Venipuncture, also known as phlebotomy, is the process of obtaining intravenous access for the purpose of collecting blood specimens or for intravenous therapy. It is one of the most common invasive procedures performed in healthcare and requires proper technique and precautions to minimize risks and maximize success. Before performing venipuncture, there are several important steps that should be followed to ensure patient safety and comfort and to obtain quality specimens. However, the most crucial preparatory step is proper patient identification using at least two independent identifiers.
Patient Identification
Verifying the patient’s identity is widely regarded as the most vital step preceding venipuncture or any other invasive procedure. This prevents one of the most dangerous errors in healthcare – performing a procedure on the wrong patient. Positive patient identification helps ensure the right patient receives the intervention intended for them, avoiding potential harm. Guidelines from the World Health Organization, The Joint Commission, the American Society for Clinical Pathology, and other leading authorities all emphasize patient ID as the primary safety measure before any blood draw or IV line placement.
Proper patient identification requires using at least two independent identifiers, such as the patient’s full name and date of birth. Other appropriate identifiers may include medical record number, phone number, or address. Identifiers should be obtained directly from the patient or their ID band if they have one. For patients who are unconscious or otherwise unable to identify themselves, identifiers can be obtained from a family member or the individual who brought them in. However, at least one identifier should still come directly from the patient, such as scanning their wristband.
After verbally inquiring the patient’s name and DOB or other identifiers, these details should be cross-checked against their medical record, requisition, wristband, and any other available documentation. Any discrepancies must be resolved before proceeding further. This two-step verification process should occur at the bedside right before venipuncture. If the procedure is being performed outside of a stretcher or bed, the patient should still be asked to state identifying details even if they have already provided them earlier. This reinforces the critical habit of patient ID with every venipuncture.
Importance of Correct Patient Identification
Performing venipuncture or any invasive procedure on the wrong patient can potentially lead to delayed care, unnecessary repeats, complicated diagnosis and treatment, severe harm, or even death. Here are some key reasons why properly identifying the patient is the most crucial step before venipuncture:
Prevents misdiagnosis
Lab results from blood specimens can drive clinical decision-making and direct patient diagnosis and treatment. If blood is drawn from the wrong patient, test results may be attributed to the wrong person leading to incorrect diagnosis, inappropriate treatment, and serious patient harm. This is especially dangerous if the two patients have similar presenting issues making the misdiagnosis less obvious. Positive patient identification is the only way to reliably link the blood sample to the correct patient to avoid this potential catastrophe.
Averts unnecessary repeat testing
If blood is drawn from the wrong patient, it may necessitate repeating the venipuncture to obtain a specimen from the intended patient. This exposes patients to added discomfort, inconvenience, and risk of complications. It also leads to wasted staff time, supplies, and specimen quantities that may be limited. Confirming patient identity prevents mishaps that require re-collection.
Upholds patient safety
Some lab tests and blood analyses like ABO typing and crossmatching are used to ensure blood product or transplant compatibility prior to administration. If these specimens are collected from the wrong patient, it could pave the way for life-threatening ABO incompatibility reactions or transplant rejections. Additionally, blood cultures contaminated by misidentification could lead to patients receiving unnecessary or incorrect antibiotics. Positive patient ID safeguards transfusions and therapies.
Prevents allergic reactions
Patients can have severe or even fatal allergic reactions if administered medications or blood meant for another patient. Transfusing improperly crossmatched blood can provoke dangerous hemolytic reactions. Medicating the incorrect patient may cause anaphylaxis, serum sickness, or adverse events. Identifying patients properly forestalls inadvertent allergen exposure.
Avoids unnecessary testing or treatment
Some diagnostic blood tests or intravenous therapies are intended for specific conditions. Administering these to the wrong patient may lead to unnecessary testing or procedures that can be both wasteful and potentially harmful. This includes unnecessary blood transfusions, thrombolytics, chemotherapy, and more. Confirming patient ID verifies tests and Rx are clinically appropriate.
Reduces healthcare costs
The downstream effects of misidentification like repeat testing, incorrect treatment, lengthened hospital stays, and complications all inflate healthcare spending. A 2018 study estimated up to $1 billion annually is wasted on patient misidentification. Positive patient ID maximizes appropriate resource utilization.
Upholds compliance
Regulatory bodies like The Joint Commission mandate patient identification as a National Patient Safety Goal. Facilities may face penalties or citations if found non-compliant with ID protocols. Following positive patient ID procedures demonstrates adherence with safety standards.
Limits legal liability
Healthcare facilities may be subject to malpractice lawsuits or civil monetary penalties if patients experience harm due to misidentification. Following rigorous patient identification procedures shows reasonable diligence was exercised to avoid errors. This helps defend against liability claims.
Two-Person Verification
To further bolster patient safety and redundancy, many policies also require a second qualified healthcare worker to independently verify the patient’s ID immediately before venipuncture. This two-person verification enhances accuracy. One person checks the wristband or asks the patient identifying details while the second person confirms these match the lab requisition and medical record. Any discrepancies should be solved before proceeding.
Having two clinicians independently perform and concur on ID checks right before invasive procedures provides an additional safety net against potential slips or oversights by any one practitioner. It helps catch any patient identification issues at the last possible moment before venipuncture. Two sets of eyes and hands are better than one.
When Should Patient ID Be Verified for Venipuncture?
Comprehensive patient identification should happen at multiple timepoints across the testing process, but is most critical immediately before venipuncture. Here are key times patient ID validation should occur:
Order Entry
Patient ID should first be verified when the laboratory requisition or orders are placed into the system. This ensures the details populate correctly from the start to set up downstream ID checks.
Specimen Labeling
Before labeling collection tubes, vials, or blood culture bottles, patient details on the label should be double checked against the requisition. Standard practice is to label specimens in the presence of the patient.
Specimen Collection
Just before performing the venipuncture, clinician(s) must verify patient ID directly with the patient at bedside using two independent identifiers, as discussed above. This is the most vital final ID check before puncturing the patient’s vein.
Specimen Transport
Before placing specimens in pneumatic tubes or handing off for transport, patient name on the label should be re-verified against the requisition as a final check. Some facilities have transport staff verify ID.
Sample Receipt and Processing
The testing laboratory should confirm patient name/details on specimens when received match the attached requisition. ID should also be checked during specimen aliquoting, analysis, and result reporting.
While verifying patient identity is important throughout the testing process, doing so immediately before sample collection at bedside is the most crucial step. Positive ID confirmation enables accurate labelling, diagnostics, and treatment while averting potential harm from mismatches.
Exceptions to Bedside Identification
Certain patient situations may preclude always re-confirming wristband or bedside identity checks before venipuncture, including:
- No patient wristband (newborn nurseries)
- Bandaged/inaccessible wristband (burn units)
- Conscious sedation or anesthesia
- Homecare setting
- Combative patient
In these instances, staff should still aim for two-person verification and use at least one alternate patient identifier, such as checking name against a homecare intake list or an anesthesia record. However, variances should be minimized and workflows adapted where possible to maximize direct patient ID confirmation before venipuncture.
Patient Identity Errors
Despite stringent policies, patient misidentification errors still occur. The most common types are:
Name confusion
Patients with similar-sounding names are accidentally switched, often due to similar spelling. Hyphens, middle names, suffixes or prefixes may also contribute. Meticulously checking first and last names averts confusion.
Room number mix-ups
Assuming a patient’s identity based on room or bed number without actually checking wristband or asking details. Room numbers frequently change.
Pre-labeling specimens
Printing labels ahead before verifying patient ID at bedside can lead to placing on incorrect vials.
Unlabeled specimens
Collecting any blood sample without immediately labeling in front of patient skips identity verification.
Monitoring the wrong patient
In telemetry units, ECG leads or oximetry may be misplaced on the incorrect patient, leading to data attributed to the wrong individual.
Documentation errors
Incorrect patient details entered on paper or electronic forms due to illegible handwriting, autofill errors, or drop-down selection mistakes.
Compliance
To encourage adherence with positive patient identification protocols, healthcare organizations should implement:
Staff training
Annual competency-based education highlighting the critical importance of ID verification before venipuncture and consequences of errors. Emphasizes safety behaviours.
Visual reminders
Posters, stickers, whiteboards, or displays reminding staff to check ID before any blood collection or IV start. Keeps goal top of mind.
Checklists and forms
Update paper and EMR forms to mandate checkboxes, signatures, or other documentation that ID was verified before procedures.
Double checks
Incorporate identification confirmation by two staff members before venipuncture as standard practice. Multiplies redundancy.
Leadership involvement
Manager rounding to monitor compliance with patient ID process and provide real-time reinforcement or redirection. Demonstrates priority.
Staff accountability
Tie adherence to ID protocols to performance reviews and professional advancement. Incentivizes diligent practice.
A multi-pronged approach across policies, processes, technology, and culture is key to ensuring universal compliance with positive patient identification each and every time before venipuncture.
Special Considerations for Unique Populations
While the same two-identifier verification process applies broadly, additional accommodations may be needed for certain patient groups:
Language barriers
Use qualified medical interpreters to communicate and confirm ID if language discordant. Avoid using family as interpreters.
Hearing or vision impaired
Ensure available hearing aids, reading glasses. Use large text or braille. Speak facing the patient.
Cognitively impaired
Check wristband, rely on caregiver, use recent photograph if available. Avoid over-reliance on patient statements.
Pediatric patients
ID confirmation per hospital policy and institutional process. May utilize crib cards, anklets, or bassinet identification.
Transfusions and transfusable products
Type and screen/cross samples require two staff to verify UHID and documentation. Additional recipient confirmation required before administering products.
Policy and Protocol
Each facility should have specific written policies and protocols outlining the procedures for positive patient identification and two-person verification before venipuncture or any invasive procedure. This ensures consistent, standardized processes across the organization. Policy elements should include:
- Required use of at least two patient identifiers
- Direct communication with patient for verbal confirmation
- Checking wristband when available
- Cross-referencing identifiers against requisition and medical record
- Documenting completion of identification checks
- Two qualified staff members independently performing ID verification
- Defined escalation chain for any identification discrepancies
Program managers should oversee compliance monitoring, data analysis around identification issues, continued staff education, and updating policies to evolving best practices.
Technology Solutions
Emerging technologies offer ways to augment and strengthen patient identification practices:
Barcode systems
Scannable barcoded wristbands and labels integrated with electronic systems provide an added safety net for ID confirmation before venipuncture. However, barcode systems still require backup manual checks.
RFID
Radio frequency identification via wearable tags or chips allows electronic detection of patient identity at nursing stations or bedside. Can automatically populate information into EMR.
Biometrics
Use of fingerprint, facial recognition, iris scanning, or vascular pattern recognition to validate identity without reliance on wristbands or human observation. Still requires direct interface.
Point-of-care systems
Mobile devices like tablets allow staff to electronically verify patient ID and scan barcodes at bedside immediately before venipuncture. Can integrate with facility information systems.
Auto-populating labels
Portable or bedside printers that automatically print specimen labels with patient details only after scanning barcode or RFID chip on patient wristband. Links to medical record.
While promising for strengthening identification, new technologies should augment rather than replace sound nursing workflows and frontline human checks that are the ultimate backstop against error.
Summary
In summary, verifying patient identity using at least two identifiers immediately before performing venipuncture or any invasive procedure is universally regarded as the single most important and safety-critical step. This prevents mix-ups that can lead to wrong diagnoses, unnecessary repeats, downstream errors, patient harm, legal liability, and significant costs.
While ID confirmation is vital at all stages, positively identifying the patient through wristband checks and active inquiry at bedside just before vein puncture provides the final opportunity to intercept any potential mismatches and ensure the right sample is collected. Two-person point-of-care verification adds another layer of safety redundancy. Supported by training, documentation, technology enhancements, and institutional culture, robust adherence to patient identification protocols is essential to error prevention and the highest standards of care. When collecting any blood sample, accurately knowing “who’s vein is it?” matters greatly.