Patient Safety: Unconscious Patient with No ID
A phlebotomist is called to the emergency department to draw blood from an unconscious patient who was brought in by ambulance after a motor vehicle accident. The patient has no identification and is unable to provide any information. The emergency department is busy, and the nurse asks the phlebotomist to draw blood for a type and crossmatch, complete blood count, and chemistry panel. The phlebotomist notices that the patient's wristband is missing. The nurse says, 'Just draw the blood; we'll sort out the ID later.'
1. What should the phlebotomist do in this situation? Explain the reasoning based on patient safety and confidentiality principles.
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The phlebotomist should not draw blood without proper patient identification. According to patient safety goals, all patients must be identified using at least two identifiers (e.g., name and date of birth, or name and medical record number). For an unconscious patient with no ID, the phlebotomist should:
- Ask the nurse to apply a temporary identification band with a unique identifier (e.g., 'Trauma Unknown' plus a number) and use that as the patient's ID.
- Verify the ID with the nurse and document the temporary ID.
- Ensure the blood tubes are labeled with the temporary ID at the bedside.
- Never draw blood and label tubes later; mislabeling can lead to wrong blood type or incorrect test results, which can be life-threatening.
- Confidentiality: The phlebotomist must protect the patient's health information; using a temporary ID does not violate confidentiality as long as the information is handled securely.
2. What are the potential consequences of following the nurse's suggestion to 'just draw the blood'?
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Potential consequences include:
- Misidentification: Blood may be labeled with incorrect or missing information, leading to wrong test results or wrong blood type for transfusion, which can cause a fatal transfusion reaction.
- Delayed treatment: If the sample is rejected by the lab due to improper labeling, the patient's treatment may be delayed.
- Legal and ethical issues: Violation of patient safety standards and hospital policies, potentially leading to disciplinary action or legal liability.
- Confidentiality breach: If the patient's information is not properly tracked, it could be mixed with another patient's records.
- Compromised care: Without proper ID, the patient may receive incorrect medications or procedures based on mislabeled results.