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Photo courtesy of Karl Oyri
One Size Does Not Fit All: An Initiative to Improve Pediatric
Patient Safety at Children’s National Medical Center
By Susan Stanley, MSN, RN
Long ago in the land of babes, a techno-savvy group of nurses began
questioning the lack of well fitting armbands for the children. “Why do I have to
tape this giant band on my 3 kilogram baby? It always falls off anyway. I’ll just
tape it to the crib – that will work.”
his may sound like a fairy tale, but in reality, properly fitting identification (ID)
Tbands for pediatric patients is a challenge. In order to provide an age-specific
ID band, a team of clinicians at Children’s National Medical Center (CNMC) in
Washington, D.C. developed a task force to develop and implement point of care
access for pediatric ID bands. Sounds simple enough, right? Three arduous years
after the task force began its work, the staff at CNMC is on the verge of the actual
implementation. This article will outline the journey of the CNMC task force to
identify the desired elements and develop a concept of age-specific ID bands, and
the challenges encountered in this process. In a future article, the process of
implementation of the plan as well as lessons learned will be discussed.
Review of Current ID Band Processes
“To help reduce patient identification errors, most hospitals use patient ID
bands that can either be worn on the wrist or ankle” (“Technology in patient
safety,” 2005). At CNMC, the admissions department staff prints a “one size fits
all” ID band during patient registration, and in most cases, applies it to the child’s
wrist. In the Neonatal Intensive Care Unit (NICU), this band is unsuitable, forcing
the nurse or clerk to create a patient ID band by trimming the patient name,
medical record number, and account number from a pre-printed label and affixing
it to a soft band used for neonates. This soft band is then applied to the baby’s
extremity. In the presence of skin fragility, the ID band is secured to the bed. If,
for any reason, the ID band is removed, a new band is requested from admissions
via phone or fax and delivered to the unit with an expected time delay. Temporary
ID bands are available on the inpatient units that require trimming of a pre-printed
patient label to fit on the band. A frequent problem necessitating application of a
replacement band is contact with moisture from the patient directly or from
patient care activities that denigrate the visibility of the patient information on the
band needed for proper identification.
A series of interviews and scheduled demonstrations for band printers and ID
band designs led to selection of a vendor, Zebra Technologies. Our important
selection criteria included:
• Appropriate ID band size choices for pediatric patients
• ID band reprint capability at the point of care
• Ability to upgrade ID bands in the future to include Radio Frequency
Identification (RFID) without need to purchase brand new equipment.
• Thermal printing to maintain water proof integrity of printed ID Band
information
Designing the ID Band Elements
The design of the new band was one of the unexpected challenges for the task
force. Initially, the task force thought it wise to limit the information on the ID
band to patient name, medical record number, and encounter/account number
because a new band would not need to be generated if the patient’s attending
physician changed, or if the patient transferred to another
Page 5 • 4th Quarter 2006
continued on page 6
More Member News
Bytes of Interest
Debbie Harris, Columbia, MD, was featured
in the Howard County General
Hospital publication, Wellness Matters,
Vol.10, No. 4, Winter 2007 in an article
called, “Helping Hand gives a Head
Start.” Debbie is a volunteer for the
Community Action Council of Howard
County serving those in need.
Focus on Military members: CARING
has 38 members currently servicing in
the US Military service. Lori Frank
(Navy) and Angela Stone (Army) are
currently in Iraq. Saturnino “Tony”
Chavez (Army) is stationed in
Wurzburg, Germany. Margaret
Beaubein (Navy) is in Okinawa. We
thank our troops for serving within and
outside of the United States.
Karen S. Martin, Omaha, NE, reports
that an international conference, The
Omaha System: A Key to Practice,
Documentation, and Information
Management, will be held April 12-14,
2007 in Minneapolis-St. Paul, MN.
Details are posted on www.omaha
system.org, The Conference is cosponsored
by Martin Associates and the
University of Minnesota School of
Nursing.
Michael J. Sutter, Champaign, IL, was
interviewed and featured in a Health
Management Technology article,
“Clinical Systems are a ‘Go’ in Real
Life.” See http://www.healthmgt
tech.com and select the article from
the January 2007 issue.
Pauline Ellis, MPA, BSN, RN, COHN-S,
CLCP, Lake Ridge, VA died January
2007. She was an active member of
CARING from about 1998 to 2005.
She attended many meetings. In the
2002, Vol. 17 No, 2, CARING
Newsletter, Pauline penned a fascinating
account of Anthrax and the US
Postal service (USPS). She was an
Occupational Health Nurse at the
USPS in Washington, DC and used
information management tools to help
solve healthcare problems - a true
informatics nurse. She also presented
her story at a CARING meeting. Our
condolences go to her family.
Please send items for future newsletters
to: Susan K. Newbold,
snewbold@umaryland.edu