Thursday, 13 August 2009

Q & A: Wristbands improve patient safety

Q: Dear Donal, I was wondering if it would be possible for you to comment on the NPSA 'standardising wristbands' safer practice notice that will come into force on 18th July this year, in the context of outpatient haemodialysis?

We are experiencing some problems with various interpretations of the safer practice notice when applied to outpatient haemodialysis patients.

I have been asked to ensure that every patient has a new identification wristband attached, each time they attend for outpatient dialysis.

The nurses are being put into a panic by being told that it is 'illegal' to give any drug such as epo/iron during dialysis (and even saline washback at the end of dialysis) unless there is a wristband in place.

Looking at the actual NPSA document, it appears that it applies to "hospital inpatients in general acute and community settings". This infers that outpatient haemodialysis, as a chronic disese treatment., is not within the remit.

I am sure that this is not the only dialysis unit to be asking themselves this question, and so I wondered if you could clarify. David Gledhill, Unit Manager - Haemodialysis, North Cumbria University Hospital NHS Trust

A: Dear David, as you say, the wristband Safer Practice Notice specifies that the recommendations are to implemented by " all NHS organisations in England and Wales that use patient wristbands". It also says that the SPN "applies to hospital inpatients in general acute and community settings." As such, it is not necessary for outpatients attending for haemodialysis at renal units to wear wristbands. However, the purpose of the Notice was to make patient identification as safe as possible and that must be a concern in respect of patients attending for regular haemodialysis. The Safer Practice Notice relating to correct blood transfusion, recommends in 3b photo identification cards for patients who undergo regular blood transfusions. While few dialysis patients get regular blood transfusions, many of course get intravenous iron and quite frequently people on dialysis are receiving intravenous antibiotics. It may be appropriate to consider whether patients undergoing regular haemodialysis would be safer with a similar approach.