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One Size Does Not Fit All:
An Initiative to Improve Pediatric Patient Safety at Children’s National Medical Center
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room. This set of data would require
3 lines of text on the band. Next,
feedback was solicited from several
hospital departments to determine
any other required elements.
Additional requirements and
considerations were discovered
during this design phase:
• The Radiology and Imaging
department and the Operating
Room required the date of birth
(DOB) as an identifier to
differentiate same name and
similar name patients.
• Hospital administration required
inclusion of the CNMC Bear
logo
• Patient’s hyphenated names
would not fit on one line with
current limited print characters.
• Adding DOB and separating the
first and last names on 2
separate lines increased lines of
text on the band from 3 lines to
5 lines
• Barcodes for future use and
current technology
Barcode Technology
In order to prepare for future
barcode technology envisioned at
CNMC, the task force team realized
that addition of a barcode to the ID
band was needed. They proceeded to
learn more about barcode technology
than they ever expected. First
consideration was given to using a 2
dimensional barcode that would
contain the required patient data
elements. However, the equipment
currently used in Laboratory
Medicine department cannot read a 2
dimensional barcode. They use
barcode scanning of a linear, onedimensional
barcode on the received
specimen label. Because barcode
scanning for nursing and patient care
activities is not yet in use at CNMC, the team decided to begin with a linear, one
dimensional barcode that only captures the patient’s medical record number. In the
future, use of either 2-dimensional barcoding or RFID is anticipated and
Laboratory Medicine expects to upgrade their system accordingly.
Pilot Testing
Before advancing further in the project, a pilot test of proposed ID bands was
implemented for one week on an inpatient psychiatry unit, a surgical care unit,
and the NICU, to determine the integrity of the material, security of the adhesive
used, and ease of use by staff. The bands were pre-printed with “TEST BAND”
and were applied to the patient along with the official ID band in current use.
Informational letters were given to the parents to explain the project.
Next, a survey was conducted to elicit feedback on the piloted bands from
parents, staff, and patients. The feedback results included the following:
• The majority of the staff responses indicated approval of the new band. They
found it easy to use and apply. All staff responses showed preference of the
band to display the patient’s last name on the first line in bold font and that
the pediatric and adult bands be the same width. Three of the staff responses
suggested a bigger font size. One response suggested addition of a data
element - medical service.
• The adhesive area of the band was less secure for older children because
they could pick at the seam.
• Parent responses indicated the desire for a band that would fit their child
appropriately instead of attaching it to a crib or bed.
This feedback led to a modification of the design of the adhesive area by the
Figure 1
Serrated Slits in the
Band
Adhesive Overlap Area
vendor to replace the smooth
even seam with a serrated seam.
This seam format strengthens
adhesion as well deters a child
from lifting the entire edge. The
serrated seam in a jagged format
adheres more easily and will be
more difficult for the child to
lift. If the child picks at the
edges and lifts a seam, the
serrated portion will shred but
not lift the whole edge. See
Figure 1. The team also elected
to standardize the width of the
ID bands for neonatal, pediatric,
and adult as well as a band format to print the last name on the first line in bold
font. Figure 2 shows the new ID band design.
Figure 2
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