers the Importance."  March 17, 2011.  Accessed April 7, 2020.