What are the key elements organizations need to understand regarding the use of two patient identifiers prior to providing care, treatment or services ?

Any examples are for illustrative purposes only.

Intent
The intent of the requirement is to reliably identify the individual as the person for whom the service or treatment is intended and to match the service or treatment to that individual. The glossary of the accreditation manual defines a patient identifier as "Information directly associated with an individual that reliably identifies the individual as the person for whom the service or treatment is intended. Acceptable identifiers may be the individual's name, an assigned identification number, telephone number, date of birth or other person-specific identifier."  Use of a room number would NOT be considered an example of a unique patient identifier. 

Additional examples of identifiers may include, but not limited to: 

• An assigned identification number (e.g. medical record number, etc).
• Telephone number or another person-specific identifier
• Electronic identification technology coding, such as bar coding or RFID, that includes two or more person-specific identifiers 

While standardization of the identifiers used is beneficial, there are settings and situations when variations may need to be employed. For example, in an outpatient setting where ID bands may not be used as an information source, an infant or toddler, an unresponsive patient, etc. The organization determines how accurate patient identification will be completed in these types of situations.   The two patient identifiers should be consistent within each setting, not just whatever the individual practitioner or staff person wishes to use

Armbands
An armband in and of itself is not a patient identifier, rather an example of a source where patient identification information may be located. It is the person-specific information that is the "identifier," not the medium on which that information resides.
The Joint Commission does not require the use of arm bands. However, when armbands are used as a means of conveying patient/resident identification information, the band must be attached to the patient/resident at all times. Simply placing it on the bedside table or taping it to the bed would not be acceptable. 

Non-communicative Patients/Residents
For those individuals who are non-communicative or are confused, each organization determines what process will be used to safely identify these individuals.  Such expectations must be clearly communicated to staff, and should be based on promotion of individual safety, not convenience or workflow.

Applicability to Nutrition Services
At a minimum, the requirement applies whenever the patient/resident requires a special diet or the meal/snack that is being delivered is part of a special diet. To ensure consistency, organizations have found it easier to implement this requirement by applying it to all patients/residents receiving diets or snacks. 

Containers used for blood and other specimens
The intent of the goal is met when the patient is correctly identified using two identifiers and the containers are labeled with two identifiers in the presence of the patient.  In practice, it is relatively common to label a urine container prior to giving it to the patient for collection, as long as  the individual collecting the specimen verifies the identity of the patient using two patient identifiers and then labels the container while in the presence of the patient.  Labeled containers which are not used due to failure of the patient to provide a urine specimen must be IMMEDIATELY discarded.  The practice of pre-labeling blood tubes prior to seeing the patient and matching them at the time of collection is not acceptable.

Use of temporary names
Under some circumstances, a patient's identity may not be able to be verified and a temporary means of identification must be used. An example of such circumstances may include an injured, unresponsive patient presenting to the emergency department.  Although not addressed in the requirements, a temporary "name" (e.g., John Doe) and an emergency department number or medical record number may be assigned.
These identifiers could then be used to identify the patient and match against specimen labels, medication orders, blood product labels, etc. In this process, formal identification of the patient should occur as soon as possible and once confirmed this identifying information should be used instead of the temporary identification.  Ultimately, the organization determines how such scenarios should be managed. 

Use of an alias to protect anonymity
There are no Joint Commission standards that address this practice. Organizations should evaluate risks associated with this practice. However, if an organization implements use of an alias, two patient identifiers must still be used, as defined by policy.