How much leeway do you allow your staff in the testing process?

[Mabel Adams]

I would like to know how many labs have specific policies defining details of patient testing, like formats for labeling testing tubes/gel cards and set-up patterns in racks vs. how many let the techs decide how to do such things.

[Malcolm Needs ☆]

We go with the first option because i) it is NHSBT policy, ii) it is our auditors requirement, but iii) and, probably most importantly, if one Biomedical Scientist has to take over from another half way through testing (e.g. the first Biomedical Scientist is taken ill), the second Biomedical Scientist knows exactly what is what.

[adiescast]

We allow some leeway. Most professionals label their testing well enough that you can pick it up even if it is not exactly the way you label. I also allow choice for beginning the test again or continuing from where the other person left off. Where there is likely to be a detriment from beginning the test again (say an allogeneic adsorption), I give guidelines for labelling to allow the next person to be able to pick it up.

People often come with long entrenched labelling habits. While it is possible to change these habits, if their label process is adequate to identify the patient and the test, why go through a period of increased risk of confusion on their part to force them to change to my way? Since we do not have regulatory requirements for a particular standardized label process within laboratory tests, each lab has its own way of doing it.

[Candybar]

At our hospital tubes must all have the same information on them but the how we write them...order...and how we place the tubes in our rack is the tech choice.

The tubes have to have the test you are doing and two numbers either from the MRN or accession number on each tube.

[epfeiffer]

We have minimum labeling requirements for all testing, however the order in which we place our tubes for testing is totally up to us.

[David Saikin]

I tell my techs that I have to be able to continue their work if they are unable to . . . they have leeway in labeling but within the above boundary.

[John C. Staley]

When I would get a new tech in, I told them that my criteria for labeling testing tubes was simply that some one else could pick up their tubes and easily figure out who and what was in the tube. They could put those tubes in the rack any way that wanted that made sense for them. I also told them that they needed to develop a system and stick to it everytime. I can't tell you how many times a problem was discovered simply because a tube was in the wrong spot in the rack.

I've seen about every way there is for some one doing tube testing to put their tubes in the rack but only my way really made any sense.

[L106]

My sentiments exactly, John!

Donna

[Byfaith]

Is there anyone out there in the hospital setting that require writing the entire last name on ABO/Rh & IS crossmatch tubes? How about first and last initial, or just last initial is it is unique within the patients being set up?

Big debate here - looking for a sensible consensus!!

[adiescast]

We usually write first and last initial unless you have more than one patient matching, then you write enough of the last name to distinguish. The more you have to write, the longer it takes, but the more accuracy there is in distinguishing. I always write the entire last name (plus first initial, depending on other patients in rack) on the plasma tube and the cell suspension tube. I feel that those are more likely to be picked up by someone else to continue work than the ABO/Rh and immediate spin tubes (plus the latter are such short tests it is much less trouble to simply repeat them if they are interrupted).

[bloodbankninja]

We get to do it however we feel comfortable doing it. I think most people where I work write the first three or four letters of the last name, and whatever reaction the tube is for.

I think it would bother me if someone told me how to arrange the tubes in the rack.