Specimen Labeling

[mprandealr]

We would NEVER allow pre-printed labels.

I know they say don't use the word NEVER, so;

The only printed labels allowed are from bedside vein to vein tracking systems that use Barcoded wristband labels or in more upto date systems RFID wristbands and then these labels on the samples must be handsigned, dated and timed.

[BBKT]

I've heard stories of phlebotomists and nursing drawing 2 tubes for blood bank samples and they put the second tube in their pocket so when they get the call that a second tube needs to be drawn for ABO verification they pull the tube out of their pocket instead of drawing the patient a second time. YIKES!

[mprandealr]

In respone to BBKT I would say that those pesky phlebotomists are "fraudulant" and take disciplinary action if able to prove:mad:. In my experience as the phlebotomists are part of our staff they are exempleary, it is occasionaly nurses but usually the "know it all" doctors.

What we are trying to achieve is a very safe Transfusion practice. Identifysing and minimising the high risk areas/practices. Sample collection and labelling is one of the highest risks.

[Townsend]

We use barcoded labels that are printed at the patient's bedside at the time of sample collection. (Collection Manager via Sunquest Lab IS) There is no foolproof method, as someone can find a way around every safeguarded method out there if they really want to.... such as the patient wristband bing scanned and labels pre-printed, but our staff is doing their best to train the phlebotomist's the right way from the get-go. We do not use a separate BB armband and always require the patient's name and MR number - NO ACCEPTIONS for pre-transfusion testing!

On another note, we have for many years required a second sample (collected at a different time) or a check against a previous blood type on record before we give type-specific blood. This does increase our O red cell usage, so this may not be a realistic option for many institutions. I have heard of other hospitals doing this and taking a more proactive approach to the collection of the second sample to decrease O usage - I believe the articles were in recent editions of AABB's Transfusion.

[Liz]

In my career, I have used handwritten labels, handwritten BBID bands, pre-printed labels on Typenex barcode bands, and we will soon go to handheld barcode readers/label printers for labeling. I agree with Marilyn above; it's not the method that you use, but the care that is given to the patient identification process at the bedside. I have seen every version of "cheating" by nursing. I am convinced that the best way to protect the patient from this is to do two independent blood draws for Blood Bank specimens, one by Lab personnel.

What brand of hhBarcode readers? and how have the logistics been settled that is .. how many per floor etc?

Thanks

[lalamb]

We use hand written Typenex bands (name, MRN, Date, Time , Phelb/rn identifier). DOB or finanical biling # (which is unique) is accepted but rarely used. MRN's can turn over and be reused.

We don't want pre typed labels - to easy to pick up the wrong one, and the print is so small, it's easy to miss subtle spelling variations. Labeling aliquote tubes forces one to look at the spelling, date,etc.

We don't let the phlebs/RN's correct anything on the labels -not the date or adding their initilas, or fixing transposed letters, or missed double letters. Don't want the staff in the position of " well, she let me change this, why won't you?"

The dialoge of "this would not be good in court" seems to be working. We get less grief now when/if we need a redraw.

I'm content to be the *$(%(# in BB.

[Byfaith]

We do the same as Zola Hall, along with a second draw for patients with no history. We changed to this last year from using Typenex armbands which required handwritten name, DOB. This has cut our specimen rejection rate due to mis-spellings, transcription errors DRASTICALLY. Once we got through the learning curve, everyone seems much happier with it and it is good for the patients, saving wasted time!

Edited October 8, 2010 by Byfaith

[Brenda K Hutson]

Our transfusion service has required handwriting the specimen label directly from the armband for more than 10 years. This policy was implemented two supervisors ago in an effort to ensure that the armband was examined and specimens correctly labeled. We do not use a separate blood bank band. Recently, we have had a rash of mislabeled specimens drawn by nursing, some of which had to be redrawn three times. We are getting pressured by several nursing departments and physicians to allow pre-printed labels to be used because this has been delaying component availability. My department director does not want to allow this policy change, because she doesn't want to risk mislabeled specimens. I have heard several stories from staff that the nurses just take the blood to the nurses station and label from the chart anyway. She has asked me to find out what the rest of the blood bank world does. :bonk:

Hand writing the labels!! That is a recipe for errors if ever I heard one. There are other ways to get better compliance (less errors) than this. Try the barcode armbands/specimen labels. Perform the 2nd blood draw mentioned in another post (since it sounds like they are being drawn multiple times with the system you have). And probably other suggestions. I cannot even imagine how many errors you must see with this manual system. So you identify the patients correctly but they then have to be redrawn because the information written on the labels is erroneous. What does that accomplish then?

Brenda Hutson, CLS(ASCP)SBB

[fenwayman]

I work at a multi system hospital that has always employed computer generated labels.

I prefer them to hand written for several reasons

1)legibility-no mistake on who the patient is and their mr# 2)clerical errors-opens the door to errors in interpretation of who you are dealing with.

3) label at the bedside-we had a case several years ago where the nurse had collected a patient in a semi-private room(patient had one room mate) and labelled both patients blood work at the nursing station which lead to a sentinel event-patient eventually died as a result of not labeling at the bedside-can't imagine this practice would even go on anywhere.

I would try all I could do to convince your director to switch from hand written to computer generated and push for Labeling at The Bedside

[tkakin]

We use the hand written labeling system with only phlebs drawing specimens. We do not allow them to add information to the specimen at a later time. I would love to go to the barcoding/scanning system however we have a hospital that is not willing to move toward that system. I was wondering what people do when using preprinted labels. I can see how people may get in a hurry at the bed side and label the specimens potentially with the wrong label. Do you have them put a check mark next to the identifiers to force them to check?

Teresa

[Brenda K Hutson]

You can have them put a check; stand on their head; say "I checked" 4X; etc.; but the reality is that either they will follow instructions or not.

What they should do (with pre-printed labels) is ask the patient their name when entering the room; check paperwork (or lattice hand-held; whatever they use to tell them who needs to be drawn) against the armband; and then, once all specimens have been drawn and labeled and BEFORE leaving the bedside, check each specimen label against the armband to make sure they match. That is our policy and yet we do still get the rare specimen where the incorrect patient's label was put on another patient's specimen (though it is a more frequent problem when Nursing draws the specimens in that they may hand them off to a clerk to label; or leave the room and grab some labels and never go back and check; etc). Every scenario is possible.

That is the beauty of the barcode system; they would have to scan the armband and could then scan the specimen labels against the armband. The 2nd blood draw is also helpful to decrease errors (though I heard someone the other day reference it as "drawing the patient; standing in the room 5 mins. and then drawing them again; NOOOOOOO). 2 separate draws at 2 separate times! And I would say, if possible; 2 different phlebotomists.

Brenda Hutson, CLS(ASCP)SBB

We use the hand written labeling system with only phlebs drawing specimens. We do not allow them to add information to the specimen at a later time. I would love to go to the barcoding/scanning system however we have a hospital that is not willing to move toward that system. I was wondering what people do when using preprinted labels. I can see how people may get in a hurry at the bed side and label the specimens potentially with the wrong label. Do you have them put a check mark next to the identifiers to force them to check?

Teresa

[reidhospbb]

We use preprinted labels with a separate Blood Bank ID number that is on the blood bank armband. The person who obtains the specimen must put their initials on the tube to allow look-back if problems arise.

[Karen Olsen]

Hand writing the labels!! That is a recipe for errors if ever I heard one. There are other ways to get better compliance (less errors) than this. Try the barcode armbands/specimen labels. Perform the 2nd blood draw mentioned in another post (since it sounds like they are being drawn multiple times with the system you have). And probably other suggestions. I cannot even imagine how many errors you must see with this manual system. So you identify the patients correctly but they then have to be redrawn because the information written on the labels is erroneous. What does that accomplish then?

Brenda Hutson, CLS(ASCP)SBB

Saves lives!!!!!

Not every facility can afford to implement the barcode/label system yet.

[conwaysbb]

Saves lives!!!!!

Not every facility can afford to implement the barcode/label system yet.

This is of course based upon hand-writing label at the patient bedside. Preprinted computer generated labels, using a barcode scanner that generates the patient label at bediside, handwritten labels, typenex or additional blood bank numbering; it doesn't matter what you use, if the label is not placed on the specimen at patient bedside.

As for allowing additions or changes to the specimen label after reciept, we have made it a policy that no changes can be made. If there is a complaint from a physician or nurse, only the blood bank manager or the medical director can approve the exception. My staff is not authorized to make these decisions. If the error includes either the patient name or medical record number, no exception is made and a new specimen is requested. Reponses to physicians or nurses telling us the patient will bleeed to death, is to inform them that emergency release blood is always available, but the paitent's physician will have to sign the emergency release form. Exceptions are made in regards to date or initials, but on irretrievable specimens (neonatal specimens where the patient is extremely anemic; patient in OR and bleeding). However, the only individual that can come down and correct/add is the individual whp drew the specimen,, which includes physicians, so we document on the request form that specimen was corrected in blood bank.

We also have the support of a NJ State Dept of Health regulation , which specifically states " In the case of a discrepancy or doubt, another specimen shall be obtained and used for these procedures". So we have the law to back us up.

I regularly educate medical students about specmen errors due to patient ID errors or specimen lableing errors. 1 specimen error in 100 specimens is 99% compliance. 1 in 1000 specimen errors is 99.9% compliance, 1 in 10,000 specimen errors is 99.99% compliance...pretty good odds. However, no one wants to be that 1 patient who recieves that wrong unit of blood.

there goes my diatribe on the subject

[Brenda K Hutson]

Well, it is a requirement that you document "in some way," who drew the specimen (who was hopefully the same person that labeled it). But just because they know you can find them, does not mean mistakes will end; although it is a start. Having started at my current Hospital 3 years ago, I have found that there is the staff with the high standards and good work ethic who try to learn and follow instructions. Then there is the staff that will just do "what they can get by on." Once I show the latter that I have a way to trace a given issue, it is amazing how I start seeing compliance! Sad but true; just makes more work for us though.

Brenda Hutson, CLS(ASCP)SBB

We use preprinted labels with a separate Blood Bank ID number that is on the blood bank armband. The person who obtains the specimen must put their initials on the tube to allow look-back if problems arise.