Patient Identification Part 2

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Patient Identification (Part 2)
29th September 2009
Presenters Dafydd Thomas Mark Thomas
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NHS Reality
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NHS Reality
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Mrs Jones Reality
NHS Reality - MITU
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Mrs Jones Utopia
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The Solution

• Every patient must be uniquely identified in an
  unambiguous manner.
• This identification must be tied to all requests,
  medications, procedures, devices etc. applied to
  the patient.

Australian Commission on Safety and Quality in
Healthcare (2008). Technology Solutions to
Patient Misidentification. Report of Review.
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NPSA Recommendations

• Use the NHS number as the national patient
  identifier on
• Patient correspondence
• Patient notes
• Patient wristbands
• Electronic records
• Educate patients on its use
• Primary Care organisations to inform new patients
  of their number

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NHS Number First name Last name DOB Sex
NPSA Standard
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First name Baby All Last name Thomas gtOne D
OB 21 June 2007 All Sex Male 50 NHS
Number N4Babies
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The Times Monday 28 September 2009
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To err is human but to really screw things up
takes a computer
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Safety System errors Aviation Design
F1 Technology Tescos Human Error/Violatio
n
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The Requirement

• Identify a patient unambiguously using Gold
  Standard demographic
• Use identification for all patient related
  activity
• Link electronic records held in different
  systems, accurately unambiguously

Prerequisite to the development of patient
centric record e.g. Welsh Clinical Portal
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IHC Projects

• Duplicate Records Project
• 5.5m invested from 2004 2008
• Reduction in duplicate records
• Reduction in missing NHS numbers

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Duplicate Records Results
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IHC Projects

• Bar code Labelling Project
• Barcode label printers supplied to GP surgeries
• Used for Pathology test requests
• Correct, legible patient information on request
  forms
• Patient identifiers scanned into hospital systems
  eliminating manual entry

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Labelling Project Results
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Background

• Multiple records
• and identifiers for same patient

• Separate departmental systems
• Separate manual (error prone) registration
  processes

(Multiple records and identifiers for same
patient)2
Trust Merger

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Merger Consequences - ABM

• 1 Patient with records potentially in
• 2 PAS
• 2 Pathology
• 2 Radiology
• 2 Theatres
• 4 Pharmacy Systems...

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Scale of the Problem - ABMU

• 2 PAS Duplicate Potential Duplicates
• iPM
• 170,000 duplicates
• 40,000 potential duplicates
• PIMS
• 5,000 duplicates
• Across both PASs
• 100,000 duplicates
• 50,000 potential duplicates

• 1 Person resolving duplicates
• 3.6 years to resolve potential duplicates
• 54 years to amalgamate case notes of duplicate
  records

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Impact of the Problem

• Clinicians presented with long list of results
  for patients that could be the same
• 2000 David Jones
• 25 of Stephen Davies share date of birth with
  another Stephen Davies
• 15 of records with surname Jones, Davies,
  Williams, Thomas or Evans

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BBTS into Google

• British Blood Transfusion Society

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BBTS into Google

• Big Bad Toy Store
• Bethesda by the Sea (Chapel - USA)
• British Blood Transfusion Society

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Impact of the Problem

• Patient information missing (or incorrect) when
  making key clinical decisions
• Unnecessary tests re-ordered for patients as
  results contained in other unknown records

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Identification across Wales

• Identify patients across Wales
• Regional/National Pathology services
• Patients moving across boundaries
• (Welsh) Clinical portal
• Local identifiers not enough may conflict with
  other organisations identifiers
• The NHS number is only part of the solution

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NHS number

• Unique number for every person registered with a
  GP practice in England and Wales
• Welsh Demographic Service (WDS) is the master
  store for Wales fed from GP systems
• Use recommended by NPSA from Sept 09

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NHS number

• Issues with relying solely on the NHS Number
• Manually input into disparate clinical systems
• 814 pathology radiology results where same
  hospital number has gt1 NHS number
• Not always available - 50,000 records without NHS
  no. in results reporting database
• Blood Gas Scenario

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Requirements a reminder

• Link patient based information across different
  departments/organisations (including merged
  organisations)/Primary Care
• Provide Gold Standard demographic record in
  order to
• Safely consistently present all relevant
  information to clinicians involved in care

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Creating the Gold Standard

• Patient search
• Consistent process
• Staff training/awareness
• Registration obtain NHS no. from WDS in real
  time
• Batch trace with WDS to ensure full NHS no.
  completeness
• Utilise automatic address searching tool

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Creating the Gold Standard 2

• Amend demographics at PAS level
• Shared to other systems
• Up to date demographic available to all
• No manual entry of numbers
• Bar coded labels
• Electronic test requesting

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eMPI What it does

• Identifies and automatically links duplicate
  records
• Identifies potential duplicates
• Enables potential duplicates to be managed in a
  live environment protecting the Gold Standard
• Signposts to records in other systems
• Shares Gold Standard demographics with other
  systems
• Enables safer workflow between departments

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Welsh eMPI

• IHC procuring one common eMPI
• Will be implemented 6 times in LHBs same
• Prerequisite to safely identifying patients
  across the PAS, other systems and service
• Powers local systems safely
• Powers the WCP - which pulls all the patients
  data based on their ID from the different systems
  into a common view of the record
• Contract signed November 09

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eMPI

• This is only the
• End of the beginning

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The Bro Morgannwg MPI

• MPI linked to PAS and clinical systems
• Matching algorithm determines definite and
  potential duplicate records
• Results
• 45,000 duplicate records reduced to 5,000
  duplicates
• 40,000 PAS records ( case notes)
  amalgamated/volumes linked
• 7 potential duplicates (4 definites) identified
  and resolved each day
• 1 patient, 1 record
• Gold standard maintained

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Daily Duplicate Registrations
Average 4 per day
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Key Principles

• New consistent
• Standards need to be in place for patient ID
  across all departmental systems
• Application of these standards requires
  significant changes in departmental workflow
• Adherence to these standards needs to be
  proactively monitored and assured

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Key Principles 2

• Ongoing resource to be allocated
• Reallocation of resource needed to provide
  sustainable robust patient identification
  processes Safety and Financial Reasons
• Information must be in real time to maintain gold
  standard and support operational processes

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The How to Guide

• Reducing harm as a result of patient
  identification errors
• Achieving the Gold Standard in patient
  identification

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Driver Diagram

• Support front-line staff to reduce the
  opportunity for patient identification errors
• Develop back room functions to reduce the risk
  of patient identification errors and provide
  clinical staff with a more complete record of care

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Process Measures

• Compliance to searching process
• Proportion of patients with standardised
  bar-coded wristbands
• Number of new duplicates created per day

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Outcome Measures

• Number of cases of harm due to patient
  misidentification errors
• Number of cases of harm where critical
  information is missed as patient information is
  unlinked across systems

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Driver 1

• Support front-line staff to reduce the
  opportunity for patient identification errors
• 6 interventions
• Redesign patient searching process
• Redesign patient registration process
• Redesign birth death notification processes
• Promote the use of NHS Number as unique patient
  identifier
• Identify all patients using standardised
  bar-coded wristbands
• Use NHS Number when requesting tests and other
  services

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Driver 2

• Develop back room functions to reduce the risk
  of patient identification errors and provide
  clinical staff with a more complete record of
  care
• 7 interventions
• Implement an Enterprise Master Patient Index
  (EMPI)
• Identify and resolve potential duplicate and
  duplicate patient records
• Amalgamate duplicate records
• Link disparate systems
• Batch trace NHS Number for existing records
• Provide a patient-centric view of information
• Maintain Gold Standard in patient identification

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Appendix 1

• Achieving change in practice
• Getting started
• Use the Model for Improvement
• Forming the Team
• Setting Aims
• Barriers that may be encountered
• Measurement

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Conclusion

• Organisations need to review their administrative
  processes and patient identification policies to
  minimise risk of duplicate records
• An Enterprise Master Patient Index is essential
  to managing patient records safely
• A successful project has already been completed
  in Wales, so it is possible for other
  organisations to implement similar solutions
• The 1000Lives Campaign methodology can assist
  organisational teams implement their local
  solutions successfully