When Two Identifiers are Not Compliant
“What two identifiers do you use to identify the patient?”
“Name and date of birth.”
This everyday interaction between a nurse and a surveyor shows compliance with the Joint Commission’s NPSG 1A, right? Not so fast …
This interaction illustrates how many organizations are being caught off guard in meeting the expectation of the National Patient Safety Goal regarding patient identification. While name and date of birth are appropriate patient characteristics for meeting the expectations of the standard, using them does not go far enough.
Not Two Identifiers, 2×2 Identifiers
The intent of the patient identification goal is to assure that the patient is accurately receiving medications or blood, that blood is drawn appropriately, that test results are accurately communicated, and that appropriate treatments are being delivered to patients. The process established by the organization should accomplish the following:
- Identify two (2) unique pieces of patient information as a source for comparison. Based on the setting, this may include name, date of birth, medical record or account number, or a picture of the patient in longer term settings.
- The unique identifiers are compared between two (2) sources of information containing the patient information.
- The process should assure that the two pieces of information are compared between both sources of patient information (2×2) to validate that the information is correct.
Plugging the 2×2 Holes
When a patient situation calls for identification procedures, staff must assure that 2×2 verification occurs. This includes:
- When administering medications or blood, even if they have been retrieved from an automated device
- When collecting blood or urine specimens (IP or OP)
- Before conducting patient treatments or procedures
- When providing nutritional supplements as part of a prescribed diet
When testing compliance with the 2×2 expectation, consider asking the following questions during tracers:
- When the staff member looked as the patient’s bracelet, did he/she have a reference source in the other hand (MAR, chart, test order sheet)?
- When the staff member asked the patient for his/her DOB or name, did he/she have a reference source in the other hand (MAR, chart, test order sheet)?
- Following the observation of a “read-back: of a telephone order, can the nurse provide the observer with a reference source containing the two pieces of patient information that were verified prior to communicating with the individual about test results or medications?
- Are nutritional supplements distributed with a 2×2 identification step?
- Do transporters use 2×2 identification when picking up patients for tests or procedures?
- What is used for 2×2 identification when passing medications in isolation rooms?
- What resource do respiratory therapists use for 2×2 identification when giving respiratory treatments?
