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Check, Compare, Confirm

By Lydia Kleinschnitz

Lydia KleinschnitzTwo years ago, which now feels like a lifetime ago, we had a couple of near misses in our imaging department. Those misses comprised of patients with the same name or just before completing an exam, discovering that there was another part of the patient’s body that needed to be added to the scan.

Every imaging department wants to avoid a wrong patient or a wrong exam scenario. If a patient’s safety is in question, one occurrence of wrong exam or wrong patient is one too many. In order to prevent any of these mistakes from happening, our leadership team worked with frontline staff to see what could be done to help streamline patient and order confirmation.

The first thing we tackled was our requisition. The requisition is what our imaging software displays once an order is entered into the patient’s electronic record. It is a paper or electronic screen that the technologist uses to identify the patient and the exam to be done. Our team updated the req by removing unnecessary information and making it easier to read. It now allows your eye to go directly to the patient and exam order. With less clutter and with use of shading, whether using the paper or just accessing the computer screen, the tech has a much easier time finding what he or she needs before proceeding with the patient care.

Next the team developed a pneumonic device to help staff remember the process of positive patient identification. They unveiled the three Cs to patient ID; check, compare and confirm. Checking is always the first step. In a private area ask the patient to state their name and date of birth. This is critical that a patient state their name and not the tech asking by reading the name to the patient. We also use two identifiers, so we ask the date of birth along with the name. Compare is next and that is when the staff will review the patient’s information on their identification band and the information that is on the requisition. Lastly confirm, this is done by asking the patient to state what exam they believe they are to receive and to confirm with the order in hand. If a patient is unable to communicate, two staff members conduct this process together. Once all staff were trained, we thought our near miss issues were out of the way.

We thought this, until the pandemic hit us. Our imaging volumes dropped and life in our department slowed. As the pandemic started to slow, life started to return to normal. That normal feeling didn’t last long as our patient exam volume and staff turnover increased to levels not seen in some time. Suddenly we found ourselves with tighter staffing schedules, a less experienced team and many patients to care for. Although we have an annual positive patient ID competency, a few near misses occurred. The leadership team immediately decided it was time to once again remind staff to go back to the basics and revisit the three Cs to patient ID. We initiated an online review course, a checklist to the requisition with in-person practice. We are currently working to find an IT patient identification solution that is compatible with our radiology applications. We hope that as we continue to build and mentor our team, that combining technology and our three Cs that the near miss will become a thing of the past. Until then the three Cs to patient ID – check, compare and confirm – will remain front and center.

Thanks for all you do.

Lydia Kleinschnitz, MHA, BSN, RN, is the senior director of imaging services at UPMC Presbyterian Shadyside.

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