1. Laboratory Procedures Clinical Vanderbilt University Medical Center Nashville, TN Department of Pathology

2. Who to Contact? The Main Lab: 343-9155 (3-9155) Client Services (Reference Tests): 322-4844 (2-4844)  Reference test are tests that are sent to an outside facility. These numbers are resources which you can access at any time for any questions you may have about how a test is drawn, what color tube, etc.

3. Labels Labels should be legible. ALL test tubes and urine cups must be labeled. Pt’s Name, MR# Required on all specimens http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/F575E10C0648EB8686256A6B00502EA9

4. Requisitions All requisitions require: Pt’s Full name Pt’s MR number Current date Current Billing Number Doctor’s code Clinic code Doctor’s signature ICD-9 Code(s) Tests ordered clearly marked

5. Patient Verification is MANDITORY Two identifiers should be used Name DOB ID Bracelet (if available) SSN Government Issue Driver’s License, ID Card with Picture Photograph: VPH Medical Record (chart) http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/29B5F84E98DB814986256CB5007E4E6D

6. Causes of Common Labeling Errors Failure to verify patient properly Not labeling specimens immediately after drawing specimens Failure to label specimens before leaving patient’s side.

7. Effect of Labeling Errors Incorrect laboratory results will be reported. Delays laboratory results. If detected, specimen may be discarded. Incorrect results may hinder proper patient care, or even death.

8. 5 Steps to Effective Labeling 1. Verify Patient Identification by 2 identifiers. 2. Match Patient ID to requisition. 3. Match Patient ID to Specimen Label(s) 4. Label specimen before you leave the Patient. 5. Match the label to Requisition as the specimen is bagged for transport.

9. Specimen Packaging Requisition should be folded so the patient’s name and priority shows through the plastic bag. Blood tubes and urine specimens should be packed in separate bags. Blood Cultures should be packed separate from blood tubes. Requisitions should be inserted in pocket provided separating blood from paperwork. TUBE Pt. Info Priority Name, Mr#, Billing Code, DR's Code, Clinic Code Priority (STAT, Routine) TUBE

10. Safety Universal Precautions at all times PPE’s (Gloves, lab coats, etc.) Discard sharps properly ASAP Keep your work area clean and organized

11. Tube Order 1. Red or Gold top, (aka SST or Tiger top) Light Green, (Lithium Heparin) 2. Blue top 3. Green Heparinized (dark Green) 4. Lavender EDTA (always last)  If a Blood Culture is ordered, draw the blood culture first and collect the rest in the original order.  All tubes should be gently inverted to avoid hemolysis and clotting.

12. Blue Sodium Citrate Tube If a PT or PTT is ordered by itself always draw 3 to 5 ml. in a discard tube. (RED or Gold) These specimens should be sent ASAP. This tube must always be full.

13. Tips For Good Customer Service 1. Always let patient see you change gloves. 2. Always let the patient see you taking out new equipment. 3. Always be courteous 4. Always maintain a clean appearance both personally and professionally. 5. Always be confident. * Remember you are in control.

14. Tips to Avoid Hemolysis Use the largest bore needle available whenever possible. Avoid using syringes to draw blood. Avoid using Butterfly needle sets. Do not push blood into tubes with syringes and butterfly needle sets. Make sure the blood is being draw under the tubes own evacuated system. Make sure the blood flow into tube is quick and constant. Always invert tubes (especially tubes with additives).

15. Who to Contact? The Main Lab: 343-9155 (3-9155) Client Services (Reference Tests): 322-4844 (2-4844)  Reference test are tests that are sent to an outside facility. These numbers are resources which you can access at any time for any questions you may have about how a test is drawn, what color tube, etc.

16. Serum Vs. Plasma (Fluid Part of The Blood) Serum No Anti-coagulant Red Top or SST (Gold Top) Tube. Plasma Anti-coagulated Lavender Dark Green Top Light Blue

17. Latex Alternatives Nitrile Gloves Vinyl Gloves Nitrile Tourniquets Cartoon Band aids If all else fails use regular tourniquets over cloth (Sleeves, Gauze)

18. Questions and Answers

19. Star Panel To Access Non- Vanderbilt Patient Accounts, security needs to be obtained for VPLS. Contact Security Manager, request SAMS (Security Access and Maintenance Team) access form for VPLS Security.