Proper patient identification must be made before blood collection.
When the United Clinical Laboratories (UCL) phlebotomist places his/her initials on the blood specimen(s) and associated paperwork, he/she is verifying that proper patient identification has been made. If there is any doubt or question concerning proper patient identification, consult the site supervisor or a pathologist.
Note: It is important to understand and follow the policy concerning proper patient identification before performing any blood collection procedure.
A. Routine Patient Identification:
All routine inpatients (with the exception of unidentified emergency room patients) are identified using written armband identification. Inpatients are required to have an identification bracelet (armband) with their name and a unique identifying number on it. (The Typenex armbands used for emergencies and traumas, described in II.1.B., have only a unique number.) Inpatient identification is made using this armband. Never attempt to identify persons by their room and/or bed number. The armband will usually contain additional information such as room number. The minimum information required is the patient name, first and last, and a unique identification number. At the Finley site, this is the medical record number. At both Mercy locations, it is an assigned unique number. This bracelet/armband is usually placed on the patient’s wrist, but it may be located on an ankle. Under very rare circumstances, it may be taped to the forehead. The bracelet/armband must be physically attached to the person, not on the bedside table or taped to their bed, pinned to their gown, etc. The name and number found on the identification bracelet must match exactly the name and number found on the test requisition(s). For routine ordered test requests, if the name and number do not match, inform nursing service and explain that blood cannot be collected from this patient until the discrepancy is resolved.
B. Stat Inpatient Identification:
If the request is for a STAT test that requires blood to be drawn immediately, and the patient does not have an armband, (i.e. this is not an emergency room or trauma/disaster patient), a Typenex armband with a unique, temporary, master identification number is placed on the patient by the phlebotomist.
Note: The Typenex identification number is written by the phlebotomist on all test requisitions, and specimen containers. The advantage to this type of identification is that it is easy to use and can be used very quickly. The disadvantage is that it does not have the patient name written on it. There is a danger that it may be cut off by other hospital staff that do not recognize it. A routine bracelet/armband must still be placed on the patient as soon as possible. When the patient is given a routine armband, the original phlebotomist must re-identify the patient and write the patient name and identification number on all paperwork and specimens drawn at the time of the Typenex identification. The Typenex number is left in place on the specimens and paperwork for comparison. Each phlebotomy tray has at least one Typenex band on it at all times. When the Typenex armband is used, it is important to explain to the patient (if conscious) and the nursing staff the importance of leaving the armband in place for at least 3 calendar days. A situation that requires the use of a Typenex armband is reported to the site supervisor or a pathologist as soon as time permits.
C. PAT/PAS (Preadmission Testing or Preadmission Services):
All PAT/PAS patients are required to have on their person an identification bracelet/armband with their name and a unique identifying number on it. The name and number found on the identification bracelet must match exactly the name and number found on the test requisition(s).
D. Emergency Room/Trauma Patients:
When the situation involves an emergency room trauma, or a multiple disaster with treatment of unidentified people, patients are assigned an identification bracelet/armband from a trauma/disaster packet by Emergency Department nursing staff. The pre-assigned bracelet/armband has a unique patient identification number and remains on the patient for at least 3 calendar days after detailed identification including patient name and date of birth is made. If blood has been crossmatched for the patient on the basis of trauma packet identification, the trauma armband must remain on the patient until the crossmatched blood has been released. UCL staff use the Typenex system if trauma/disaster packets are not available. (Refer to section II.1.B. of this procedure.)
E. Specimens collected for Blood Bank procedures:
All specimens obtained for compatibility testing require extra identification steps. Refer to section II.3 of the “General Processes, Blood Bank” protocol.
A. Outpatients that come to a UCL site for blood or other specimen collection:
Outpatients that come to a UCL site for a blood (or other specimen) collection procedure have not been formally admitted and do not have an identification bracelet/armband. Active communication using two identifiers is used to identify these patients. This identification is done first by the person who registers the patient. The patient name and one other identifier must be used. If the date of birth is used as a second identifier, it must be the month, day and year. An address or phone number can also be used as a second identifier. If the patient is too young, mentally incompetent or does not speak the language of the receptionist, a relative or friend must identify the patient by full name plus one other identifier.
The person collecting the specimen(s) must also use active communication using two identifiers before collecting the specimen(s). The full patient name and at least one other identifier are used. To identify these clients correctly, verbally call for them, using their first and last name. After they are seated in the drawing area, use active communication to make a positive identification. Have the patient spell his/her first and last name. For example, “Hello, I’m Sue from the lab and your doctor requested that I draw some blood form your arm (or collect a urine, throat culture, etc.). Would you please spell you first and last name for me?” Do not say the person’s name for them. Do not ask, “Is your name_______________?” or “Are you Mr.________________?” If the date of birth is used as a second identifier, it must be the month, day and year. Do not ask, “Is your birth date __/__/__?” They must state the correct birth date. An address or phone number can also be used as a second identifier. If the patient is too young, mentally incompetent or does not speak the language of the phlebotomist, a relative or friend must identify the patient by full name plus one other identifier. If a relative or friend is part of the active communication step in patient identification, that person must write his/her initials next to the phlebotomist’s initials on the laboratory test requisition.
B. Outpatients drawn by UCL staff at another location:
Outpatients that are drawn at another location; e.g., at a nursing home, may or may not have an armband for patient identification. If there is no armband, active communication is used to identify these patients. The full patient name and at least one other identifier are used. If the date of birth is used as a second identifier, it must be the month, day and year. If the patient is mentally incompetent or does not speak the language of the phlebotomist, a nurse, relative or friend must identify the patient by full name plus one other identifier. If a nurse, relative or friend is part of the active communication step in patient identification, that person must write his/her initials next to the phlebotomist’s initials on the laboratory test requisition.
C. Outpatients for Blood Transfusion:
Outpatients that have blood collected for crossmatching should have a hospital identification bracelet. In an unusual or extenuating circumstance, a Typenex armband may be used. It is very important to explain to the client the purpose of the armband (hospital or Typenex) and the importance of wearing it until their transfusion(s) is completed.
D. Identification for clients drawn by UCL staff at Health Fairs, Cholesterol Screens, etc.:
Clients complete their own paperwork, including a self-addressed envelope and labels at health fairs, screens, etc. This paperwork stays with the client and is presented directly to the phlebotomist. Before any blood collection procedure, the phlebotomist asks the client to state his/her name and address and checks that all paperwork and labels match.
1. JCAHO 2005 National Patient Safety Goals and Specimen Collection
2. Procedures for Collection and Diagnostic Blood Specimens by Venipuncture; Approved Standard 5th Ed.
3. Ernst, Dennis, “Specimen Collection Standards Complete Major Revisions”, Medical Laboratory Observer (MLO), February 2005.
4. Mayo Medical Laboratories, “Patient Identification”, July 29, 2004.
i. 2-14-90 R. Schaefer
ii. 12-1-92 R. Schaefer (Revised: Note, I.A.,IA.1.and 2., I.B.,II.B.)
iii. 6-28-95 R. Schaefer (Revised: Delete trauma kits; wording)
iv. 9-3-96 R. Schaefer (Revised: Mercy Trauma policy; wording)
v. July 2002 R. Schaefer (Revised: II.1-3.; III.1,3 &4.)
vi. August 2005 R. Schaefer (Revised: I.; II.1.A-D.,2.A-D.; III.)
vii. February 2007 R. Schaefer (Revised: II.1. & 2. omit SSN)