Safe Labeling of Laboratory Specimens Mandatory training module for all staff obtaining patient specimens Fall 2007

Mislabeled Specimens Mislabeled specimens can result in patient death due to transfusion of incompatible blood or inappropriate treatment based on erroneous results Mislabeled specimens can result in patient death due to transfusion of incompatible blood or inappropriate treatment based on erroneous results Following procedures to properly identify patients and label the specimen can eliminate this risk. Following procedures to properly identify patients and label the specimen can eliminate this risk. Causes of mislabeled specimens Causes of mislabeled specimens Improper patient identification Improper patient identification Improper labeling of specimens Improper labeling of specimens

Patient Dies From Blood Mismatch; Inova Fairfax Employee Screened Wrong Woman; [FINAL Edition] Avram Goldstein. The Washington Post. Washington, D.C.: Aug 29, pg. B.01 The technician collected the sample from the patient on the wrong side of the curtain in the semiprivate room, they said. The technician may have failed to perform two identification screens that were required: checking the name on the patient's plastic hospital bracelet and asking the patient to state her name aloud, said Russell Seneca, chairman of surgery at the hospital.

JCAHO 2004 National Patient Safety Goals Improve the accuracy of patient identification Improve the accuracy of patient identification Use at least two patient identifiers (neither to be the patient’s room number) whenever taking laboratory samples or administering medications or blood. Use at least two patient identifiers (neither to be the patient’s room number) whenever taking laboratory samples or administering medications or blood. At Winthrop the patient’s name and medical record number must be used for all patients. At Winthrop the patient’s name and medical record number must be used for all patients. If a patient sample is to be drawn/collected (in an emergency) prior to registration, name and date of birth must be used. If a patient sample is to be drawn/collected (in an emergency) prior to registration, name and date of birth must be used. For outpatients, name and date of birth must be used. For outpatients, name and date of birth must be used.

Standard Process for Patient Identification and Specimen Labeling 1. Proceed to bedside with tubes/specimen containers and barcode labels (tubes/specimen containers must not be pre-labeled) 2. Confirm patient identity by comparing the name and MRN on the barcode label to the name and MRN on the ID band for each specimen obtained. The information on the label must match the information on the ID band exactly. Note: a) Specimen is not to be drawn on any patient who does not have an ID band or if information does not match exactly. b) The nurse should identify the patient and place an ID band on the patient prior to any specimen being obtained.

Standard Process for Patient Identification and Specimen Labeling (Cont’d) 3. Obtain specimen 4. Prior to labeling the tube/specimen container, while still at the bedside, confirm the patient identity by comparing the name and MRN on the label to the name and MRN on the ID band. 5. Affix barcode label to the tube/specimen container AT THE BEDSIDE. Note: a) Never leave the bedside before labeling the tubes/specimen containers. b) Do not write any information on the tube’s blank label. c) For Blood Bank Specimens Only - The barcode label must be signed/initialed by the individual drawing the blood.

Emergency Department, Labor & Delivery – in Extreme Circumstances Only When a lab generated barcode label is not available because the patient is not registered: Label the tube/specimen container at the bedside writing the patient’s name and D/O/B directly on the tube/container with a pen. Label the tube/specimen container at the bedside writing the patient’s name and D/O/B directly on the tube/container with a pen. Blood Bank specimens only - sign or write your initials on the tube label. Blood Bank specimens only - sign or write your initials on the tube label. Note:Barcoded labels are available for all registered patients

Labeling of Specimen in Extreme Circumstances If the barcode label is not available due to system failure or under extreme circumstances: Label the specimen at the bedside by either Label the specimen at the bedside by either Hand writing the patient name and MRN on the specimen tube label / container or Hand writing the patient name and MRN on the specimen tube label / container or Affixing a patient’s chart label to the tube / container Affixing a patient’s chart label to the tube / container Blood Bank specimens only - sign or write your initials on the label. Blood Bank specimens only - sign or write your initials on the label. Note: Never double label the tube

Specimen Labeling ALWAYS ALWAYS  Always - verify the patient’s identity using two identifiers (name and MRN # or name and D/O/B) (Name and D/O/B for unregistered patients in ER and Labor & Delivery Emergency Only)  Always - confirm the patient’s identity again when labeling each tube/specimen container NEVER  Never - label tube/specimen container prior to obtaining specimen  Never - leave the room/bedside before labeling the tube/specimen container  Never – collect specimen from a patient without an ID band.  Never – double label a specimen/container.

Mislabeled Specimen Improperly labeled specimens will be rejected by the laboratory.

Specimen Labeling Please complete the post test which is attached Please complete the post test which is attached Give the post test to your supervisor for review and filing Give the post test to your supervisor for review and filing If you have any questions or concerns speak with your supervisor If you have any questions or concerns speak with your supervisor Patient Safety is our priority. Do not take short cuts.