Tuesday, May 8, 2018

NAHAM Suggests Best Practices for Joint Commission Proposal Regarding the Use of Distinct Naming Conventions for Newborns

The Joint Commission has developed a new element of performance to be added to the National Patient Safety Goal NPSG.01.01.01 applicable to hospitals and critical access hospitals that provide obstetric services, specifically labor and delivery, nursery care, and/or NICU services.  The proposed NPSG.01.01.01, EP 3 requires the use of a distinct naming convention for positive patient identification for newborns:

For newborn patients: Use distinct naming systems methods for accurate patient identification.
Note: Examples of methods to prevent misidentification include the following:
 — Distinct naming systems using the mother’s first and last names and the newborn’s gender (for example, Smith, Judy Baby Girl or Smith, Judy Baby Girl A and Smith, Judy Baby Girl B for multiples).
— Standardized practices for identification banding (for example, two body-site identification and barcoding).
— Establish communication tools among staff (for example, checking for two patient identifiers prior to medical record entries and visually alerting staff with signage nothing newborns with similar names).
— Utilize a second person prior to high-risk procedures for positive identification purposes. This could be a second medical professional or approved family member to verify patient name or medical record number.
The associated rationale for the proposal is to the point, with the last sentence seemingly a conclusion many in Patient Access will already have arrived at in an effort to ensure positive patient identity in the bold new world of portable electronic records:

Newborns are at higher risk of misidentification due to their inability to speak and lack of distinguishable features. In addition to well-known misidentification errors such as wrong patient/wrong procedure, misidentification has also resulted in feeding a mother’s expressed breastmilk to the wrong newborn, which poses a risk of passing bodily fluids and potential pathogens to the newborn. A reliable identification system among all providers is necessary to prevent error.

In fact, NAHAM has long supported the general rationale and principle of NPSG.01.01.01 requiring at least two patient identifiers in the clinical setting; in fact, NAHAM has advocated for the development and implementation of robust patient identity integrity programs for use throughout healthcare facilities, recognizing that hospital registration is the front line for ensuring the patient is positively identified, matched with existing healthcare records, and directed to the appropriate clinical setting.  NAHAM-recognized best practices include multiple patient identifiers to achieve this goal, and NAHAM’s 2016 publication of its Best Practice Recommendations for the Collection of Key Patient Data Attributes seeks to drive an across the board adoption of practices focusing on five essential data points for patients: names, address(es), phone number(s), date of birth, and gender.  Working with the Office of the National Coordinator for Healthcare IT (ONC), NAHAM offered its Best Practice Recommendations emphasizing that data integrity through robust collection and recording protocols plays an essential role in patient care and identification in the clinical setting.  Acknowledging the importance of registration in positive patient identification, the ONC developed the Registrar Playbook based on NAHAM’s data collection recommendations. 

Positive patient identity includes the need for consistent naming conventions throughout all healthcare settings, and this has become increasingly important given the great diversity in the U.S. population and cultural and ethnic influences on family names, given names, and preferred names. 

Of interest to Patient Access, the new element of performance, “Use distinct naming systems methods for accurate patient identification,” offers the following example using the mother’s first and last names and the newborn’s gender as a compliant naming convention: “Smith, Judy Baby Girl,” or in the case of multiple births: “Smith, Judy Baby Girl A” and “Smith, Judy Baby Girl B.”

This convention or other very similar ones are generally employed in hospitals today, recognizing, as has the Commission, that the use of nondistinct naming conventions have been associated with increased risks of wrong-patient errors, and recognizing the unique circumstances involved with newborns.  The Commission has also provided previous guidance regarding the use of temporary names that are not distinct enough to address the risks of misidentification.  See, Temporary names put newborns at risk. Quick Safety – Issue 17 (The Joint Commission: October 2015).

The Commission’s proposal seems to provide flexibility for each hospital to adopt its own specific naming convention for newborns so long as it is distinct, is used consistently, and includes at a minimum the elements included in the Commission’s example noted above.  This allows a hospital to ensure that compliance with proposed NPSG.01.01.01, EP 3 will be appropriately linked to its current systems and its larger set of protocols associated with patient records and data integrity.  That’s important, even recognizing the long-term goal of the adoption of common patient data collection protocols, including naming conventions, across all healthcare settings.

At least until such time as all hospitals are using common data collection protocols and all IT systems in use can support specific data fields, this flexibility allows hospitals to adopt even more robust practices from which new best practices may emerge.  In the case of a naming convention for newborns that will support NPSG.01.01.01, EP 3, there is the potential for space limitations for characters on a newborn’s identification band, bracelet, specimen labels, and in some electronic systems.  Using the format of mother’s last name – mother’s first name – the word “Baby” followed by the newborn’s gender and birth order (when applicable) (e.g., “Smith, Judy Baby Girl A”) risks losing essential identification information when the mother has a name with over a certain number of characters.  Hyphenated last names, as well as lengthy names based on cultural and ethnic norms, are a reality that can and should be taken into consideration.

To address the space limitations noted above, NAHAM has suggested not using the word “Baby” in the naming convention for newborns and using a different order for the key identification information: mother’s last name – newborn’s gender – newborn’s birth order – mother’s given name.  For example –

“Dougherty, Girl A Mary Elizabeth” and “Dougherty, Girl B Mary Elizabeth”

“Vaidaynathen, Girl A Gowriprabha” and “Vaidaynathen, Girl B Gowriprabha”

“Penobscott-Smith, Girl A Penelope” and “Penobscott-Smith, Girl B Penelope”

These, as examples of an alternative distinct naming convention to positively identify newborns, should be consistent with proposed NPSG.01.01.01, EP 3, and will ensure that the newborn’s gender and birth order are not at risk of being “dropped” as the final characters in the newborn’s identification by banding,  labeling, and other systems.  This order ensures the mother’s last name and all or a portion of the mother’s first name will be captured.

Compare the more commonly used convention and the emerging practice introduced above (where the underlined characters risk being “dropped” because the number of characters exceeds, in these examples, 25) –

Dougherty, Girl A Mary Elizabeth
Dougherty, Mary Elizabeth Baby Girl A

Dougherty, Girl B Mary Elizabeth
Dougherty, Mary Elizabeth Baby Girl A

Vaidaynathen, Girl A Gowriprabha
Vaidaynathen, Gowriprabha, Baby Girl A

Vaidaynathen, Girl B Gowriprabha
Vaidaynathen, Gowriprabha, Baby Girl A

Penobscott-Smith, Girl A Penelope
Penobscott-Smith, Penelope, Baby Girl A

Penobscott-Smith, Girl B Penelope
Penobscott-Smith, Penelope, Baby Girl B

Given the important role of identification banding and labeling of specimens and medicines in the clinical setting, NAHAM sees an opportunity for hospitals to ensure that their systems for banding and labeling be able to capture the most important identification information for newborns, recognizing that the mother’s first and last names may cause the entire naming convention to exceed the available spaces on bands, bracelets, and labels.