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:

We encourage the use of preprinted labels for BB specimens. We also use a special BB armband and have a second specimen policy.

It could be worth your while getting a copy of;

Cummins D, Sharp S, Vartanian M, Dawson D, Amin S, Halil O. The BCSH guidelines on addressograph labels: experience at a cardiothoracic unit and findings of a telephone survey. Transfusion Medicine 2000; 10: 117-120.

Dave Cummins has made something of a study of this subject.

:D:D:D:D

This may help too!

http://www.rcn.org.uk/__data/assets/pdf_file/0009/78615/002306.pdf

We use pre-printed labels and Blood Band ID, we require a second verifier that must write their computer ID on the on the label along with the nurse or lab asst. that collected the sample.

Thank you for sharing Fluffy.

There was a debate about labelling before or after the draw.

We use pre-printed, and a second sample if there is no history on the patient.

You must raise awareness of proper pt Id, if not then whatever means you use will not seem to be enough.

We use computer generated labels and BloodLoc Identification Codes - I would never be able to read my own writing if forced to do manual labels BUT I do understand the reasoning for doing so (and many places do require handwritten blood bank labels).

Also, note that the person who draws the blood is traceable. This way they know they are accountable and pay close attention to follow regulations including bedside labeling.

We use hand labeled tubes with a "blood bank number" written on the tube. The BB number is found on the second, additional armband that is applied to the pt at the time the initial BB specimen is collected.

The tube label contains: pt full name, dob, collector's ID (their computer log-in), date collected, BB number. We opted not to use MRN as a second pt identifier as it could be copied from a pt label that just might be accidentally hanging next to the pts bed.

The only pre-printed labels we accept are cord bloods or perinatal OB workup samples.

We use hand labeled tubes ALSO

........I have heard several stories from staff that the nurses just take the blood to the nurses station and label from the chart anyway....... :bonk:

I don't think the issue is necessarily handwritten vs pre-printed labels. The issues are: (1) Is the process for sample collection one that encourages correct labeling? and (2) Are people correctly following the process? Do you routinely audit sample collection? Information from audits could help identify the issues and gain buy-in from nursing administration for whatever your process is. My experience tells me that the staff stories are probably correct, but you need the data to create the right kind of change. Sounds like it might be time for a cross-department quality improvement committee.

we use computer labels and they must have pt. name. MR#, date and phlebotomist initials on them. we coordinate this with Hollister Blood bank bands.

We are changing vendors and will most likely be using typenex barcoded bands. These include an area to insert a preprinted label and has a water proof overlay that will stick down. I am going to required that the lab person and a nursing person initial the preprinted label before it is stuck to the band to ensure that the patient was properly identified. This will help us as well when we go to electronic transfusion in meditech soon. We are going away from handwriting due to difficulties reading certain handwriting.

My lab does the handwritten BB labels with a second identifier..Both of these labels must match patient info on the patient"s BB bracelet exactly ie with phlebo's ( the RN's at my hospital donot draw blood) computer name and date and time of draw...

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.

I have seen every version of "cheating" by nursing.

Ha. That's very true. There's always "that guy" (or girl) that finds a way to elude the safety of the system because it feels more comfortable for them or saves them a couple seconds of convenience but possibly endangers the patients.

We use computer generated labels (our two identifiers are Patient's Full Name and Medical Record Number), with collectors initials and date/time hand written on the sample at the patient's bed side . We also have a second ABORh verification policy.

Thank you for all those who have responded. I have another question for those of you who hand-write the labels. We use the Name and MR number as our 2 unique identifiers. If a nurse writes the name, date of birth and hospital visit number correctly, but omits the MR number, do you allow them to add the MR number? All patient info is correct so I am leaning toward allowing the addition since the patient has been correctly identified, but is this openning a can of worms? We must have the MR number because there are too many characters in the visit number to fit in the wristband field in the computer.

We use preprinted, computer generated, labels. The patient also has a blood bank ID bracelet which one of the numbers MUST be attached to the specimen. We also use electronic PPID which helps prevent mislabels. The nurse will scan the patient's armband, then the medical record number on the label. If there is a mismatch then the user gets an error message. We also require sample labeling at bedside.

The medical record number is required by CAP. All of our sample labels are computer generated so the patient name, medical record number, and a accession number is always on the label.

We don't allow corrections for the MR# because we consider that a patient identifier.

We hand label and require 3 identifiers - name, MR# and the blood bank ID #, which is on a separate armband. Those 3 things must be correct for the specimen to be acceptable. If the the phleb omits date, time, location or initials, they can add them to the label. Almost all of our draws are done by phlebotomists, not nurses, so that makes it easier for us to enforce. We have very few specimens rejected.

If the MR# is not on the specimen then the patient has to be redrawn..only time that I know of that we made an exception to that rule was a surgery patient and the surgeon took responsibility for the

for the draw...

I agree that pre-printed labels can introduce error, specially for employee`s that do not understand the importance of bedside labeling. The hand written labels can also introduce spelling and numerical errors. The solution how ever is very strict no-tolerance requirements from deviation policy,alot of documented education.Followup to making sure it is everyones is doing the same thing the same way. I have found that the bar code indentification system is not only a real tool for transfusion identication but also pharmacy, So talking about safety, it is priceless as our lives.

We're going to be moving to the bar-coded typenex band others have mentioned (uses a printed label), and I will be glad to leave the handwriting -error problems behind. All patients have a"regular" hospital wristband as well as the typenex.