Patient identification is the foundation of safe healthcare delivery. Before a medication is administered, a specimen is collected, a procedure is performed, or a blood product is transfused, the patient must be correctly identified. The two-identifier verification process that healthcare organizations use to prevent identification errors, typically name and date of birth confirmed against a barcoded wristband, is one of the most widely implemented patient safety practices in clinical medicine.
It is also one of the first patient safety practices to degrade during an EHR downtime event.
The barcoded wristband that makes two-identifier verification fast, reliable, and scannable depends on the EHR to generate it. When the EHR goes offline, the standard wristband printing workflow stops. Organizations without a functional electronic backup revert to handwritten wristbands, verbal identification, or in some cases no formal identification process at all for patients who are registered during the outage. Each of these alternatives introduces identification risk that the barcoded wristband was specifically designed to prevent.
Why Identification Errors Are Particularly Dangerous During Downtime
Patient identification errors are dangerous at any time. During downtime events they are particularly dangerous for several compounding reasons:
Clinical decisions are being made with incomplete information. When the EHR is unavailable, providers may not have access to the patient’s complete medication history, allergy information, or prior clinical documentation. They are already operating with less information than they would have under normal conditions. An identification error in this context means that the limited information they do have may belong to the wrong patient, compounding an already information-poor clinical situation.
The volume of manual processes is elevated. During a downtime event, clinical staff are managing more manual processes simultaneously than they do under normal operations. The cognitive load of managing handwritten records, verbal communications, and paper forms increases the probability of errors across all manual processes, including identification verification steps that are normally automatic.
New patients arriving during the outage have not been formally identified through the EHR system. A patient who arrives during an outage and is registered using a paper process may have a handwritten wristband with only partial identifiers, no wristband at all while awaiting registration completion, or a wristband that was written incorrectly and cannot be corrected through the normal EHR workflow. These patients are at elevated identification risk for the duration of their encounter and potentially beyond it if the wristband information was not accurately captured.
The clinical team may not recognize that identification safeguards are degraded. Staff who are focused on managing the clinical and operational demands of a downtime event may not consciously register that the identification verification process they normally rely on is not functioning correctly. The automatic nature of barcode scanning means that its absence requires explicit attention that the demands of a downtime event make difficult to sustain consistently.
How dbtech Maintains the Identification Infrastructure During Downtime
dbtech’s Downtime Solution is specifically designed to maintain the barcoded identification workflow during an EHR outage, which means the patient safety safeguards that depend on that workflow continue functioning regardless of EHR availability.
The mechanism is the pre-assigned downtime encounter number bank. During implementation, dbtech is configured with a bank of encounter and medical record numbers that are reserved specifically for downtime registrations. These numbers are coordinated with the EHR so that they do not conflict with numbers the EHR will generate when it comes back online. When a patient is registered during a downtime event, whether as a new patient or as an established patient whose wristband needs to be reprinted, dbtech assigns a downtime encounter number from this pre-loaded bank and uses it to generate a properly formatted barcoded wristband.
The barcoded wristband generated by dbtech during a downtime event works exactly like an EHR-generated wristband. It can be scanned at the bedside before medication administration. It can be scanned in the lab before specimen collection. It can be scanned in radiology before imaging. The barcode scanning workflow that the clinical team depends on for the second identifier in their two-identifier verification process continues without interruption, and without any visible difference in the patient experience.
The Specific High-Risk Clinical Workflows That Depend on Identification
Several specific clinical workflows carry elevated identification-error risk during downtime events and deserve specific attention in any downtime preparedness program:
Medication Administration
Medication administration using barcode medication administration (BCMA) is the workflow most directly affected by identification infrastructure degradation. Nurses who cannot scan a wristband before administering a medication must use manual two-identifier verification, which is slower, more error-prone, and provides no electronic audit trail confirming that verification occurred. Organizations that maintain the barcoded wristband through dbtech during a downtime event can continue BCMA scanning with minimal disruption to the medication safety workflow.
Laboratory Specimen Collection
Laboratory specimen collection requires patient identification at the point of collection to prevent specimen misidentification, which the College of American Pathologists identifies as a significant patient safety risk. Handwritten labels on specimens collected during a downtime event create specimen identification risk that travels with the specimen through the entire testing process and affects the patient whose result is returned.
Blood Product Transfusion
Blood product transfusion has the most severe consequences of any clinical workflow where identification errors occur. The pre-transfusion identification protocol, which requires a two-identifier verification at the patient’s bedside immediately before hanging the product, is a mandatory patient safety requirement that does not permit shortcuts regardless of system status. Organizations whose blood bank systems depend on EHR connectivity for product labeling need specific downtime protocols for blood product administration, and those protocols should include how patient identification is verified when the EHR is unavailable.
Procedure Verification
Procedure verification in perioperative settings includes the surgical safety timeout, which requires correct patient identification as one of its mandatory elements. A surgical timeout conducted on a patient with an unverified identification, or with a handwritten wristband whose information could not be confirmed against an EHR record that was unavailable, is a patient safety process that has been partially compromised.
Building Identification Continuity into the Preparedness Plan
The most practical patient safety investment that any downtime preparedness program can make is ensuring that the barcoded identification infrastructure remains functional throughout every downtime event. This means:
- Verifying that the downtime encounter number bank is adequately sized for the expected volume of patients who would need to be registered during an outage lasting up to 48 hours at the facility’s typical daily census.
- Confirming that wristband printers connected to the downtime workstations are operational, stocked with wristband material, and included in the monthly workstation verification described in our post on what good downtime governance looks like at the department level.
- Establishing a specific protocol for reprinting wristbands for patients whose wristbands are removed or become unreadable during a downtime event, so that the identification workflow does not degrade for patients who are already admitted when the outage begins.
- Including patient identification continuity as a specific evaluation criterion in every downtime drill, with observers specifically looking for whether clinical staff are using the barcoded identification workflow or reverting to manual verification during the exercise.
To learn how dbtech’s downtime solution maintains barcoded patient identification throughout an EHR outage, request a demo or contact our team to discuss the wristband configuration for your specific facility environment.