Missing patient identification wristbands were causing problems for the phlebotomy team at Ulster Hospital and presented a significant patient safety risk. By changing the hospital’s wristband supplier and educating health professionals about the issue, the phlebotomy team reduced the number of patients without a wristband from up to 20 a day, to just 2 a week. This work was featured in our ‘Bottoms up’ film. Here we look in more detail at what the team achieved and how they did it.

Identification wristbands are a critical part of making sure the right patient receives the right care, but the phlebotomy team – who see around half of all patients at Ulster Hospital each day –repeatedly came across patients with either no identification wristband, or one where the writing was illegible.

‘A patient can’t have anything done to them without a wristband or some form of identification,’ explains phlebotomist Heather George. ‘As a team, we were so frustrated by it, because it happened all the time. You had to find somebody to put a wristband on the patient, because patients have to have wristbands on all the time, 24 hours, when they’re in hospital.’

Tackling wristband quality issues

An audit by the team revealed that around 18-20 patients a day had a missing or illegible wristband. There were three main contributing factors: the quality of the wristbands; patients being able to remove their wristbands themselves by breaking them or stretching them; and health professionals removing wristbands to carry out procedures such as inserting a cannula and then not replacing them.

The team tested a variety of wristbands to find out which ones met their requirements of being waterproof and not easily removed by patients. Having identified a clear winner, they began the process of ending the hospital’s existing supply contract. This was far from straightforward, but with perseverance, they secured a new contract for the wristbands that performed best in the tests.

Making it everyone’s responsibility

Focusing on just one ward to start with, the team talked to people about the role that wristbands play in patient safety and avoiding potentially dangerous incidents, such as giving the wrong medication to someone. They worked closely with nurses to explain the importance of checking that every patient has a wristband and replacing any that are missing, and put posters up on the wards as a reminder.

They also added a wristband information sheet into the patient pack for pre-arranged admissions, so that patients knew they could ask for a new wristband if theirs was removed or fell off.  

Inspiring results

With good results on one ward, the team rolled the initiative out across a whole directorate. They exceeded their target of reducing the number of missing or illegible wristbands by half and managed to cut these incidents by 95%. These results have been sustained, with a September 2015 audit showing 98% compliance.

‘It makes life just so much easier. You can get in, get through the list and come out again, with no chasing around or having to come back and do it again,’ comments Heather. ‘From a patient safety point of view, it’s a nice feeling to know you’ve done something to ensure their safety, because it was a big issue, with big implications for a serious incident.’

The work has had a much wider impact too. The team are now helping with the selection of wristbands to be used in all hospitals in the region. 

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