Letter to the Director
CALL ME BY YOUR NAME. Protected patient: Reflections on removing the patient's name in Patient Safety
CALL ME BY YOUR NAME. Paciente protegido: reflexiones sobre lo que implica privar del nombre propio para la Seguridad del Paciente
A. Romeraa,
, A. Garridoa, M. Lemaa, A.M. Contrerasb
Corresponding author
andreilla111@hotmail.com
Corresponding authors at: C/ Rodríguez San Pedro 72. CP, Madrid, 28015, Spain, Tel.: +606642609 /915430966
Corresponding authors at: C/ Rodríguez San Pedro 72. CP, Madrid, 28015, Spain, Tel.: +606642609 /915430966
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Protected patient: Reflections on removing the patient's name in Patient Safety" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "350" "paginaFinal" => "351" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Romera, A. Garrido, M. Lema, A.M. Contreras" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Romera" "email" => array:1 [ 0 => "andreilla111@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Garrido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." 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CP, Madrid, 28015, Spain, Tel.: +606642609 /915430966" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">CALL ME BY YOUR NAME</span>. Paciente protegido: reflexiones sobre lo que implica privar del nombre propio para la Seguridad del Paciente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We are writing to you in our capacity as Safety Auditors in Anaesthesia, to comment on the safety implications derived from a name. These issues arise from 2 critical incidents in twin paediatric patients whose identity had been voluntarily concealed by their legal guardian, and who were identified by the terms <span class="elsevierStyleItalic">protected, protected</span> followed by a case history number. The case history number written on the wristband did not correspond to either patient, but to his brother. In both cases, the surgical check list had been completed correctly,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> except for the part where the patient's name should be filled in. The patients, with incorrect case history numbers, underwent surgical procedures. They were not injured, but the potential for injury (surgery, diagnoses and wrong medical treatments) is unquestionable.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The analysis of this incident is complex, and requires some clarifications:</p><p id="par0015" class="elsevierStylePara elsevierViewall">- Patients admitted to hospital are usually identified by means of 3 details: full name, date of birth and sex. This system is very effective, not only because of the synergy of the three details (it is almost impossible for 2 patients to coincide in each and every one of these categories), but because these data are personal. Private. Unique. They belong to the patient more than any other identification code ever can. Thus, if a patient is assigned a name that is not theirs, he or she will, in most cases, be easily spot the mistake and thus prevent the medical error.</p><p id="par0020" class="elsevierStylePara elsevierViewall">- Although only common in 3 specific scenarios – cases of mistreatment, persons of public interest, hospital employees – all patients admitted to the hospital have the right to request that their identity be concealed. In this regard, they are protected by the Spanish Data Protection Act 15/1999, and Organic Law 3/2018, which calls for the protection of the <span class="elsevierStyleItalic">fundamental rights of individuals, especially their honour and personal and family privacy</span>. To this end, the Spanish health system has created so-called <span class="elsevierStyleItalic">Anonymisation Procedures</span>, which allow personal data to be processed so that the information obtained cannot be associated with identifiable persons, including the replacement of the individual's name with a generic code. In our hospital, this code is <span class="elsevierStyleItalic">protected, protected</span>. The process of anonymisation begins in the Admission Service. There, the patient is attended by a doctor, who is in charge of replacing his or her name with this generic code, and linking this to a unique case history number.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The very concept of Modern Safety Culture is based on the paradigm that healthcare procedures can cause injury. This incident, however, is a unique example of a new reality: some of the measures taken by the Health System to protect patients can make them more vulnerable.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The reality is that an individual's name is a safety barrier. One of the best, in fact.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The right of an individual to conceal their identity is also a safety barrier. We would like to emphasize that both doctors and patients must be informed of the difficulties inherent in this paradoxical situation. The aim of our letter is twofold: to raise awareness of this situation in both patients and doctors. With regard to patients, we suggest including an informed consent clause in the Request For Anonymisation form that is handed in to the Admission Service. This should inform patients that, by concealing their identity, they waive their right to one of the Health System's safeguards against medical errors. This consent clause should also specify that the Health System will thereafter assign them a <span class="elsevierStyleItalic">new name</span>: the case history number. This number will be the only means of identifying the patient, and it will therefore be their responsibility to know and verify it when requested. We, the treating doctors, must also perform meticulous, repeated identity checks, as an additional safety net, thereby showing that we are aware of the alienation inherent to an identification code, and conscious of the fact that a number will never identify a patient as perfectly as their own name.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Romera A, Garrido A, Lema M, Contreras AM. <span class="elsevierStyleItalic">CALL ME BY YOUR NAME</span>. Paciente protegido: reflexiones sobre lo que implica privar del nombre propio para la Seguridad del Paciente. Rev Esp Anestesiol Reanim. 2019;66:350–351.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO guidelines for safe surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Alliance for Patient Safety" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2008" "editorial" => "World Health Organization" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006600000006/v1_201905290656/S2341192919300915/v1_201905290656/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006600000006/v1_201905290656/S2341192919300915/v1_201905290656/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300915?idApp=UINPBA00004N" ]
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