Patient Identification Errors Tip Sheet

Accurate patient identification is a foundational safety practice. When identification fails, the result can be wrong patient, wrong procedure, wrong medication, wrong test, or wrong documentation. This tip sheet offers a fast, actionable overview to help teams prevent identification errors across clinical and operational workflows.

Who it’s for:

Nurses, physicians and frontline care teams
Registration, admitting, and scheduling staff
Lab, radiology, imaging and procedural areas
Pharmacy teams and medication safety leaders
Risk, quality and patient safety teams

What it can be used for:

Reinforcing two-identifier practices at every point of care
Reducing wrong-patient orders, labels, specimens, and documentation
Strengthening safety at transitions (admit, transfer, discharge)
Supporting audits, rounding, and compliance monitoring

What’s Inside:

Situation: Common scenarios where ID errors occur (similar names, high volume, interruptions)
Background: System factors that increase risk (workarounds, EHR issues, label printing, registration gaps)
Assessment: Where to look for vulnerabilities across intake, bedside care, diagnostics, and procedures
Recommendations: Practical steps to standardize identification, reduce workarounds, and confirm identity

Access the Tip Sheet

Patient identification errors continue to burden health care across the care continuum. Read the research-based recommendations to advance accurate patient identification.