The ideal temporary identification would use sex alongside names, numbers and dates of birth that are recognisably temporary, unique, and different from other unidentified patients being treated simultaneously. Whilst the absolute ideal cannot be reached within current IT systems that would reject dates of birth that are clearly temporary rather than real (eg 30 February) the alert Safer temporary identification criteria for unknown or unidentified patients and its recommendations represent consensus on the best possible options and are compliant with the existing guidance listed below.
The alert requires:
Edited, randomised phonetic alphabet list for temporary names
Use of randomly generated combinations of first and surname from an edited phonetic alphabet eg Foxtrot Whisky. The edited list in the document below excludes names (eg Juliet, Mike) or those that risk confusion in a healthcare setting (x-ray). Please re-sort this list again in random order before locally using, to reduce the risk of using the same name at the same time as a neighbouring trust that has switched to this naming method around the same time as you.
Randomised temporary number
Prefix a randomly generated seven-digit number with the relevant standard NHS trust code (eg RPH). If this is not possible due to local IT system incompatibility then any randomly generated series of digits should be used, with the trust code or name added to the patient wristband. Compatibility needs to be considered for any IT system an unknown/unidentified patient could link to eg radiology and pathology systems including blood transfusion. A local team member with skills in Excel or similar programmes will be able to generate a list of seven-digit random numbers without duplicates. Alternatively there are a number of random number generators available on the internet (ensure you search for and select one that generates a ‘unique’ list ,ie excludes duplicates).
An estimated age
1 January plus estimated year of birth should be used. An individual estimated age is safer than a standard age for all patients to ensure females of potential child-bearing age are given Rh D and K-negative red cells and the age-related needs are met for certain blood products (eg non-UK plasma from countries with a low risk of variant Creutzfeldt - Jakob disease for patients born on or after 1 January 1996).
If sex cannot be identified due to severe injuries, and age estimation indicates, temporary identification should default to female sex to ensure females of potential child-bearing age are given Rh D and K-negative red cells.
This temporary naming and numbering system is consistent with:
British Society for Haematology Guidelines:
These guidelines define best practice as "at least one unique patient identifier, often a temporary emergency ID number, together with the patient's sex, must be used". Additionally there must be robust mechanisms for the issue and later withdrawal of these temporary ID numbers and for the subsequent linking of any duplicate patient's clinical and transfusion laboratory records. The guidelines also explain the importance of estimated age instead of using the same DOB for any unidentified patient which can lead to misinterpretation of pathology results because normal ranges are given by age, and may not ensure females of child-bearing age are given Rh D and K-negative red cells and the age-related needs for certain blood products (eg variant Creutzfeldt-Jakob post 1996).
NHS England Emergency Preparedness Resilience and Response Core Standards 2017/2018:
"The organisation has arrangements to ensure a safe identification system for unidentified patients in emergency/mass casualty incident. Ideally this system should be suitable and appropriate for blood transfusion using a non-sequential unique patient identification number and capture patient sex."
Further evidence on the importance of adopting this temporary naming and numbering system can be found in:
Right blood, Right Patient (Section 8,page 51) describes identification errors in relation to key identification data sets, ie first name, last name, date of birth and unique identifier, no identification bands and bedside check not undertaken.
- National Quality Assessment Service for Blood Transfusion Laboratory Practice: questionnaire findings
Annual scientific meeting of the British Blood Transfusion Society, Poster 57,
page 53. Information received from 333 participating laboratories in 2013
indicated that 53% of hospitals used ‘unknown’ or equivalent for patient name
and also assigned sequential numbers. Findings also indicated that only a
minority of labs have introduced systems to address the issue.