OK, on to bigger and better controversies

[Malcolm Needs ☆]

Eric,

Took some time nibbling away. The best mover was a retrospective lookback at form/specimen/identity issues (We keep sheets in the labfor that purpose) - by far the biggest outliers were junior docs. That plus selected readings from surveilance reports and the feedback from SHOT meetings (where it is a problem with all delegates), a resolve to do something about it, a supportive Hospital Transfusion Committee and the consultant who is joint director of the BT service in the hospital. Good luck with it.

Regards

Eoin

Sounds like the General had an excellent army!

More power to your elbow Eoin.

:D

[mjshepherd]

I had to go to a strict "No Tolerence" policy about a year ago for this same reason. Nursing collects most of our blood specimens...I won't go into that nightmare.

We were accepting corrections for minor errors, i.e. name misspelling, no phleb initials. However, the "minor" errors got more and more ridiculous, patient initials instead of full name, wrong year of birth. So, I finally was able to get the director on board with standardizing all of our specimen requirements, full name, dob, mr#, date/ time of collection, and intials of collector. Now our policy states that any re-collectable specimen not completely and correctly labeled will be discarded without testing.

[KE4JC]

I had to go to a strict "No Tolerence" policy about a year ago for this same reason. Nursing collects most of our blood specimens...I won't go into that nightmare.

We were accepting corrections for minor errors, i.e. name misspelling, no phleb initials. However, the "minor" errors got more and more ridiculous, patient initials instead of full name, wrong year of birth. So, I finally was able to get the director on board with standardizing all of our specimen requirements, full name, dob, mr#, date/ time of collection, and intials of collector. Now our policy states that any re-collectable specimen not completely and correctly labeled will be discarded without testing.

You go MJ!!

:clap:

[KKidd]

Brenda, stick to your guns. I have had a run-in with the ED director when a patient's name was not spelled correctly and the sample had to be re-collected. I have even rejected specimens from the OR. IF it is an emergency I tell them they are free to give uncrossmatched blood. For us the only deviation from name and MR# is if the account number is used. It is specific to that patient at the moment and can be referenced back to the patient. As for the armband number, it can't be used for initial ID when drawing the sample so I don't use it as one of the 2. Of course everything must be letter and number perfect - if the "S" is left off of Mary Woods last name a new tube is collected. Good Luck!

:judge::judge::judge:

[Kashmira patel]

Thanks to so many of you for your input to my question about sharing records when you purchase a new Hospital (which opens this Sunday, and NO, we did not get their records).

Next question: Again, with 26 years and 6 Institutions, I can be a stickler (but at the same time, usually have a good pulse for the standard of practice). Our current issue of discussion at my Hospital has to do with specimen labeling; what is required and what is acceptable (to me, they are one and the same). In my experience, it is not uncommon for the Blood Bank to have stricter specimen labeling policies than other areas of the Lab; however our QA coordinator is stating that what is acceptable for one dept., should be acceptable for all depts.; OK, that's fine with me then, as long as all other depts.have my standards )!

I go strictly with the AABB Regulation 5.11.2.3; in summary, we should only accept what is complete, accurate and legible.

So, when I quote that, I am then told that "complete" is relative; that is is just a guideline.

One last insert before I state "my" requirements: I know that some places who use Red Armbands for BB draws, allow the Red Armband# to be 1 of the 2 unique identifiers. I spoke previously with both an FDA and AABB Inspector regarding this in that "my" feeling is that a number that is just stuck to a tube, does not "uniquely identify a person." If I call another Hospital and say I have their patient and want to know their antibody history, they are not going to ask, "Ok, what is their red armband#?!" The Inspectors I spoke to, agreed with that (though I see the Technical Manual lists it as a possible identifyer; so this is just my bias).

I want FULL Name (to be complete), and FULL MR# or D.O.B. as the 2nd identifier. I recently took a specimen back to phlebotomy, noting that the complete name was not there; they said it was; I said it was missing the last letter; I won't repeat what they said......

How about all of you; what are your thoughts/biasis/requirements for specimen labeling for the Transfusion Service.

Thanks!

Brenda Hutson, CLS(ASCP)SBB

Brenda,

We require patient's Full last name and first name as it appears on the patient's armband and Medical Record Number/DOB, with the date, (time optional), and signature/initials of the collector on all the samples for the Laboratory services, including Transfusion Services. There are no exceptions for Blood Bank samples, all the required information must be on the sample.

What helps us with the compliance is the NJ Department of Health Mandate for (N.J.A.C. 8:8 Collection, Processing, Storage and Distribution of Blood) Processing Blood Product recipient samples, which clearly states the above requirements. See if the below URL is of any use to you.

http://nj.gov/health/phel/bbank.shtml

Kashmira

[chiggins]

Our largest problem was with junior doctors out-of-hours, but I finally convinced the CEO and HR to include blood transfusion training requirement by our Haemovigilance Officer or myself (Quality Manager) in their contract. They MUST attend pre-employment (usually when they visit the employment health nurse for the obligatory checks). As the contract is signed off by them, it becomes a legal obligation and we get great attendance at training.

Acknowledging that this is an old thread; this is a struggle that I experience at my facility. I'm still relatively new and on the middle end of the totem pole here so I don't have too much voice but I am frustrated with the way specimens are handled here. The blood bank has a strict policy requiring full name, medical record number, date of birth, legible signature of phlebotomist and time/date drawn, which is great. The rest of our lab doesn't have the same procedure. Specimens that are drawn by new phlebotomists, certain nursing floors and physicians will often be incomplete and even so far as unlabeled entirely (getting a phone call, saying they're tubing down specimens on so and so but they didn't have labels and could we label them for them please? has happened more than once).

It would be nice to have a hospital wide policy in effect with appropriate specimen labeling training for anyone who would be drawing specimens.

Edited May 26, 2010 by chiggins

[labqm]

Well, we are really strict. We required the tubes be hand labeled with full name (including any initials), MR#, Date of birth, date, time and phlebotomist initials. We make no exceptions for blood bank samples but it is easier for us to enforce since we have the NJ DOH inspections.

[Brenda K Hutson]

Acknowledging that this is an old thread; this is a struggle that I experience at my facility. I'm still relatively new and on the middle end of the totem pole here so I don't have too much voice but I am frustrated with the way specimens are handled here. The blood bank has a strict policy requiring full name, medical record number, date of birth, legible signature of phlebotomist and time/date drawn, which is great. The rest of our lab doesn't have the same procedure. Specimens that are drawn by new phlebotomists, certain nursing floors and physicians will often be incomplete and even so far as unlabeled entirely (getting a phone call, saying they're tubing down specimens on so and so but they didn't have labels and could we label them for them please? has happened more than once).

It would be nice to have a hospital wide policy in effect with appropriate specimen labeling training for anyone who would be drawing specimens.

We do have a hospital wide policy that must be followed by anyone drawing blood (phlebotomist; RN; etc). The Policy was written by the Lab Manager over phlebotomy).

Brenda Hutson CLS(ASCP)SBB

[bbqalc]

Brenda,

At our institution, the name and medical record number on the specimen label must match the name and MRN as it appears on the bracelet exactly. The signature of the person drawing the specimen and the signature of a second person who verifies that the correct patient has been drawn is also required in addition to the draw date. The person who actually drew the specimen circles his/her signature.

The second person verification was insituted by our Hosptial Safety Committee after a near miss. So this is an administrative policy, not a blood bank policy.

[Brenda K Hutson]

I need to re-visit this issue of specimen labeling; specifically, what do you do if a complete name is a mandatory requirement for your specimens but the last name is so long, that all that prints out on the label is the last name! We had a patient recently who had 21 letters in the last name (long, hyphenated Indian name; had seen patient before with only part of that last name); and 6 letters to the first name. Though the entire name was captured in our Transfusion Service computer; and the Hospital LIS; the Lab System through which the phlebotomy orders are processed (and labels print out) had cut off part of the last name and part of the first name.

When this came up previously, I stood my ground and stated that the phlebotomist could hand-write the missing part of the name (and note: the patient's armband had the complete name because that comes from the Hospital LIS system). There was also some discussion with the phlebotomy manager about having the text wrap around on long names so that it is all captured on the labels (but apparently that was never initiated).

So can I just get some more feedback about what others do with these really long names when the Name is one of your 2 identifiers (and your SOP states you will only accept a complete Last,First Name)?

Thanks,

Brenda Hutson

[AMcCord]

The phlebs write the whole name on the specimen from the armband and write the whole name on the requisition from the armband.