I promise this is the last time...

[Brenda K Hutson]

Ok, my apologies for bringing up this subject "again," but just left a rather tense meeting with the Inpatient and Outpatient Phlebotomy Managers and we will pick this up again later this week to "make a final decision." I could use ALL of the input out there; regardless of your stance.

With relation to labeling of patient specimens for the Transfusion Service:

I have always been very strict on this with little room for exceptions (and that is in 6 different Institutions). In the past 2 weeks, we received specimens on 1 outpatient and 1 inpatient in which the last names were so long that part (or all) of the first names were truncated. The BB Specimen Labeling SOP as well as the Lab Guide (just for BB) state that for inpatients, there must be a complete first and last name and a MR#. The 2 identifiers defined for outpatients are the first and last name and D.O.B. However, the Managers believe we can/should make exceptions for patients with names so long that part of the first name is cut off. They state that there are still other pieces of documentation that identify the patient (for inpatients, the D.O.B. is also on the specimen labels; for outpatients, though the MR# may be on the specimen, it is not used as an identifier since the patient does not have a Hospital band on (just a red typnex band). The Outpatient Manager stated that you had other things to assist in identifying the patient; i.e. most of the name, D.O.B. and sex! I cannot believe she would suggest the sex, which has a 50/50 chance of being right should be acceptable to assist!

The Managers also believe that since the other areas of the Lab are more lenient than this, that we should above all, be consistent and that I should not require stricter requirements for the BB; that all Lab results are cricitical.

Anyway, I would love to hear from as many people as possible on:

1. The specimen requirements of your BB

2. Do you make any exceptions? If yes, in what areas?

3. Do the same strict requirements go for ALL of the other areas of the Lab in your hospital?

Need responses by Thursday!

Thanks so much,

Brenda Hutson, CLS(ASCP)SBB

[Malcolm Needs ☆]

I think that what the Managers should realise is that, although all the other Pathology results might well be critical, it is rare for an errant result from the other disciplines to have the capability to kill a patient in a very short space of time.

This may sound like I am exaggerating the situation, and, indeed, in most cases I may be, but if an ABO blood type is grouped incorrectly, because the sample is mistaken for another patient, this can, and does, happen.

The question is, if this should happen, who would get taken to court? The phlebotomist for not labelling the sample fully, or the person in the Blood Bank for accepting the poorly labelled specimen? I think I already know the answer to that one.

I would stick to your guns Brenda.

Sex indeed, as an identifier!!!!!!!!!!!!!!!!!

:(:(

[Dar]

Brenda, Our institution considers sex a identifer also??? Very strange! We have recently started using the typenex band that allows the pre-printed labels from our computer system. Of course, occasionally, names are cut off. We managed to get the typenex armband number on the corporate policy as a unique identifier for transfusion. While it is not the ideal situation, it does give me some comfort.

[BBKT]

In our computer system when the name is truncated on the label, the name is also truncated in the computer. Therefore the name on the tube matches the name in the computer and the name that prints on the crossmatch tags. I admit, not a good sytem, but at least the names match everywhere. We also use a tyenex armband so we have a third identifier to utilize.

[rravkin@aol.com]

Brenda,

At our facility we encounter the same situation. We allow for the first name to be trucated but the last name, MR#, and DOB are required in addition to the phlebotomist intials, date, and time of collection. We will reject the specimen if any of this info is missing or illegible. Also, according to AABB standards the specimen sumitted for BB testing must contain three unique indentifiers; these do not change. Additionally, the same strictness with patient indentification becomes more lenient as patients become more distant from the hospital. Floor specimens require three unique indentifiers while outpatient specimens require first and last name with the exception of BB.

Edited March 16, 2010 by rravkin@aol.com

[Susan.Sullivan]

At our facility, I would accept a truncated first name if the dob &/or medical record number were complete; we do use a secondary wristband with a unique BB # for transfusion candidates. Have you investigated reducing the font on the label to allow for more characters (or is it already barely visible?) The BB has always had higher standards than the other lab departments. And I agree that while a wrong H&H or wrong glucose can lead to a patient treatment error; an error with an ABO/Rh could be a fatal event! I would love to be on the front page of the Boston Globe for Winning Power Ball~ NOT for a fatal transfusion/ error at my facility! The only edit that is allowed to a BBK specimen label is the addition of a last name if the collecting phlebotomist only placed their initials on the tube. ALL other omissions, mis-spellings, missing digits of DOB/MR are cause for discard and recollection.

To mitigate the risk of transfusion errors we have implemented a verification of pt blood type PRIOR to transfusing ABO specific products. While some argue that it is cumbersome for the BB we found it to be a very easy to apply on our lab.

My suggestion: hand the phlebotomists a sharpie and a roll of labels and tell them to hand write the paient info if it is truncated and does not fit your policy!

Stick to your guns... This is patient safety!

~Sue

[MM@WIH]

At my facility we do not accept truncated names on tubes for the transfusion service. The phleb is required to review the label and hand write in the missing letters before signing the tubes.

Good luck

[tbostock]

We have the "truncated" problem as well. To make it even more interesting, the number of characters allowed on hospital wristband for 1st and last name does not match the number of characters that the computer display or the lab accession label allows. Since we are trying to emphasize the patient safety part to nursing, if they handlabel directly at bedside (like they are supposed to) and the name exactly matches the one on their hospital ID band, we accept it because they are following policy. If they label at the desk, from the chart, etc, we see that it does NOT match the wristband and know that they did not label at bedside.

This is a constant nightmare for us, but we are pretty vigilant about it.

And, yes, BB is stricter because we can kill someone pretty quickly if it's wrong; dramatic, but true.

[PammyDQ]

At my facility we do not accept truncated names on tubes for the transfusion service. The phleb is required to review the label and hand write in the missing letters before signing the tubes.

Good luck

Such a simple solution...this is what we tell them in that situation...just write in the missing letters and you're good to go! (patient wristbands are complete)

Edited March 16, 2010 by PammyDQ
added a thought

[webersl]

Brenda,

... Also, according to AABB standards the specimen sumitted for BB testing must contain three unique indentifiers...

I think, just two independent identifiers? 5.11.2

[mawomack]

We have a hospital wide policy that accounts for exceptionally long names. So yes, we make an exception if the first name gets truncated. Name and DOB are the required identifiers. However, we have a separate Blood Bank armband system (not Typenex, it is home grown).

[KarenJ]

We require that all blood bank samples be hand labelled, with full first and last name, DOB, and date ,time and initials of the person drawing the sample. We do not accept truncated first names or nicknames. The typenex bands give us a 3rd identifier with the ID #. We have recently implemented collection manager, but decided against allowing the preprinted labels. We tried it, but were getting labels generated by the LIS and HIS in addition to the hand held collection manager. So it was back to the old stand by. The only exception is cord bloods, they have a preprinted label from the mother's chart. The cord types don't go to the permanent file---but that is another topic.

We also require a blood type on a separate specimen, pretransfusion, if we have no history on file.

Edited March 16, 2010 by KarenJ

[MAGNUM]

I require 1 full Pink EDTA tube for all inpatients, and 2 full Pink EDTA and 1 full Red top tube for outpatients in the unlikely incidence that they should have a positive antibody screen. As for labeling I use the Hollister cards and as you probably know there is a big specimen label to this the collector must affix either one of our laboratory labels or a hospital label. In either case the full name must appear on the specimen(s), if it is too long to be included on the label, then it MUST be written in. Also the patients medical record number must be included on the labels as well as the DOB, the date of collection, the time of collection, and the initials of the collector. If there is any deviation then I have a special filing cabinet that is colored red where the specimens are stored, in other words they are discarded as being unacceptable and there are no exceptions. I require them to be labeled the same throughout the house. The rest of the laboratory is a little more lenient when it comes to labeling, they will allow the collector to "fix" the discrepancy if it exists. In my humble opinion no one has ever died because they had an incorrect WBC count or at least disabled they way they could if there was an incorrectly collected specimen.:cool:

[Brenda K Hutson]

Oh my gosh; so many responses! Thank you all very much.

I know the requirement is 2 identifiers; and I know that can be a lot of things (name; MR#; typenex band#;D.O.B.; SS#). Here is where I keep getting stuck (but that is why I am asking; trying not to be unreasonable); I guess I am thinking that once your Institution decides what 2 identifiers it is going to use (i.e. for Inpatients we use Name and MR# and for Outpatients we use Name and D.O.B. and both are spelled out in our Policies), that when/if one of those identifiers is missing and/or incomplete, is it acceptable to "change" your Policy (so to speak) and accept one of the other identifiers in that case? Sounds like many of you think it is.

Also, I should have added inititally that for our Inpatients, they now have barcodes on the armbands and the phlebotomists scan that for orders (but we don't use that barcode in our dept.; can't recall why now but was problematic for our computer system per our I.T. dept.; so we apply a separate barcode number label to all specimens when we receive them in the Transfusion Service).

Thanks again!!

Brenda Hutson, CLS(ASCP)SBB

[adiescast]

We also allow truncated names if they match the computer. We use a blood bank armband number as one of the unique identifiers, so if the name is incomplete we use the bracelet number and the medical record number. We do allow name and date of birth for prenatal patients only.

I have always felt that the lab should have consistent labeling standards and much more strict than they usually use (like ours!) : )

[KarenJ]

. If one of the identifiers is missing we don't accept the sample. It has to be exact, all the time. And we have been accused of being unreasonable more than once. If a sample doesn't meet the requirements ,and there is no time to redraw, we can use our emergency release policy.

For prenatal patients we use name and DOB. But it still has to be handwritten.

Edited March 16, 2010 by KarenJ

[Dr. Pepper]

Yes, AABB requires just 2 identifiers on the "label bearing sufficient information for unique identification of the patient." We have the same problems with truncated names. The current fad for compound names compounds the problem. (And wait a generation - when Benedetta Palazolla-Ventriglia marries George Martinelli-Tillinghast, do they name their son Martin Martinelli-Tillinghast-Palazolla-Ventriglia? Just wondering.) We will accept truncated names with DOB and MR# but give them universal donor O RBC and AB plasma products. This doesn't happen often enough to pose inventory problems. We have tried to get the phlebotomists (in our hospital mostly nurses) to hand write the missing letters with no success - hey, if they ever actually stopped to read the label they'd never use the wrong one, would they?

[adiescast]

Ha ha...too true!

[velliott]

In my facility we require all blood bank specimens to be hand-written. The main reason is because long names will not print on the Sunquest label. Yes, we do require a full name. We also require the MR number, DOB, location ,date / time. We place an additional blood bank armband on the patient as another identification system. I have had many heated discussions about collection of specimens and other collection areas are not allowed to collect specimens for blood bank because they just don't get it. I also tell them we are the only facility in our area that has not had a near-miss. We do not accept names that are not perfect, no exceptions, they must be re-collected. Are your phlebotomy managers lab or nursing trained? One of the things we do when we train new phlebotomist is bring them into blood bank and show them what we check when we get our specimen. It shows them how good handwriting is a must. We also show them a unit issued and then I go with nursing to the bedside to check and hang the unit. Sometimes its hard to know the whole picture. Now if you issue blood thru the pneumatic tube this might be an issue.

Another point...we had Joint Commission watch a transfusion. When the nurses checked the unit one was at the patients armbands and the other nurse was checking on a bedside table. The patient was in a private room. The inspector threw a fit because the 2nd nurse wasn't "at the bedside". She was maybe a foot away. :mad:

[L106]

Another point...we had Joint Commission watch a transfusion. When the nurses checked the unit one was at the patients armbands and the other nurse was checking on a bedside table. The patient was in a private room. The inspector threw a fit because the 2nd nurse wasn't "at the bedside". She was maybe a foot away. :mad:

Oh, !!!!

Your Blood Bank Department must be in excellent shape if that's the worst problem that the inspector could find to throw a fit about!!

[Brenda K Hutson]

Yes, AABB requires just 2 identifiers on the "label bearing sufficient information for unique identification of the patient." We have the same problems with truncated names. The current fad for compound names compounds the problem. (And wait a generation - when Benedetta Palazolla-Ventriglia marries George Martinelli-Tillinghast, do they name their son Martin Martinelli-Tillinghast-Palazolla-Ventriglia? Just wondering.) We will accept truncated names with DOB and MR# but give them universal donor O RBC and AB plasma products. This doesn't happen often enough to pose inventory problems. We have tried to get the phlebotomists (in our hospital mostly nurses) to hand write the missing letters with no success - hey, if they ever actually stopped to read the label they'd never use the wrong one, would they?

My point exactly; how are they "matching" the information when in fact, part of the name is missing on the label?

Though perhaps as another person suggested, what they see on the requisition and/or hand held barcode scanner is also the same number of spaces for the name (so also truncated).

Brenda

[BSIPHERD]

In my facility we require all blood bank specimens to be hand-written. The main reason is because long names will not print on the Sunquest label. Yes, we do require a full name. We also require the MR number, DOB, location ,date / time. We place an additional blood bank armband on the patient as another identification system. I have had many heated discussions about collection of specimens and other collection areas are not allowed to collect specimens for blood bank because they just don't get it. I also tell them we are the only facility in our area that has not had a near-miss. We do not accept names that are not perfect, no exceptions, they must be re-collected. Are your phlebotomy managers lab or nursing trained? One of the things we do when we train new phlebotomist is bring them into blood bank and show them what we check when we get our specimen. It shows them how good handwriting is a must. We also show them a unit issued and then I go with nursing to the bedside to check and hang the unit. Sometimes its hard to know the whole picture. Now if you issue blood thru the pneumatic tube this might be an issue.

Another point...we had Joint Commission watch a transfusion. When the nurses checked the unit one was at the patients armbands and the other nurse was checking on a bedside table. The patient was in a private room. The inspector threw a fit because the 2nd nurse wasn't "at the bedside". She was maybe a foot away. :mad:

Our transfusion procedure requires that both the Transfusionist and a Witness verify that information on the patient's armband matches information on the unit label and unit tag. Even if the 2nd nurse was an inch away and wasn't verifying information from the armband, we would consider it a deficiency. So depending on how your procedures are written, I'm with your inspector!

[Brenda K Hutson]

In my facility we require all blood bank specimens to be hand-written. The main reason is because long names will not print on the Sunquest label. Yes, we do require a full name. We also require the MR number, DOB, location ,date / time. We place an additional blood bank armband on the patient as another identification system. I have had many heated discussions about collection of specimens and other collection areas are not allowed to collect specimens for blood bank because they just don't get it. I also tell them we are the only facility in our area that has not had a near-miss. We do not accept names that are not perfect, no exceptions, they must be re-collected. Are your phlebotomy managers lab or nursing trained? One of the things we do when we train new phlebotomist is bring them into blood bank and show them what we check when we get our specimen. It shows them how good handwriting is a must. We also show them a unit issued and then I go with nursing to the bedside to check and hang the unit. Sometimes its hard to know the whole picture. Now if you issue blood thru the pneumatic tube this might be an issue.

Another point...we had Joint Commission watch a transfusion. When the nurses checked the unit one was at the patients armbands and the other nurse was checking on a bedside table. The patient was in a private room. The inspector threw a fit because the 2nd nurse wasn't "at the bedside". She was maybe a foot away. :mad:

I would definitely not want to go to a process of having all specimens hand-written. You are just asking for errors in doing that. We have an outpatient transfusion facility that sends us hand-written specimens and we do find errors, as well as difficulty reading some of the writing. However I am not opposed to the use of a printed label that they could then "add onto" any letters that might be missing in a long name. But then this is one of the reasons given by the Inpatient Phlebotomy Manager for not asking them to do that; that we are just setting them up to make more errors and have more rejected specimens.

I know the Outpatient Phlebotomy Manager was a Chemist when she worked on the bench; have no idea about the Inpatient Manager. But my Lab has been very much a Chemistry oriented Lab for many, many years so trying to get across that Blood Bank really is different, has been a struggle (but the good news is, we just got a new Lab Manager and she is a Blood Banker; someone I recommended; YEAH).

I have always been strict in requirements but am realizing that sometimes you can have exceptions without it having to mean that you have endangered the patient. I am just trying to find that fine line with specimen labeling.

Thanks,

Brenda Hutson

[Malcolm Needs ☆]

In the UK, we only accept hand-written specimen tubes for blood transfusion, unless the sticker is produced at the bedside (or wherever the specimen is drawn) and the sticker is produced by bar-code reading the patient's wristband.

This was following two papers that showed real problems with the use of pre-printed addressograph labels.

Cummins D, Sharp S, Vartanian M, Dawson D, Amin S, Halil O. The BCSH guideline on addressograph labels: experience at a cardiothoracic unit and findings of a telephone survey. Transfusion Medicine 2000; 10: 117-120.

Sharp S, Cummins D. The BCSH guideline on addressograph stickers: an update. Transfusion Medicine 2001; 11: 221.

:):)

[slc7067]

I think you should stick to your guns. The possible consequences are just too dire. We also have the truncating problem, and our phlebotomists and nurses fill in the missing letters on the label. We have the same specimen criteria across all of the lab departments (full name spelled correctly, med rec number, DOB, date, time and initials) however blood bank is the only department that routinely checks for completeness.