Quality in practice: implementation of hospital guidelines for patient identification in Malawi.

QUALITY PROBLEM OR ISSUE: Patient identification in a teaching hospital in Malawi. Initial assessment 34% of hospital staff recalled a misidentification event in the preceding year; less than 10% of staff described the use of unique patient identifiers other than name when taking blood samples and 98% of laboratory requests included no identifiers other than name. CHOICE OF SOLUTION: Hospital identification guidelines based on WHO guidelines to introduce identification wristbands; encourage routine use of an identifier in addition to name on laboratory requests and improve bedside identification procedures. IMPLEMENTATION: Provision of wristbands, educational materials, workshops and distribution of written materials to promote the new guidelines with regular monitoring. EVALUATION: At 5 months 65% of in-patients wore wristbands compliant with WHO identification guidelines and 55% of cross-match forms used a second identifier. Only 10% of non-cross-match forms had a second identifier. The use of recommended bedside identification procedures was rarely observed. Guidelines were welcomed by both staff and patients; identification wristbands were found useful in difficult identification situations. Lack of time, staffing and unimportance of procedures were given as reasons for not following guidelines. LESSONS LEARNED: Identification procedures can be rapidly introduced in a developing world context in a manner acceptable to patients and staff. Tangible tools such as wristbands appeared easier to implement than changing practice by education. Recommendations for wider implementation include increased engagement of patients in addition to healthcare and management staff; use of rejection criteria for inadequately labeled samples; generating further evidence about the prevalence, type and consequences of patient misidentification events.