Bedside Identity Check

The bedside check is the final barrier against transfusing the wrong blood to the wrong patient. Most serious ABO incompatible transfusions occur because the check was missed, rushed or done away from the patient. The check is performed immediately before each unit is started, by two trained staff or by one staff member with a validated electronic system, and it must be performed even in emergencies.

Safety preparation.

• Gather the prescription, the patient wristband, the unit and the transfusion record.

• Perform the check at the bedside, with the patient present, in good light, without interruption.

• Perform the check for each unit, and never carry out checks for several patients at once.

Special groups.

• Unconscious or unidentified patients: the patient must wear an emergency identity wristband with a unique number matched to the sample and the unit.

• Children and neonates: identity is checked with the parent or guardian and the wristband, and with the unique hospital number.

• Language barrier or hearing impairment: use an interpreter and rely on the wristband.

Checks of the patient.

1. Ask the patient to state full name and date of birth, if able. Do not read these out for the patient to confirm.

2. Compare with the wristband: full name, date of birth and hospital number.

3. Confirm consent and the baseline observations.

Checks of the prescription.

1. Patient identifiers match the wristband.

2. Component, quantity, special requirements, rate and indication are correct.

3. The prescription is signed and the date is correct.

Checks of the unit.

1. The unit number and the component on the label match the compatibility tag and the prescription.

2. The patient identifiers on the tag match the wristband.

3. The ABO and RhD group of the unit is compatible with the recipient, using the rules for that specific component.

4. The expiry date and time are valid, and the unit is within the time limit out of storage.

5. Special requirements are met (irradiated, cytomegalovirus safe, washed, antigen negative).

6. Visual inspection of the bag is acceptable: no leaks, no clots, no unusual colour or turbidity, no signs of haemolysis (a purple or dark plasma layer in red cells), and swirling visible in platelet concentrates.

Equipment. The prescription chart, a compatibility tag or label, a blood giving set and, in electronic systems, a validated barcode reader.

Procedure.

1. Both checkers wash their hands and approach the patient together.

2. One person reads aloud the details from the unit and the tag, and the other reads the wristband, and both confirm the match independently.

3. The patient is asked to state name and date of birth, and the answer is compared with the wristband.

4. Both sign and record the time and the unit number on the record.

5. Take baseline temperature, pulse, blood pressure, respiratory rate and oxygen saturation.

6. Start the unit, and remain with the patient for the first 15 minutes.

If any discrepancy is found. Do not start the unit. Return it to the blood bank with the paperwork, and inform the senior nurse or clinician. Do not correct labels, and do not use a unit from another patient. Obtain a new sample if there is any doubt about the identity of the patient.

Electronic systems. The patient wristband and the unit barcode are scanned, and the system confirms the match. A manual back up check is still required where the system fails.

Complications of a failed check. ABO incompatible transfusion with acute haemolysis, renal failure and death, and transfusion to the wrong patient with exposure to infection or alloimmunisation.

If a wrong unit is discovered. Stop immediately, keep intravenous access, assess and treat the patient, retain the unit, send urgent samples and inform the blood bank and a senior clinician. Report the incident.

Documentation. Names and signatures of both checkers, time, unit number and results of checks.

Quality assurance. Observe practice at the bedside, audit the quality of checks and train staff in human factors, including the effect of interruptions and haste. A rule that no one is interrupted during a check is helpful.