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Stepwise Success

Safe Choices

Published July 8, 2009 5:58 AM by Scott Warner

The other day at a meeting about patient identification the subject of redrawing an improperly identified patient for the blood bank came up. One person thought this a terrible idea and said, "This is all about saving the patient a stick." "Actually," I said, "it's about giving the patient the correct unit of blood."

When talking about choices, safety is your common ground. In this case, both sides advocated patient safety: fewer needle sticks versus safer transfusions. Both are legitimate safety concerns, although the risk of an adverse transfusion reaction obviously outweighs the discomfort of another needle. It isn't always this easy.

For example, a nurse collecting samples in a trauma situation may judge that it is more important to attend to a patient in acute distress than identify and label samples immediately.

Another example is a doctor weighing treatment options and the patient condition who decides he wants a result on a compromised sample or other testing that seems out of the ordinary.

One comment I hear occasionally when discussing patient identification is, "They just don't care about the patient." But unless we are aware of an assessment of patient risk at the time, we don't know that. We shouldn't assume another professional isn't focused on patient safety. It's lack of knowledge and not lack of caring that's the problem.

Faced with this, we need to open a dialogue. The nurse in the trauma situation can understand the risk associated with mislabeled specimens and telephone for help. The doctor who wants the best results to treat a patient can understand why it's important for the laboratory to know what he or she wants. At the same time we understand the concerns of "the other side," making it possible for us to do our job better.

All it takes is picking up a phone or taking a walk down the hall. That's a safe choice to understand what's best for the patient.

2 comments

Good story that shows that patient safety is the common ground!  Thanks for sharing.

Scott Warner July 29, 2009 5:23 PM

Yesterday morning, I noticed that a patient's PT/INR had dramatically decreased from 54.7/5.6 around 5 AM on July 22 to the current result of 13.0/1.3 - and also discovered that she had not received any blood bank products during that time frame.

I called the patient's nurse and asked if there might be any reason for that difference.  Although she had not received fresh frozen plasma, she DID get a 1-mg Vitamin K IV dose about four hours after her critical high INR was called.

The nurse greatly appreciated my investigating the reasons for the PT/INR delta flag and ruling out the possibility of a different patient's specimen being inadvertently labeled with that patient's name.  It's always great to receive positive feedback from nurses!

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Danville Regional Medical Center July 24, 2009 1:35 AM
Danville VA

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