Changing validated LIS results

[kdavis]

In a recent discussion, a friend shared that he had been asked by someone in an administrative position in his laboratory to change the results of ABO testing that had been verified and reported through the LIS some time prior. The issue was that a sample from a renal transplant donor had tested as B Pos on one occasion. A subsequent specimen on the individual tested O Pos and at that time another sample was drawn and tested O Pos as well. (The original (B Pos) specimen was no longer available to be retested.) I'm guessing the administrator was just born yesterday and believed this to be the first and only time this sort of thing had happened, because she asked him to change the results of the original testing to make it an O Pos specimen. I told him that such an action violates every regulatory, legal, ethical and moral standard I can think of, especially since the original results cannot be proven to have been wrong and it sounds like it was an attempt to avoid admitting a mistake either in collection, labeling or testing. My facility would note in the medical record that the correct type had been confirmed by testing to separate samples drawn at different times by different people and add an error comment on the incorrect blood type.

Has anyone else ever had such a request made? How does your facility handle situations like this? 

[goodchild]

We wouldn't change the original results. We have a whole algorithm for blood type changes and they can only be completed in the LIS by a select few individuals.

 

Depending on how obvious of a change it was (e.g. past history of Rh pos due to weak D that we currently interpret as Rh Neg), I would probably carefully review the medical record to see if it was an overlay. Perhaps the encounter that originated the B POS blood type was actually a different patient registered to the wrong medical record number, or perhaps this current O POS patient was registered with the wrong medical record number. This sort of thing can be a bit confusing and may need consultation with medical records department.

 

We confirm with two samples. Usually two techs and/or methods. Then document the details with a hospital incident report.

[Dr. Pepper]

"I told him that such an action violates every regulatory, legal, ethical and moral standard I can think of, especially since the original results cannot be proven to have been wrong and it sounds like it was an attempt to avoid admitting a mistake either in collection, labeling or testing."

AGREE, AGREE, AGREE! And with Goodchild. From time to time we encounter historical typing discrepancies like this. We determine the actual type, as Goodchild, with two samples. Then we see if there's a technical reason (weak D, BMT, change of reagent/methodology - we use tube and our affiliate uses gel). Then try to figure out what happened, sometimes impossible because it always seems that the old result from 6 months ago was the bogus one. Besides Goodchild's scenario it could have been WBIT, identity borrowing or theft, or a mixup in samples in the lab (I've seen all of these). Document, correct old reports, incident report, and correction in the LIS BB history (when you're very sure of the true ABO/Rh).

[SMILLER]

One weekend I had a back-and-forth with a nurse about changing crappy ABG results.  On our LIS, corrected resutls are displayed with a comment - the previous results are listed also.  The nurse insisted that I delete completely the initial results.  For some reason she did not want them on the chart at all.  She did not believe me when I told her that no result can be completely erased, and that I would not do it even if it was possible.  She was quite irate over that.  She said she would put in an incident report about my repsonse. 

 

Scott

[David Saikin]

funny how that stuff occurs. I got written up once for not providing blood culture reports 1/2hr after the specimen was collected . . . The Medical Director provided some direction to the intern. (I reported "no growth upon plating")

[Malcolm Needs ☆]

The kind of people who tried to "write up" Scott and David should have their crayons taken away until they can learn to play nicely!...or, to put it another way, they should have their ability to try to ruin others' professional lives taken away until they actually have a clue about what they are talking - which, in the case of most such people, is a life sentence!

 

       

[kirkaw]

I digress, but in response to David's post, I had a resident bring a specimen for culture to the Microbiology department, where I was working part-time as a student, and he asked if he should wait for the results.

[mollyredone]

I digress, but in response to David's post, I had a resident bring a specimen for culture to the Microbiology department, where I was working part-time as a student, and he asked if he should wait for the results.

And you said, Sure, pull up a chair!

[SMILLER]

Recently we had a MTP that was intitiated in the ER.  A physician there who should have known better called the BB to discuss why we couldn't get the initial cooler down there faster ("don't you have one sitting on the shelf ready to go?").  We apologized as we had to cut him off as we were a bit busy WITH THE MTP THAT HE INITIATED.

 

So four of us are busy getting the next series of coolers ready (patient went to OR pretty quickly), and this doc has a PA from ER call up to discuss his issue with us again.  We did have a manager nearby to talk to him for a minute, but then had to cut him off as well.

 

Scott

[tbostock]

We can change any result in our LIS, but it keeps track of it, shows who did it and on what date, and throws an exception.  We would always have a comment attached why the change had to happen.  But nothing can ever really be "deleted".

 

While we're on a physician complaint kick...a surgeon called last Saturday SCREAMING that we did not have a certain size of tissue in Blood Bank that he needed for a Sunday surgery.  He said he is filing an incident report and slammed the phone down.  I wish he had a chance for us to tell him:

1. He used the last one the day before, Friday afternoon after 4 pm.  Unless the Tissue Fairy comes overnight...

2. Hospitals are open on weekends, most companies are not.

3. This particular piece of tissue costs about $20,000, so we can't really keep multiples of every size in stock.

4. This is a new tissue, we've just had it for a couple months...how did you save lives before it was invented?

 

OK, rant over.  For now.

[goodchild]

We can change any result in our LIS, but it keeps track of it, shows who did it and on what date, and throws an exception.  We would always have a comment attached why the change had to happen.  But nothing can ever really be "deleted".

 

While we're on a physician complaint kick...a surgeon called last Saturday SCREAMING that we did not have a certain size of tissue in Blood Bank that he needed for a Sunday surgery.  He said he is filing an incident report and slammed the phone down.  I wish he had a chance for us to tell him:

1. He used the last one the day before, Friday afternoon after 4 pm.  Unless the Tissue Fairy comes overnight...

2. Hospitals are open on weekends, most companies are not.

3. This particular piece of tissue costs about $20,000, so we can't really keep multiples of every size in stock.

4. This is a new tissue, we've just had it for a couple months...how did you save lives before it was invented?

 

OK, rant over.  For now.

 

Tissue bank oversight is the hardest and least fulfilling part of blood banking.

[Dr. Pepper]

 

We can change any result in our LIS, but it keeps track of it, shows who did it and on what date, and throws an exception.  We would always have a comment attached why the change had to happen.  But nothing can ever really be "deleted".

 

While we're on a physician complaint kick...a surgeon called last Saturday SCREAMING that we did not have a certain size of tissue in Blood Bank that he needed for a Sunday surgery.  He said he is filing an incident report and slammed the phone down.  I wish he had a chance for us to tell him:

1. He used the last one the day before, Friday afternoon after 4 pm.  Unless the Tissue Fairy comes overnight...

2. Hospitals are open on weekends, most companies are not.

3. This particular piece of tissue costs about $20,000, so we can't really keep multiples of every size in stock.

4. This is a new tissue, we've just had it for a couple months...how did you save lives before it was invented?

 

OK, rant over.  For now.

Thankfully my physician daughter seems to have been absent the day in med school when they give the workshop on arrogance and intractability. Edited November 24, 2015 by Dr. Pepper