Extra "just in case" specimens - How do you handle them

[DAWNA1983]

How do other labs handle "just in case" extra specimens.  We continually receive specimens with no orders...blood cultures, urine specimens, tubes of blood.  We were keeping a log sheet of these specimens that included who we called about orders, time called, location, computer search, tech, etc.  This has become a nightmare. 

 

Dire insight is needed on how other labs handle extra specimens.

 

Thanks in advance,

Dawn Arnett, MT

Kings Daughters Health

[tbostock]

We used to get tons of extra samples; mostly nurse collected specimens, they would draw a "rainbow" on every patient.

We calculated how much (in $) we spent per year discarding unnecessary specimens: cost of needle, tubes, cost to discard. Once the leadership got wind of the waste of money, sadly that got their attention. We are now seeing drastically fewer, but it is still a daily educational process to tell them that they should not draw extras.

We also convinced them that it was technically against state law to draw blood for tests without a doctor's order.

Keep fighting the good fight...it's worth it. Having a huge "extra" rack where a "real" specimen can get lost in is potentially dangerous.

[Deny Morlino]

Our LIS team created "tests" for the extra tubes collected with any frequency.  At times we have a nurse or physician request that we collect an extra specimen.  Our phlebotomists are seasoned enough to make an accurate determination as to when an extra is warranted.  ED draws their own "rainbow" so extras are frequent from them.  An extra lavender tube has a test possibility of XLAV, blue top has XBLU, extra green top gets XGRE, and extra SSTs get XSST. This makes things  easier when phlebotomy is looking at a previous order to see if a previous sample is available for use when testing is added.

[SMILLER]

We have one of those "extra" racks for blood specimens, but compared to the number of legitamate tubes drawn w real orders, we really do not have that many extras. Sometimes an area will add another order later, and it is a good thing that we have the extra specimens--it avoids a redraw.

If we get an extra blood specimen, we just rack it with the other estras and toss them at the end of the shift.

No-order Chest fluids, CSF, etc. we still have to call and check on, as they are not easily replaceable if tossed.

Scott

Scott

[adiescast]

We also have a specific test in the LIS that we order for extra tubes (called "save") that lists the color tubes that were received. These are placed in a rack in the refrigerator. We do have a separate "saveb" for tubes that come properly labelled for blood bank. Those extras are saved in a rack in blood bank. The blood bank extras are saved for 3 days. I think the lab saves are kept for 1 day. The LIS test makes it easier to locate the tube when the order shows up.

[MAGNUM]

We have a specific code called a holdclot, that only the laboratory has access to order. When we order the holdclot, we insert the phlebotomists initials, the date and the time into the computer. We go ahead and spin and separate the specimen. Then if the floor decides to order products we have a sample already in house and the floor order attaches to the holdclot order keeping the same 72 hour dating as the holdclot.

[pbaker]

Does anyone remember an article discussing how much money was saved when extra tubes were no longer collected?  Our blood bank routinely has 10-15 extra tubes per day with a miniscule amount actually being used. I'm sure the core lab has even more. Sometimes the same patient has an extra tube multiple days in a row (No wonder we have to transfuse patients!!!)  We are thinking of performing a cost saving study but vaguely remember one already being done. 

[Dr. Pepper]

We also have "JIC" tests set up in the computer to track these and a rack to store them. Good point on the cost savings by limiting the raindow draws.

[Joanne P. Scannell]

We have a BB HOLD 'test' ... no testing is done but the information (e.g. BB Wristband #, Phlebotomist) is recorded as a 'test result' in our LIS.  This provides documentation that there is a usable sample, when it was drawn, when it was recieved in the lab, and when the BB Tech addressed the sample. 

 

The main lab has similar.

 

And we do have a policy that we (BB and the Lab) do not accept specimens with no orders ... so, either order a real test or order a 'HOLD'.

[nmartin]

We have an order called HOLDBB.  The MD has to order it.  When we receive the specimen, we enter the unique BB armband number in our computer (after checking for correct labeling) under this test code and the test code also automatically calculates a 3 day outdate - so that specimen can be seen in our Blood Bank module and we know if it is a good specimen to use.

[lalamb]

Our ER routinely draws a rainbow whenever they start an IV. They are dropped off at the lab and spun. Vast majority of those get orders.  We periodically call ER with "where's my orders?" if the tubes sit w/no orders appearing.

 

During AM draws, phlebs will draw an extra grn if only a CBC is ordered, and visa versa. Has saved the pt a stick on more than 1 occasion.

 

Doc's can order a Band 'n Hold. Same principle as others...no charges are dropped, we spin it, report it as "Received", and write the name on the board as a quickie reference.

Get them mostly from OB and ER.

 

We did a $$$ survey once..and were told not to draw extra tubes. Don't know if they considered phleb time /cost in having to redraw tho...

[tms8313]

we do not want "extra" Blood Bank tubes drawn unless it is a critical patient situation.  We made a new policy:  If the patient is critical, we hold the tube for 60 minutes to allow the orders to be written and placed in the computer.  If no orders are received, then the tube is discarded and a new specimen is collected when orders are placed. 

The problem we had in the past was either 1) when the "extra" BB specimen was drawn, a BB armband was not issued to the patient (as required at the time of specimen collection).  When orders were received, testing done, and products issued, then everything had to be redone because there was no corresponding armband on the patient   or 2) a BB armband was issued, but no orders were ever placed so no testing was performed.  This confused the OR staff when they saw a pink armband on the patient and assumed a type and screen/crossmatch had been done.