1. 1 1 Chapter 1 Specimen Management Professor A. S. Alhomida Disclaimer The texts, tables and images contained in this course presentation (BCH 376) are not my own, they can be found on:  References supplied  Atlases or  The web The texts, tables and images contained in this course presentation (BCH 376) are not my own, they can be found on:  References supplied  Atlases or  The web King Saud University College of Science Department of Biochemistry

2. 2 2 The result of any laboratory test is only as good as the sample received in the laboratory

3. 3 3 The Problem You have arrived for work and notice a urine specimen on the counter with a requisition to perform urinalysis and culture. The requisition form had the patient’s name, and ordering physician. Upon examining the urine, you notice that the urine is cloudy and has a strong odor of ammonia.  How would you proceed? You have arrived for work and notice a urine specimen on the counter with a requisition to perform urinalysis and culture. The requisition form had the patient’s name, and ordering physician. Upon examining the urine, you notice that the urine is cloudy and has a strong odor of ammonia.  How would you proceed?

4. 4 4 Specimen Management 1.Specimen Collection 2.Specimen Transport 3.Specimen Handling 4.Specimen Referral 5.Specimen Storage 6.Specimen Disposal 1.Specimen Collection 2.Specimen Transport 3.Specimen Handling 4.Specimen Referral 5.Specimen Storage 6.Specimen Disposal

5. 5 5 The Quality Assurance Cycle Data and Lab Management Safety Customer Service Patient/Client Prep Sample Collection Sample Receipt and Accessioning Sample Transport Quality Control Record Keeping Reporting Personnel Competency Test Evaluations Testing

6. 6 6 Impact of Specimen Management on Patient Care Essential to accurate laboratory diagnosis Directly affects patient care and patient outcome Influences therapeutic decisions Impacts patient length of stay, hospital costs, and laboratory costs Influences laboratory efficiency Essential to accurate laboratory diagnosis Directly affects patient care and patient outcome Influences therapeutic decisions Impacts patient length of stay, hospital costs, and laboratory costs Influences laboratory efficiency

7. 7 7 Pitfalls Saying “yes” to everything  Accepting every specimen Afraid to say “No” to physicians  Someone with sufficient authority MUST support laboratory policy  Good lab practice – Patients first! Having no boundaries for technical issues Saying “yes” to everything  Accepting every specimen Afraid to say “No” to physicians  Someone with sufficient authority MUST support laboratory policy  Good lab practice – Patients first! Having no boundaries for technical issues

8. 8 8 Pitfalls Lead to Errors Resulting In: Delays in getting test results Unnecessary re-draws/re-tests Decreased customer satisfaction Increased costs Incorrect diagnosis or treatment Injury Death Delays in getting test results Unnecessary re-draws/re-tests Decreased customer satisfaction Increased costs Incorrect diagnosis or treatment Injury Death

9. 9 9 Specimen Collection Procedures Should include instructions for:  Positively identifying the patient before collecting a specimen  Required specimen for each requested test  Preparation of patient  Type of collection container, required volume, timing  Preservation of specimen, e.g., transport media  Proper specimen labeling  Special handling instructions, e.g., refrigeration Should include instructions for:  Positively identifying the patient before collecting a specimen  Required specimen for each requested test  Preparation of patient  Type of collection container, required volume, timing  Preservation of specimen, e.g., transport media  Proper specimen labeling  Special handling instructions, e.g., refrigeration

10. 10 Laboratory Handbook Compilation of documents that must be made available to all specimen collection areas Must be understood by all laboratory staff Includes:  Name and address of laboratory  Contact names and telephone numbers  Hours of operation  List of available tests  Specimen collection procedures  Specimen transport procedures  Expected turn around times (TAT)  How stat requests are handled May be referenced in the Quality Manual Compilation of documents that must be made available to all specimen collection areas Must be understood by all laboratory staff Includes:  Name and address of laboratory  Contact names and telephone numbers  Hours of operation  List of available tests  Specimen collection procedures  Specimen transport procedures  Expected turn around times (TAT)  How stat requests are handled May be referenced in the Quality Manual

11. 11 Test Requisition Patient identification Clinical data, where indicated Contact information for requesting physician or authorized individual Tests requested Time and date of specimen collection Source of specimen, when appropriate Patient identification Clinical data, where indicated Contact information for requesting physician or authorized individual Tests requested Time and date of specimen collection Source of specimen, when appropriate

12. 12 Specimen Collection: Laboratory Responsibilities Verify completeness of test request Verify integrity of the specimen  Determine adequacy of specimen  Appropriately labeled, legible identification  Determine if appropriate specimen was submitted for requested test  Identifier of the collector, e.g., phlebotomist, patient Enforce procedures for handling sub-optimum specimens  Specimen rejection criteria Verify completeness of test request Verify integrity of the specimen  Determine adequacy of specimen  Appropriately labeled, legible identification  Determine if appropriate specimen was submitted for requested test  Identifier of the collector, e.g., phlebotomist, patient Enforce procedures for handling sub-optimum specimens  Specimen rejection criteria

13. 13 Specimen Rejection Criteria: Unlabeled specimen Insufficient patient information Hemolyzed specimen Wrong tube drawn Wrong specimen submitted Inadequate volume for the amount of preservative Insufficient quantity Prolonged transport Unlabeled specimen Insufficient patient information Hemolyzed specimen Wrong tube drawn Wrong specimen submitted Inadequate volume for the amount of preservative Insufficient quantity Prolonged transport

14. 14 Specimen Handling

15. 15 Specimen Handling Handle all specimens as if infectious Use tracking system for all specimens:  Accession or logging process  Confirm actual receipt of specimens  Date and time of specimen receipt  Track aliquots – traceable to the original sample Handle all specimens as if infectious Use tracking system for all specimens:  Accession or logging process  Confirm actual receipt of specimens  Date and time of specimen receipt  Track aliquots – traceable to the original sample

16. 16 Specimen Handling Establish procedures for handling:  Stat or urgent requests  Delayed testing, e.g., storage, separation of serum or plasma from cells  Leaking containers  Contaminated forms  Preservation of specimens Establish procedures for handling:  Stat or urgent requests  Delayed testing, e.g., storage, separation of serum or plasma from cells  Leaking containers  Contaminated forms  Preservation of specimens

17. 17 Specimen Transport Train personnel in appropriate safety and packaging procedures Package and preserve specimens appropriately Transport specimens at appropriate temperature Determine acceptable transport time Determine mode of transport  Courier, ambulance, clinic or lab staff Adhere to the International Air Transport Association (IATA) regulations Train personnel in appropriate safety and packaging procedures Package and preserve specimens appropriately Transport specimens at appropriate temperature Determine acceptable transport time Determine mode of transport  Courier, ambulance, clinic or lab staff Adhere to the International Air Transport Association (IATA) regulations

18. 18 The Dangerous Goods Regulations Covers:  Packaging  Labelling Packages  Packing Instructions  Documentation  Training Are updated annually by IATA Covers:  Packaging  Labelling Packages  Packing Instructions  Documentation  Training Are updated annually by IATA

19. 19 Specimen Referral Record:  Tests or specimens referred  Date of referral  Name of person referring test Monitor or Track, and Record:  Turnaround time  Results delivery (from referral lab, to requestor)  Problems with referral Record:  Tests or specimens referred  Date of referral  Name of person referring test Monitor or Track, and Record:  Turnaround time  Results delivery (from referral lab, to requestor)  Problems with referral

20. 20 Specimen Storage Establish policy  What should be stored? Determine retention time Determine storage location  Consider ease of access Assure proper storage conditions Indexing of specimens  By day of receipt or accession number Establish policy  What should be stored? Determine retention time Determine storage location  Consider ease of access Assure proper storage conditions Indexing of specimens  By day of receipt or accession number

21. 21 Specimen Storage Serum Banks: Establish tracking procedures  Encourage use of information technology Maintain an organized, accessible storage system Monitor freeze/thaw cycles Serum Banks: Establish tracking procedures  Encourage use of information technology Maintain an organized, accessible storage system Monitor freeze/thaw cycles

22. 22 Specimen Disposal

23. 23 Specimen Disposal Develop policy for disposal of medical waste  Establish and follow disinfection procedures  Comply with local regulations  Include policy of disposal of rejected specimens Appoint someone with oversight responsibilities Establish a schedule to review all stored specimens Develop policy for disposal of medical waste  Establish and follow disinfection procedures  Comply with local regulations  Include policy of disposal of rejected specimens Appoint someone with oversight responsibilities Establish a schedule to review all stored specimens

24. 24 Summary: Avoiding Pitfalls Remember good laboratory practice  Patients first! Train all personnel responsible for collecting, handling, storage, transport of specimens Monitor rejection log Routinely communicate with customers Update handbook, procedures when methods change Remember good laboratory practice  Patients first! Train all personnel responsible for collecting, handling, storage, transport of specimens Monitor rejection log Routinely communicate with customers Update handbook, procedures when methods change

25. 25 THE END Any questions?