Involvement of alert and competent patients in verifying their own identification on blood component forms

A transfusion medicine physician in Maryland would like to know if there are any institutions that have fully incorporated competent patients in their processes to ensure proper patient identification, as opposed to just stating in their policy "Ask the patient to state his/her name" or some such. A proposal is in the early stages at the inquiring colleague's institution to develop a policy where alert and competent patients could sign their blood component forms as "second verifiers" instead of a second nurse or physician. Some people have expressed concern about being able to ensure "competence" in these patients, but this has never seemed to be an issue when they are asking these same patients to sign a consent form for transfusion, which the inquiring physician thinks is a more complex task than identifying oneself.

The inquiring physician would like to see the blood-banking community lead the way in developing systems which guide health-care providers to involve patients more actively in identifying themselves. He laments being disturbed by a promotional video of a vendor of a bar-code patient ID system which showed a health-care provider walking up to an alert patient without speaking to the patient, who sits there passively while the provider scans his wrist. He adds, "It is a shame health-care has evolved to a very impersonal system where we feel compelled to process alert people like grocery items. I think we may be missing an opportunity to create a system where we can interact more with our alert patients as human beings."

The following comments have been received.

ADDENDA Feb. 26, 2004

1. A transfusion medicine physician at the Mayo Clinic is of the opinion that, provided the patient is conscious, we should always ask them their full names (including spelling) before we look at their wristband ( if they are wearing one) and compare that with the name and unique identification number on the wrist band and blood sample . However, the Mayo Clinic physician would really question having any phlebotomist try to assess the competency of a sick, medicated, drowsy or semiconscious patient. He feels that no identification system should be set up to depend on the mental competency of the patient. He adds that if they are awake and alert, we should involve them by asking their full name. However, we might make matters worse if we have different systems set up for patients judged (by some hurried phlebotomist) to exhibit a certain level of mental alertness. He adds "Neither am I very comfortable with a requirement that patients "sign off" on their identity. We know that groggy, confused and drugged patients will often sign anything a figure of authority asks them. As to the Maryland physician's analogy with patients signing consent forms - at Mayo, the policy is that the risks and benefits of transfusion ( including risks if NOT transfused ) should be discussed with the patient (except where that is impossible because of emergency or mental incompetency) and such conversation should be documented in the physician's notes. We do not have the patient sign any specific consent form to this effect since our legal colleagues have repeatedly told us that the mere signing of a consent form per se is no legal protection from patients who can readily claim successfully that they were confused by the plethora of documents they were given to sign in the course of their episode of care."

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