I brought this subject up before, but need to look at another specimen issue now.

Previously, I mentioned requiring complete information to accept a specimen. Standards are just 2 "identifiers." However, in our Lab Guide and in my BB Policy, I established that to be First and Last Name and MR#' Outpatients w/o MR# are complete name and D.O.B. The problem that has come up twice in the past week are 2 different patients who had such long last names that part or all of the first name was missing. Now I did phlebotomy in College, in my internship and the 5 years at my first job (Techs. had to help with morning pick-up help) and I would have had to write any missing information on the specimen before submitting it (i.e. missing letters of first name).

The push-back I am getting from both the in- and out- patient phlebotomy managers, as well as Nursing is that all other hospital documents just require 2 identifiers and that as long as the specimen has 2 identifiers (i.e. maybe not complete name but has MR# and D.O.B.) that we should not be rejecting the specimen.

So, I do not want to be totally unreasonable. What are your thoughts and/or practices??

Thanks

Brenda Hutson, CLS(ASCP)SBB

The chances of compliance are greater when the policy/procedure is consistant across all departments. Keep in mind that The Joint Commission has recently loosened its stance on patient identification at the bedside. Having said all that, what is the opinion of your QA/Risk Management department? Makes for good discussion at a QA/RM meeting.

Notice that JC rules state 2 "unique" identifiers for BB. DOB is not unique (although I can't come up with a reasonable alternative for OPs). Names are not truly unique but have more variation possibilities than DOB.

Maybe since we accept "John Doe" as an identifier, we should accept whatever the shortened form of the name is. After all, a name is just a long series of letters that aren't too likely to be repeated--unless his grandson (and namesake) shows up too!

Some places consider a BB band system number one of their identifiers.

I still vote for the RFID chip implanted in all patient's bodies--probably in their brains cuz that is the only part we can't cut off or transplant.

In the UK, we are "governed" by BCSH Guidelines, and these state that there should be a correctly spelled forename, correctly spelled surname, a full Date of Birth, a Hospital or NHS Number, the date the sample was bled and the signature of the person doing the bleeding.

In the case of an unconcious, unknown patient, or in the case of a major incident, we are allowed to accept "Unknown Male" or "Unknown Female", with a Hospital Number (that must stay with the patient throughout their own stay in hospital) or a Major Incident Number (that must also stay with the patient throughout their own stay in hospital), the date bled and the signature of the person doing the bleeding.

In the case of a dire emergency, when getting a second sample would take too long, we have to have a written medical concession (although, of course, some of these are written after the emergency is over).

It is all pretty strict.

:):)

Edited March 9, 201015 yr by Malcolm Needs
I still can't spell!

For all of our orders, a requisiton prints in blood bank. When we receive a sample, it is compared to information on the order. What identifiers do you have that are consistent between the patient and order? Out-patient's present a different set of issues since they normaly do not have a hospital ID bracelet. It sounds like you are using a pre-printed label. We use a blood bank armband system and the labels are hand written. THe complete first name and last name are required. My manager complains when a sample must be recollected due to mis-spelling a name or leaving out a number on the MR#. I stand my ground.

Good luck!!!!!

:bye:

Very interesting to see the varying practices on this subject.

We do specifically address this in our sample labeling policy. We use Sunquest LIS, and most samples are labeled using the LIS label that is printed at the time of collection. Sometimes the name is too long to print the entire first and last name. We still accept the sample if it has 2 other identifiers, such as hospital number, DOB, SSN, account number. I would think you would be okay as long as you can come to an agreement (Mgr/QA/Med Director) to put a policy in place while having 2 identifiers on the sample label. Good luck!

Stephanie Townsend, MT(ASCP)SBB

Notice that JC rules state 2 "unique" identifiers for BB. DOB is not unique (although I can't come up with a reasonable alternative for OPs). Names are not truly unique but have more variation possibilities than DOB.

Maybe since we accept "John Doe" as an identifier, we should accept whatever the shortened form of the name is. After all, a name is just a long series of letters that aren't too likely to be repeated--unless his grandson (and namesake) shows up too!

Some places consider a BB band system number one of their identifiers.

I still vote for the RFID chip implanted in all patient's bodies--probably in their brains cuz that is the only part we can't cut off or transplant.

A D.O.B. alone may not be a unique identifier, but when put with the name, it is certainly a good combination (though not 100%; but I have to say that I have seen 1 or 2 in my career which were identical such that the middle initial had to be used).

Where I am currently, they allowed the red armband# used for outpatients and pre-op patients to be one of the unique identifiers (and I think that is referenced in the Technical Manual as acceptable also). I "personally" do not consider the red armband# a unique identifier in that it changes everytime (I discussed this with an FDA inspector years ago and they agreed with me, but of course, you can find one that would disagree also; so, it is must my bias).

Also, when you talk about trying to cross-reference patients between hosptials, or between the donor center (for Autologous units) and the hospital, no one is ever going to call and say "I have the name and red armband#; I need some information on that patient."

We haved moved in the direction of barcoded armbands; I just don't have that entire picture yet (does everyone who draws blood on patients use that, or just phlebotomy; do the nurses then use it prior to transfusion; etc.).

Brenda Hutson

In the UK, we are "governed" by BCSH Guidelines, and these state that there should be a correctly spelled forename, correctly spelled surname, a full Date of Birth, a Hospital or NHS Number, the date the sample was bled and the signature of the person doing the bleeding.

In the case of an unconcious, unknown patient, or in the case of a major incident, we are allowed to accept "Unknown Male" or "Unknown Female", with a Hospital Number (that must stay with the patient throughout their own stay in hospital) or a Major Incident Number (that must also stay with the patient throughout their own stay in hospital), the date bled and the signature of the person doing the bleeding.

In the case of a dire emergency, when getting a second sample would take too long, we have to have a written medical concession (although, of course, some of these are written after the emergency is over).

It is all pretty strict.

:):)

So, when you say "correctly spelled," where does a truncated first name fall into that (if due to extremely long last name and labels are printed with no more spaces to lengthen the name area)?

Brenda Hutson

For all of our orders, a requisiton prints in blood bank. When we receive a sample, it is compared to information on the order. What identifiers do you have that are consistent between the patient and order? Out-patient's present a different set of issues since they normaly do not have a hospital ID bracelet. It sounds like you are using a pre-printed label. We use a blood bank armband system and the labels are hand written. THe complete first name and last name are required. My manager complains when a sample must be recollected due to mis-spelling a name or leaving out a number on the MR#. I stand my ground.

Good luck!!!!!

:bye:

Well, I stand my ground also; unfortunately, there are 2 Phlebotomy Managers who are trying to "take my space on that ground." There has been a lot of leniency here before I came (even in the Transfusion Service; i.e. people allowed to come and add red armband label to specimen; specimens sent back for corrections; etc; things I would never allow).

This is the 6th place I have worked so when something has been done a certain way in the other 5 places and now I am working somewhere that is different, I tend to think the standard of practice must be more like the other 5 places (along with meeting regulatory guideleines of course). But I am now working in a place where most of the staff has been there 25+ years; so, change is difficult. I don't want to just dig my heals in if I am being unreasonable about something (well, actually I do want to; but I can't always).

Brenda Hutson

Very interesting to see the varying practices on this subject.

We do specifically address this in our sample labeling policy. We use Sunquest LIS, and most samples are labeled using the LIS label that is printed at the time of collection. Sometimes the name is too long to print the entire first and last name. We still accept the sample if it has 2 other identifiers, such as hospital number, DOB, SSN, account number. I would think you would be okay as long as you can come to an agreement (Mgr/QA/Med Director) to put a policy in place while having 2 identifiers on the sample label. Good luck!

Stephanie Townsend, MT(ASCP)SBB

That sounds like what I am being asked to accept by the 2 phlebotomy managers. At first I just held my ground, but in thinking more about it, I think I need to be open to discussing this and see if there is "more than one right way" that ensures patient safety.

Thanks,

Brenda Hutson, CLS(ASCP)SBB

So, when you say "correctly spelled," where does a truncated first name fall into that (if due to extremely long last name and labels are printed with no more spaces to lengthen the name area)?

Brenda Hutson

We do not accepted truncated forenames (or surnames come to that) even in the case of lbela printed at the bedside unless we have a written and signed statement that this is because there are only a certain number of characters allowed by the computer producing the label (except in a dire emergency). Otherwise we would require a hand written sample.

This very rarely happens anyway, but you can bet your bottom dollar that when it happens it will be when our own computer is also down, so we have to hand-write the compatibility labels, and it is someone with, for example, a Sri Lankan name who is having a liver transplant (I have a great mate from Sri Lanka who has 17 letters in his forename and 14 in his surname)!

:eek::eek:

We do not accepted truncated forenames (or surnames come to that) even in the case of lbela printed at the bedside unless we have a written and signed statement that this is because there are only a certain number of characters allowed by the computer producing the label (except in a dire emergency). Otherwise we would require a hand written sample.

This very rarely happens anyway, but you can bet your bottom dollar that when it happens it will be when our own computer is also down, so we have to hand-write the compatibility labels, and it is someone with, for example, a Sri Lankan name who is having a liver transplant (I have a great mate from Sri Lanka who has 17 letters in his forename and 14 in his surname)!

:eek::eek:

We have had 2 such patients in the past week (1 outpatient; 1 inpatient). Neither phlebotomist wrote the missing information (though in their defense, it is because no one ever made them do that before). So the outpatient phlebotomy Manager said I should accept the specimen because they had never been told. I countered that they "had" been told; that since I had both a Transfusion Service Specimen Policy and my section of the General Lab Policy which both stated the specimen must have a complete, legible and accurate name, I should not have to define that; it is what it is!

Brenda Hutson

We have had 2 such patients in the past week (1 outpatient; 1 inpatient). Neither phlebotomist wrote the missing information (though in their defense, it is because no one ever made them do that before). So the outpatient phlebotomy Manager said I should accept the specimen because they had never been told. I countered that they "had" been told; that since I had both a Transfusion Service Specimen Policy and my section of the General Lab Policy which both stated the specimen must have a complete, legible and accurate name, I should not have to define that; it is what it is!

Brenda Hutson

I agree with you entirely.

:mad::mad::mad:

Another thought on the subject. I work for a hospital that is a part of a multiple facility group. We have two primary care hospitals and multiple off site clinics and physician outreach.

We have a CORPORATE policy that governs what constitutes 2 patient identifiers anywhere within the system whether it is for lab purposes, dispensing medications, or performing invasive procedures. This gives us the basis for our own internal patient identification policy. The corporate policy came about due to the JC's focus on patient safety, this makes it easier when we deal with other entities i.e. nursing about rejecting a specimen that they failed to label properly.

Then using this policy as the base we created a laboratory policy which was approved by all of the laboratory services so that labeling requirements are the same whether they are for transfusion service or for chemistry. This same policy is then used throughout the corporation for laboratory specimen collection. If you go to any of our facilities you will find the same policy in all of their manuals. The policy is also posted on our corporate intranet in our department customer guide.