Specimen Labeling; let's try again..

[Brenda K Hutson]

With regard to specimen labeling, well, I won’t tell you “all†of the things they have done historically here, prior to my coming (I don’t want to shock anyone ), but specifically, this is in regard to Cord Blood specimens. The policy for labeling them has been different in every Institution I have worked at; but one thing that “has†been consistent, is that there are a lot of errors related to Cord Blood specimens.

My question arises because I recently rejected a specimen (for BB testing only) that had only 1 of the 2 labels on it; the floor was very upset.

At my current Institution, the Cord Blood Specimens come with 2 labels on them; one “mom’s†label, and one “baby’s†label. In the past (before me), if one of the labels was missing, they would send the specimen back to Maternity so they could add the other label (it is also worth noting here that we have received Cord specimens where the mom and baby labels on the specimen, are not in fact the same mother/baby combo).

So, I see a number of issues:

1. Incomplete and/or erroneous labeling

2. I would never send any specimen back for corrections and/or labeling

I would greatly appreciate your feedback,

Thanks

Brenda Hutson, CLS(ASCP)SBB

[Eagle Eye]

I agree with you. at my place once we receive specimen in blood bank no one is allow to alter their specimen. We never allow to send it back. We have same policy of two labels and one of the label is missing, we reject the specimen. We require two signature on the label.

[Lcsmrz]

Only one thing comes to mind: "What does the SOP say?" If it says two labels, then two labels it is, and if it says no relabeling, then you should reject the specimen. I don't even like correcting labels on instrumented specimens, like CSF.

However, changing long-standing practices takes retraining and notification of both nursing and current staff. At a new job, I can remember rejecting a BB specimen once per SOP, so the nurse called my boss, who allowed her to fix the label and told me not to follow that part of the SOP anymore. I quit the next day, but in hindsight, I should have stayed and helped them fix their systems; I'm sure the lab manager had no idea this was happening.

Discussing the issue with nursing will be an eye-opener. They draw the cord blood in the midst of an hour of chaotic activity surrounding the birth -- longer, if complications -- and I find just getting one label on a cord blood sample commendable. The infant is not admitted, so no labels are available, and it can be left unlabeled or mom's label marked "baby" or "twin x" can be affixed. Sometime later, toward the end of the chaos and after patients have gone, the "real" label has to be affixed before sending to the lab.

We use cord blood only if testing is requested and never for crossmatch purposes. I always wanted to add a disclaimer, like "Cord Blood results; sample identify is questionable."

[Eagle Eye]

Bravo Lcsmrz!! I would have long chat with my boss if that happens with me. ...but I have a boss who agrees with me when it comes to patient safety and compliance and following SOP(ofcourse I do nto make my rule I follow SOP). At that moment he would agree with me and if there is need we go and change procedure. As long as we have a SOP we must follow. In emergency situation my MD uses his authority and may approve soemthing but it is always documented "approved by MD".

(I wish I can quit like that when I am not happy but some time you are in a situation you can not quit on the spot eventhough if you like to).

[LABKING]

Blood bank bascis are not really established anywhere, it is something that seems to be handed down from blood banker to blood banker. Its great to see these baxic process somewhere to reinforce basic blood banking that I have found key to gain trust and simplicity in avoiding error.

[reidhospbb]

The SOP is the SOP. However, when a process is a problem look at changing the process. Why is it required to have two labels. Our SOP is to identify the cord blood with the mother. If there are twins one is labeled "A" and the other "B".

In addition, to me this is what we would classify as a "precious" specimen. Would you discard a spinal fluid sample because it was mislabeled or a surgical specimen because of a labeling error. All situations call for some common sense as well as following the SOP. Telling someone to disregard the SOP is outrageous, but asking someone to modify the SOP is sensible. If you take it to the extreme, if an 'i' is not dotted that counts as mislabeled and the specimen should be discarded, even if you can never get that specimen again. Not really providing excellent patient care.

[debB]

At my hospital we reject 1-2 cord specimens a day on the basis of labelling errors. Our SOP is that all specimens including cord blood are labelled correctly. We consider the cord blood is a baby's specimen and as such it must be labelled with the baby's name, UR and/or Date of birth. When Mary Smith has her baby it is given the name: Smith, baby of Mary. (this is the babies name - even though it incorporates the mother;s name) If specimens arrive in the lab with both maternal and baby stickers the specimens will be rejected, We do not make any exceptions for cord bloods, as we would reject all specimens labelled with more than one person's details. Rejecting specimens is always unfortunate but it is hoped that by stictly following protocol the incidence of errors will decrase - it is happenning slowly.

[LAS]

We require cord bloods to be labeled with the baby's, not the mother's identifying information. We consider them two seperate patients, with two seperate medical records. As the newborns are admitted, they are matched in our IS with their mother. If a cord blood is received with no identifying information, or with the mother's identifying information, we reject it and perform testing on a heelstick specimen.

[adiescast]

While I agree that the specimen is the baby's, many places do not create baby information in their systems until the baby arrives. That leaves the nurses without proper labels for the sample until the computer entry is completed. We have labels with preprinted fields on them. The nurses manually record the patient ID. Mom's name, baby gender, baby bracelet number, date and time of collection, collector ID. We reject samples that do not have bracelet numbers or have incorrect bracelet numbers. The baby bracelet is the same one they use to identify the baby for anything else. Mom gets a bracelet, baby gets a bracelet and Dad (if present) gets a bracelet. We will not use cord blood results for babies who require blood. We get a heel stick and do the type and screen on that. If no heelstick can be obtained or the volume is insufficient, we use Mom's sample for the screen.

[LAS]

Indeed, it seems that there are any number of ways for hospitals to handle this issue. We do have a bracelet system for matching up mom and baby but it is used for a physical match and for security reasons only, not specimen identification. We have a real problem with our L/D dept's specimen collection and labeling habits. I am very envious of the posters here who seem to have great mutually respectful relationships with their competent nursing staff. We have lots of entrenched staff members who have yet to figure out that rather than trying to make their life difficult, we are all on the same side.

[estiner]

Our system is based on the fact that at the time of specimen collection, the only label available is the Mom's. So the cord blood specimen is labeled with the mother's info so the label can be compared and verified with the mother's armband at the time of collection (our policy for all specimens). It is also labeled "CORD BLOOD".

Then when the baby is entered into the system, the mother's name, MR# and blood type is required for the cord blood order. The computer then creates an order form with both mother information and baby information. This form accompanies the cord blood specimen to the laboratory where both information is checked before accepting the specimen. We use Meditech and have the capability of attaching mother and baby in the system.

Prior to this process, nursing drew the cord blood specimens, put the unlabeled tube in their pocket until the baby was entered into the system and then labeled. Needless to say time lapse was frequent and as a result, so were mistakes. Our new process works very well.