Patient identification: problems and potential solutions

A Mobile App (BEDSide Mobility) to Support Nurses' Tasks at the Patient's Bedside: Usability Study

BACKGROUND

The introduction of clinical information systems has increased the amount of clinical documentation. Although this documentation generally improves patient safety, it has become a time-consuming task for nurses, which limits their time with the patient. On the basis of a user-centered methodology, we have developed a mobile app named BEDSide Mobility to support nurses in their daily workflow and to facilitate documentation at the bedside.

OBJECTIVE

The aim of the study was to assess the usability of the BEDSide Mobility app in terms of the navigation and interaction design through usability testing.

METHODS

Nurses were asked to complete a scenario reflecting their daily work with patients. Their interactions with the app were captured with eye-tracking glasses and by using the think aloud protocol. After completing the tasks, participants filled out the system usability scale questionnaire. Descriptive statistics were used to summarize task completion rates and the users' performance.

RESULTS

A total of 10 nurses (aged 21-50) participated in the study. Overall, they were satisfied with the navigation, layout, and interaction design of the app, with the exception of one user who was unfamiliar with smartphones. The problems identified were related to the ambiguity of some icons, the navigation logic, and design inconsistency.

CONCLUSIONS

Besides the usability issues identified in the app, the participants' results do indicate good usability, high acceptance, and high satisfaction with the developed app. However, the results must be taken with caution because of the poor ecological validity of the experimental setting.

Development and Implementation of the ANISA Labeling and Tracking System for Biological Specimens

BACKGROUND

The Aetiology of Neonatal Infection in South Asia study is a major effort to determine the causes of community-acquired neonatal infections. It involves collecting epidemiological, clinical and laboratory data in 5 sites in 3 countries. The field and laboratory research operations are streamlined to maintain integrity and validity while operating in complex and variable environments. We developed a customized system for implementation of labeling and tracking biological specimen in both rural and urban community settings and integrated into all study laboratories. This report outlines the development and implementation of this harmonized system.

DESIGN

The system links and tracks specimens with study participants and results generated from laboratory tests. Each biological specimen and its aliquots are tracked through key steps of the protocol, from collection and transport through molecular testing and long-term storage.

CONCLUSION

The labeling and tracking system allows for standardization and monitoring of laboratory processes and improves the accuracy of Aetiology of Neonatal Infection in South Asia data. Community-based scientific projects could greatly benefit by adopting this, or a similar, system for specimen tracking and data linkage.

Adverse Transfusion Reactions in Critically Ill Patients

Although transfusion therapy in the past 30 years has achieved high levels of safety, severe adverse reactions can still complicate a red blood cell, plasma, or platelet transfusion. Adverse events can be either of infectious nature (Infectious Adverse Reactions to Transfusion–IARTs) or noninfectious (NIARTs). The former are due to viruses, bacteria, or protozoa present in the transfused component. Medical doctors faced with an infectious disease in a hospitalized patient should always collect an accurate clinical history that must include transfusion of blood components and take into consideration that the viral/bacterial/protozoan infection could be related to a transfusion event. If a transfusion-transmitted infection is suspected, the clinician must contact the transfusion center that will provide a look-back of the blood products and a follow-up of the involved donors.

NIARTs may be of immunological and nonimmunological nature. This chapter provides an overview of pathogenesis, presentation, therapy, and prevention of the main NIARTs. Finally, organizational measures for the management of NIARTs are presented, in order to ensure the highest possible level of safety for the patients.

Use of safety strategies to identify children for drug administration

OBJECTIVE: To understand the use of safety strategies in child identification for drug administration.METHODS: In this cross-sectional study at a pediatric unit, drugs were distributed in a centralized and unique manner. We conducted 373 observations of the process for preparing and distributing drugs carried out by 25 nursing professionals.RESULTS: The pharmacy had distributed 198 (53.1%) medicines without identifying the drugs' label, which, while in storage, was identified with the child's first name handwritten on adhesive tape. At the time of drug preparation, the professional transcribed the drug's name as described in the prescription to the drug label for 173 (90.6%) observations of injectable drug preparation and 161 (88.5%) observations of preparation of oral drugs. Information regarding the five rights of medication administration and preparation, such as the full name of the child, appeared on 10.7% of drug labels.CONCLUSION: No safety strategies to identify children during drug administration were found, nor were any standards for data identification observed.

Decreasing patient identification band errors by standardizing processes

OBJECTIVE

Patient identification (ID) bands are an essential component in patient ID. Quality improvement methodology has been applied as a model to reduce ID band errors although previous studies have not addressed standardization of ID bands. Our specific aim was to decrease ID band errors by 50% in a 12-month period.

METHODS

The Six Sigma DMAIC (define, measure, analyze, improve, and control) quality improvement model was the framework for this study. ID bands at a tertiary care pediatric hospital were audited from January 2011 to January 2012 with continued audits to June 2012 to confirm the new process was in control. After analysis, the major improvement strategy implemented was standardization of styles of ID bands and labels. Additional interventions included educational initiatives regarding the new ID band processes and disseminating institutional and nursing unit data.

RESULTS

A total of 4556 ID bands were audited with a preimprovement ID band error average rate of 9.2%. Significant variation in the ID band process was observed, including styles of ID bands. Interventions were focused on standardization of the ID band and labels. The ID band error rate improved to 5.2% in 9 months (95% confidence interval: 2.5-5.5; P < .001) and was maintained for 8 months.

CONCLUSIONS

Standardization of ID bands and labels in conjunction with other interventions resulted in a statistical decrease in ID band error rates. This decrease in ID band error rates was maintained over the subsequent 8 months.

Quality standards and samples in genetic testing

The most critical performance indicator for medical laboratories is the delivery of accurate test results. In any laboratory, there is always the possibility that random or systematic errors may occur and place human health and welfare at risk. Laboratory quality assurance programmes continue to drive improvements in analytical accuracy. The most rigorously scrutinised data on laboratory errors, which come from transfusion medicine, reveal that the incidence of analytical errors has fallen to levels where most of the residual risk is now found in preanalytical links in the chain from patient to result, particularly activities associated with ordering of tests and sample collection. This insight is important for genetic testing because, like pretransfusion testing of patients with unknown blood groups, a substantial proportion of genotyping results cannot be immediately verified. An increasing number of clinical decisions, associated personal and social choices, and legal outcomes are now influenced by genetic test results in the absence of other confirmatory data. An incorrect test result may lead to unnecessary and irreversible interventions, which may in themselves have associated risks for the patient, inaccurate risk assessment regarding the disease, missed opportunities for disease prevention or even wrongful conviction in a court of law. Unfortunately, there is limited information available about the risk of preanalytical errors associated with, and few published guidelines regarding, sample collection for genetic testing. The growing number and range of important decisions made on the basis of genetic findings warrant a reappraisal of current standards to minimise risks in genetic testing.

Deployment of RFID in healthcare facilities-experimental design in MRI department

Patient safety has become an important issue due to medical errors. Some health care systems use Radio Frequency Identification (RFID) to identify patients during medical procedures. However, the RFID data readability especially depends upon the environment, an investigation of data reliability and signal loss is essential to making an effective deployment plan. The operation of Magnetic Resonance Imaging (MRI) is the major source of electromagnetic interference in the hospital. Therefore, this research conducts an experimental design of reading performance considering various notable factors in the MRI department. In addition to the readability experiment, this paper also measures the efficiency and reliability of implementing RFID technology in the MRI department using a simulation approach and helps hospitals by providing the measured outcomes.

Nurses' practice of blood transfusion in the United Arab Emirates: an observational study

AIMS

The aim of this study was to document nurses' practice of red blood cells transfusion.

BACKGROUND

In the United Arab Emirates hospitals, nurses are responsible for the administration of blood transfusions. The safety and effectiveness of the transfusion process is dependent, among others, on the knowledge and skills of nurses who perform the procedure. Poor practice may result in avoidable complications that may threaten patients' safety. Published work indicated that nurses' practice varied across contexts and highlighted that patients received suboptimal care and incorrect transfusion that culminated in death or morbidity. In the United Arab Emirates, publications related to nurses' practice of blood transfusion are lacking.

DESIGN

Descriptive.

METHODS

Data were collected by means of non-participant structured observation. Data collection was undertaken in two general public hospitals in the Emirate of Abu Dhabi, United Arab Emirates. A random sample of 50 nurses from both hospitals was selected. Each nurse was observed once, from 10 minutes prior to blood collection until 15 minutes after initiating a transfusion.

RESULTS

Forty-nine nurses (98%) were observed. The maximum obtained score was 13 points of a possible score of 21, and 75% of nurses scored below the 50% level. Practice deficiencies included improper patient identification, suboptimal vital signs documentation and invalid methods of blood warming.

CONCLUSIONS

Patients in both hospitals were at risk of receiving incorrect blood, suffering unobserved transfusion reaction and acquiring bacterial infection.

RELEVANCE TO CLINICAL PRACTICE

This study revealed inadequate practices that nurses and hospitals should strive to change to provide a safer and more effective care that would, hopefully, minimise the risks and maximise the benefits of blood transfusion. These findings also have implications for clinical supervision and nurse education.

Modeling and Analysis of Surgery Patient Identification Using RFID

This article proposes a workflow and reliability model for surgery patient identification using RFID (Radio Frequency Identification). Certain types of mistakes may be prevented by automatically identifying the patient before surgery. The proposed workflow is designed to ensure that both the correct site and patient are engaged in the surgical process. The reliability model can be used to assess improvements in patients’ safety during this process. A proof-of-concept system is developed to understand the information flow and to use information in RFID-based patient identification. Reliability model indicates the occurrences of patient identification error can be reduced from 90 to as low as 0.89 per 10,000 surgeries using the proposed RFID based workflow.

Registration-associated patient misidentification in an academic medical center: causes and corrections

BACKGROUND

Proper patient identification is a major factor affecting patient safety in any health care organization.

METHODS

An interdisciplinary team, using three Plan-Do-Study-Act (PDSA) cycles, reviewed the incidence of patient misidentifications resulting from registration process errors. Retrospective and prospective data were collected to determine the incidence among inpatients and outpatients.

RESULTS

Registration-associated patient misidentification errors occurred 7 to 15 times per month. Information systems deficiencies, inadequate training, and the lack of a single master patient index were among the root causes identified. After three PDSA cycles, the incidence rate for registration-associated patient misidentification errors declined for inpatients (80.5%) but increased for outpatients (30.2%).

DISCUSSION

Through an iterative process as implied in the PDSA cycle, registration-associated patient misidentification errors for established Johns Hopkins Hospital patients were dramatically reduced. A checklist is provided for other organizations to assess their vulnerability to registration-associated patient misidentification errors. The checklist suggests, for example, that organizations strive to develop a single master patient index and limit access to registration systems to staff with proper training and performance expectations.

Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety

Standardized, seamless, integrated information technology in the health-care environment used with other industry tools can markedly decrease preventable errors or adverse events and increase patient safety. According to an Institute of Medicine (IOM) report released in 1999, preventable errors have caused between 44,000 and 98,000 deaths per year. Following the report, President Bill Clinton requested that the Agency of Healthcare Research and Quality, a government agency, look into the issue and fund, at the local or state level, processes that can reduce errors. Funding subsequently was made available for research that utilizes best practice tools in clinical practice to increase patient safety. The Joint Commission on Accreditation of Healthcare Organization has placed a great deal of emphasis on strategies to reduce patient identification errors. Fragmented systems tout the individual as well as enhanced safety applications. These applications, however, are related to prevention in specific conditions and in specific health-care settings. Systems are not integrated with common reference data and common terminology aggregated at a regional or national level to provide access to patient safety risks for timely interventions before errors and adverse events occur. Standardized integrated patient care information systems are not available either on a regional or on a national level. This article examines tangible options to increase patient safety through improved state-of-the-art tools that can be incorporated into the health-care system to prevent errors.

Medication safety and transfusion errors in the ICU and beyond

The modern day intensive care unit (ICU) is a place in which patients can receive continuous monitoring of physiologic variables with concentrated patient observation and care. Despite the "intensive care," errors do occur. This article reviews medication and transfusion errors, including the different types, causes, and possible solutions to prevent these errors from occurring in ICUs and the hospital at large.

Barcode identification for transfusion safety

PURPOSE OF REVIEW

Errors related to blood transfusion in hospitals may produce catastrophic consequences. This review addresses potential solutions to prevent patient misidentification including the use of new technology, such as barcoding.

RECENT FINDINGS

A small number of studies using new technology for the transfusion process in hospitals have shown promising results in preventing errors. The studies demonstrated improved transfusion safety and staff preference for new technology such as bedside handheld scanners to carry out pretransfusion bedside checking. They also highlighted the need for considerable efforts in the training of staff in the new procedures before their successful implementation.

SUMMARY

Improvements in hospital transfusion safety are a top priority for transfusion medicine, and will depend on a combined approach including a better understanding of the causes of errors, a reduction in the complexity of routine procedures taking advantage of new technology, improved staff training, and regular monitoring of practice. The use of new technology to improve the safety of transfusion is very promising. Further development of the systems is needed to enable staff to carry out bedside transfusion procedures quickly and accurately, and to increase their functionality to justify the cost of their wider implementation.