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Unlabeled specimens


BBNBHM

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Hello everyone,

 

Just wanted to see what everyone thinks about a new policy the facility I work at is discussing implementing soon.   The new policy would be that it is ok to accept unlabeled patient specimens as long as the labels are in the bio bag with the specimens and it is only one patient.   It seems to me (and the rest of the laboratory) that this would be in violation of our accrediting agencies standards.   I haven't had time to search through all the standards for this so if anyone could point me in the right direction, I would greatly appreciate it.   Thanks.

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AABB 5.11.2.1: "The completed label shall be affixed to the tube before the person who drew the sample leaves the side of the patient."

 

CAP TRM.40230: "All blood samples for compatibility testing are labeled at the time of specimen collection in the presence of the patient with..."

 

And as Malcolm says, even if it weren't against the standards, it's a very bad idea. So you need to:

 

1. Have your phlebotomy procedure state the above (nursing, lab, docs, phleb team, whoever draws specimens).

2. Have your blood bank P&P say you won't accept specs that aren't labeled as above (like the bags).

3. Why not put it into your hospital's transfusion policies as well, approved by the medical staff. Then you can always point to it and say "It's not just us picky SOBs in the lab who say that, it's Hospital Policy". (You don't have to tell them that you wrote it.)

 

I have to say our lab will accept some specs "in the bag" but only very specific ones (timed blood draws like drug peaks, surgical specimens) that cannot be reobtained. Someone signs an affidavit.

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Such a policy will endanger lives of patients. Unlabelled samples should never be processed, nor should they be allowed to be labeled in lab by even the person who drew the sample. Safety first principle is paramount.Such samples should be dumped and new sample properly labeled in presence of patient should be collected.

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No no  no.  Besides the patient safety issue, which trumps everything else anyway, regs say specimens must be labeled AT THE BEDSIDE (or in the presence of the patient, anyway.)  Obviously, a specimen that arrives in another depatment without a label on it would not qualify.

 

This is a Risk Management issue.

 

Scott

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These things give me gray hairs, or more of them to cover that is. My favorite line about this is when I witnessed an ER nurse draw two patient's in one room, put the UNLABELED tubes in his short lab coat pocket (one set in each pocket) and start to walk out of the room. I stopped him and said "how do you know which patient is which?" His response was "we never make mistakes in the ER usually", all in one breath. He was fired shortly after that thank goodness.  Enough said- tubes arrive with no labels, in the biohaz trash they go!!!

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I must admit that, at one hospital in which I worked, we were a little bit naughty.

 

In the UK, there are a few times during the year when all the junior doctors change, and you can guarantee that you will get s spate of poorly labeled and unlabeled samples.  We used to collect the unlabeled ones, and when we had a few, the next time we got one, and the junior doctor asked if he/she could come up and label the unlabeled sample, we would present them with a choice and ask them which one was their sample.

 

We even had one junior doctor who tried to actually choose one of these samples.  He/she was given pretty short shrift, and told, in no uncertain terms, of his/her error!!!!!!!!

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Thanks for the feedback everyone.  We all feel the same way.   We are part of a health system of several hospitals and it is the main campus that is discussing implementing this new policy.   We are trying to find official standards that we can use to justify not doing it.   We all agree that it is very risky to the patients, but if they say it is the policy, then we would have to abide by that.   Frustrating to say the least. 

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  • 2 weeks later...

We do what Malcolm does - we have an unlabelled pot and ask them to pick. I was called a W&nker once...

 

In the UK we do not accept samples with adhesive labels on anyway so we wouldn't have that issue.

 

If it was a vein to vein system with barcode scanners then it would breach the terms of use.

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