Testing unidentified patients

ED unregistered patient form FINAL.doc

I am curious how others handle this as well.  For our Emergency Department, we have something similar to Nina. We have a sheet of paper with a unique barcode on it.  Once a patient is registered, they place the registration info on that paper and send to the lab for me to match that patient with those results.  We keep these forms in a binder with each of our ED meters.  I supply the unique barcodes. This process works well for us, when used properly.

My issue is with visitors or outpatients who are not banded.  Our Medical Assist team will respond when a visitor/outpatient is feeling ill or passed out and will often perform a whole blood glucose, using random numbers as the patient identifier.  They will use a meter that is assigned to a nearby location.  That then shows up on my invalid ID screen.  Some of these folks are never admitted, especially our visitors.  I know that the mind set of these responders is to assess the person quickly but I have to keep reminding them that a WBG really IS a lab test and all lab tests require a provider's order.  I am trying to set up a meeting with our Medical Assist team to discuss this and look forward to hearing how others are handling it in their facilities.

Mary

PS: I'm attaching our ED unregistered form here, if it helps anyone.

Our policy is that any visitor or employee who feels ill must be sent to ED Triage to be evaluated and have a glucometer test.  I won't say it is followed 100% of the time, but if a get an odd number I follow-up with the manager and employee and if I find out it was a self test or visitor I reinforce that this is not allowed and you must triage the patient or employee.  Once in triage, they can use our unique barcode and form which is a similar process to the one listed.

Mary - you may want to get your Risk Management team involved in the discussion.

We had this discussion some years ago at our facility.  I first asked if nursing had a "good Samaritan" type policy that might cover hospital staff that give first-responder type assistance to visitors, family members, etc., - not just for WBG but for vital signs, blood pressure, etc. as well.  They indicated there was no such policy.  I asked if they supported the testing of individuals that did not (or would not) ultimately register for care, which would mean that the care that was given could not be documented electronically.  They indicated no.  This allowed for a clear statement on the part of the facility's administration as to where they stood.

  I won't say that it never happens, but since I have been able to state the facility's official stance on providing care that cannot be documented, the occurrences of doing random WBG are very, very few - at least on the hospital meters.

In my institution we created a patient ID specific for emergency cases ( used  for employees, visitors ,  family members, patient's that are not yet registered and in need of immediate medical attention etc.), we have an emergency log sheet that the units use to document including the triage area. If the RRT ( rapid response team is called, it is the RN responsibility to inform POC that they used the emergency patient ID number).

POC users will also have to call the POCC with all pertinent information every time the emergency number is used.

Hope this helps.

My institution is similar to Kathleen's.  We have a "crash barcode" in each carry case to be used for emergency purposes (used for patients without wristbands, visitors and/or family members in need of immediate medical attention etc.).  The staff is to enter a patient identifier in the custom comment of the patient's result in the meter.

Staff is to follow up with a "crash barcode form" which includes patient name, ID number, result, date and time.  This form is sent to me, the POCC, to match with "crash barcode results" pending in the computer.  If a form is not sent, I follow up with the nurse manager of the unit.

If there is no identification entered into the custom comment of the result, it is considered an "incident" of non-compliance.  After three incidents of non-compliance, the staff member is locked out of the meter until remediated.

I do not take verbal information; only written documentation.

The process has worked very well, but it's an ongoing battle...but worth it for the patients.

thank you all for your responses

I have a similar system to Donna and Kathleen.  I will also write up as an occurrence to Quality if POC does not have resolution from the department in a timely manner.  But that is rare now.  

Would anyone be willing to share the form they use to communicate with supervisors and staff when there are "incidents of non-compliance"? We had been previously been using email for this information but need to move to a more formal process of documenting and maintaining records of correction.