Mismatching blood in transfusion operations can be deadly. So when a national audit revealed some worrying gaps in safety measures, Gateshead Health foundation trust was quick to respond

The consequences of giving the wrong blood to the wrong patient can be fatal. Among the many safety checks of blood for patients waiting transfusion, confirming patients' identities by matching prescription details with the patient's wristband has to be one of the most straightforward.

But the National Comparative Audit of Blood Transfusion 2003 showed, in some hospitals, that this simple expedient to minimising the risk of an adverse outcome was being overlooked and that more than 30 per cent of patients did not have a wristband. The audit also revealed that it was common practice not to ask a patient to wear one for a blood transfusion.

Having recognised its own poor level of compliance, Gateshead Health foundation trust decided to instigate a culture of positive patient identification through an initiative focusing on every stage of the care pathway.

'Patient ID was written into a few policies around the trust but there was no stand-alone policy,' says Lillian Bennett, blood transfusion liaison nurse for Gateshead, 'which makes testing compliance difficult because when you have an audit you must have a standard.'

A working party from pathology services set about putting together a patient identification policy for all diagnostic interventions - from phlebotomy to x-ray and physiotherapy - collecting input from across the trust's clinical areas to allow for distinct modifications. The group also decided on an implementation timetable and strategy for the policy, which was ratified in June.

All areas of care

There was then a three-month amnesty, with 'no wristband, no diagnostics' posters announcing the imminent launch of the new guidelines. Audits continued throughout this period and changes to procedure were introduced in those areas with poor compliance. Staff pay checks and patient leaflets also carried news of the improvements to safe practice.

Barcoded wristbands now provide higher levels of legibility and accuracy, and their use can be applied across all areas of care. Newborn babies can now have their own identification number rather than their mother's, a system that offers more security in the event of transfer to another unit. Barcodes on patient records or photocards may be used to identify outpatients and regular users of transfusion services.

Compliance in the few days after the policy's introduction rose to 98.5 per cent, and in June 2006 a further audit showed wristbands being used in 96 per cent of cases.