So, at my facility, we have phlebotomists who collect about 98% of our samples. On occasion, a nurse will be generous and help them out. Our BB policy for armbands states that 2 members of the staff have to be present to positively identify a patient before the sample is collected. Both initials must be on the tube and armband. We always seem to have issues with nurses drawing pink top tubes in L&D and the ER for BB testing, but they don't follow procedure. They leave the tubes for our phlebotomists to use. And I'm betting 9/10, they do and put their initials with the nurse that drew it...but not at the correct time and 2 people not being there. My questions are:  Does anyone else have this issue? and What do you do to resolve it?

We solved that problem by dc'ing the policy that 2 must identify patient and include initials on the tube.

Our phlebotomist are trained to never accept a tube and/or put their ID on it if they did not witness the draw.  If we determine that has happened, there will be discipline for not following policy.  They are very good about ratting out the nurses who try to get them to do that.

4 hours ago, R1R2 said:

We solved that problem by dc'ing the policy that 2 must identify patient and include initials on the tube.

Unfortunately, that policy is here to stay until we switch to cerner and the phlebs can scan an armband as another positive patient identifier.

13 minutes ago, pbaker said:

Our phlebotomist are trained to never accept a tube and/or put their ID on it if they did not witness the draw.  If we determine that has happened, there will be discipline for not following policy.  They are very good about ratting out the nurses who try to get them to do that.

Oh, our phlebs are too. However, I think if the tube is already drawn, they are more apt to use it rather than have a little integrity and restick the patient while there are 2 people to positively ID the patient. Unfortunately, I can't prove that with physical proof. Although, our phlebs are also very good at ratting out each other . lol.

We use bloodloc codes.  Only require one individual to id patient.  Have never worked where 2 folks had to id the patient when the specimen was obtained.  Always for transfusion, though the use of bloodloc codes should be able to alleviate that process - it is one that will die hard. 

We do 2 folks to id all specs.  Phlebs use bedside scanning/printers.  Phlebs draw about 70%.  We firmly reject all non-signed specs.  No exceptions.  Especially from ED - every hospital I've been in, the ED is notorious for mislabeling, mis-identifying specs.  We're slowly getting bedside scanning/printing to nursing.

L/D and ER are the most common places for WBIT (wrong blood in tube) across the country.  To drop your policy requiring positive id verification because people didn't like it, and then put your phleb staff in the middle is not right.  If you cannot get phleb staff to not use these specs, then I'd suggest another system - bloodloc, typenex, etc.  Safe transfusions begin with the spec.

I agree with Kate. Sure it's hard to toss a sample but would YOU put your initials on a tube that you did not witness who it came from??  If there were to be an incident where the wrong pt. was drawn or a tube was labeled wrong, the phlebotomist is liable. Not to mention that the patient may receive the wrong blood type. I have no doubt that if you have worked in a lab that receives nurse collected specimens, then you have experienced mislabeled specimens and/or wrong blood in tubes. 

Set your policy and stick to it, report all those who do not follow it. Have meetings with the ER or L&D managers that you will no longer accept specimens that did not have 2 people witness. If you sometimes let it slide, then they will sometimes not follow the rules. It's like 'tough love' .. not easy at all .. but in time they will learn. Been there, done that where the ER and Lab worked against each other and not as a Team like it should be. It's 99.9% better now due to great managers and team work. Good luck!

On 9/26/2017 at 11:49 AM, pbaker said:

Our phlebotomist are trained to never accept a tube and/or put their ID on it if they did not witness the draw.  If we determine that has happened, there will be discipline for not following policy.  They are very good about ratting out the nurses who try to get them to do that.

Same here.

4 minutes ago, AMcCord said:

Same here. We use FinalCheck for all blood bank draws and use a collection device to scan armbands to ID the patient. FinalCheck or Bloodloc would work very well until you get a electronic collection system in place.