When a new patient enters a hospital, staff members generally follow the same routine. The admitting nurse asks the patient's name, date of birth, symptoms, and any allergies to medications. From this information, a medical record is created and the patient may be admitted and is taken to a room.
However, at JPS Health Network in Fort Worth, TX, there is one extra step for admitting nurses in the Department of Psychiatry: photographing new patients.
This extra step was implemented in early 2006 when Allison Mason, RN, BS, MHA, program manager in the Department of Psychiatry at JPS, attended a monthly performance improvement review regarding medication errors.
After a medication error occurred on the adult inpatient unit resulting from the misidentification of a patient, Mason and the committee reviewed other patient identification practices on various units within the hospital's psychiatry department.
They found that the adolescent inpatient unit used patient photographs as a second identifier during medication administration and had only two recorded medication errors because of misidentification in the five years after implementing this process.
The committee rolled out this process on the adult inpatient units after hearing of its success on the adolescent unit. In the four years since photos have been used, there have been only a handful of medication errors in the JPS adult inpatient unit. When later addressed, these errors were found to have occurred because nurses had failed to use the patient photograph as a second identifier. These nurses were educated further about the process using a root-cause analysis and examining the occurrence step-by-step, says Mason.
Medication errors because of patient misidentification are especially challenging in psychiatry because patients are frequently noncompliant with wearing identification bands, are unable to answer identifying questions, or intentionally answer incorrectly, says Mason.
"In psychiatry, patients sometimes are not able to answer identification questions," says Mason. "The patient may be psychotic or unwilling to answer questions correctly, which presents the department with unique challenges."
Although patient photographs may raise a red flag for many working in healthcare and hospital settings as a possible violation of HIPAA laws, Mason says it is different for psychiatric units. HIPAA laws protect the privacy of patient health information.
"Our state laws and other regulatory standards we have to abide by are actually more strict," says Mason. "We explain to the patient what the picture is used for and how it improves their safety and quality of care."
When a patient is admitted, the admitting nurse takes a picture of the patient, which goes on his or her chart as well as a 3x5-inch index card.
Along with the picture, the patient's name, date of birth, and medical record number—unique to each patient—are all included on the card.
"Each patient card is handed down, shift to shift, by nurses and is used for identification during medication administration," says Mason.
In addition, patients wear an identification bracelet, which has a bar code that matches the one on the index card and is unique to each patient, says Mason.
Easy implementation
JPS purchased a digital camera so nurses could print patient pictures immediately.
"We wanted to make the process as easy as possible because we did not want to slow down the admission process or make it a burden," says Mason. "[Our] information technology [department] installed the camera program on one of the computers in the nurses' station, and now, taking a patient's picture during admission has just become part of the process."
The key to the process is to have a camera on each unit so all nurses have access to one, she says.
Another important factor in the success of this process was the support provided by upper management, says Mason.
"Everyone here is always ready to do something that will improve patient safety and quality of care," says Mason.
To read more about this program, please see the January 2010 issue of Briefings on Patient Safety, a product of Patient Safety Monitor.