1. Patient Identification & Specimen Collection How Proper Patient Identification and Proper Specimen Collection Affects the Accuracy of Your Patient’s Laboratory Results Patient Identification & Specimen Collection How Proper Patient Identification and Proper Specimen Collection Affects the Accuracy of Your Patient’s Laboratory Results Lake Regional Health System

2. Who Says We Have To Do This? The Joint Commission does…… NSPG.01.01.01 – Use at least two patient identifiers when providing laboratory services.  EP1: Use at least two patient identifiers when administering blood or blood components, when collecting blood samples and other specimens for clinical testing; and when providing other treatments or procedures. The patient’s room or physical location is not used as an identifier.  EP2: Label containers used for blood and other specimens in the presence of the patient.

3. NO Room For Error……. Ø Tolerance A LRHS Laboratory Services Manual for Nursing Services is available on each nursing unit and on the FISH under the lab tab. It is a complete and detailed book of instructions covering: A LRHS Laboratory Services Manual for Nursing Services is available on each nursing unit and on the FISH under the lab tab. It is a complete and detailed book of instructions covering: The ordering of testsThe ordering of tests Specimen collection requirementsSpecimen collection requirements Patient preparation proceduresPatient preparation procedures Expected test turnaround timeExpected test turnaround time Any special specimen handling procedures to insure integrity of a specimenAny special specimen handling procedures to insure integrity of a specimen

4. Accuracy of Patient Identification Accuracy of Patient Identification To insure that laboratory tests are performed on the Correct Patients use at least two (2) Patient Identifiers. Inpatients, ER, SDS and OP’s receiving treatment in a bed:  Specimens shall not be obtained without a correct and complete armband. The armband shall be replaced or corrected prior to obtaining any specimen.  Check the Patient’s armband against the laboratory requisition/label. The patient’s name and Hospital # must match exactly: Outpatients  Ask the patient to repeat and/or spell his/her name and date of birth. Verify this information is the same as printed on the order/label (young children or others unable to give their name/DOB may be identified by their parent or guardian). If there is any discrepancy do not obtain the specimen until the discrepancy is resolved.

5. The Collection Process 1.The specimen shall be collected only by personnel who have been thoroughly trained in proper procedures and instructed in the proper techniques. 2.Appropriate protective equipment shall be worn for the specimen collection procedure. 3.The accuracy of the lab result is only as good as the quality of the specimen!

6. Enter the patient’s room with the following supplies:  PPE  Blood Collection supplies or Container  Label  Requisition (if available; i.e. for Urines)  Two (2) Biohazard Bags

7. The Labeling Process Once the correct specimen is collected on the correct Patient the specimen shall be labeled by the collector in the presence of the Patient. (Do Not label tubes/containers prior to collection) The Labels on the primary specimen container must include the following information:  Patient’s full name  Hospital number (for Inpatients)  Hospital number or date of birth (for Outpatients)  Date and time specimen was obtained  Initials of collector  Source of specimen, when appropriate

8. Did you know….these factors can affect the accuracy of lab results  Order of Draw is important when collecting blood samples. Use this order… –Blood cultures –Blue tubes (must be filled to line) –Red/SST tubes –Green tubes –Lavender tubes –Grey tubes  Mix all tubes gently after filling!  Information on Lab tests and drug screen interferences available on the FISH…check out the LAB Tab!  Drawing blood above an IV site will dilute/contaminate the specimen.  Turn off infusion for at least 1 minute and waste 5-10 mls when drawing from a line to prevent contamination/dilution of the specimen.  Leaving the tourniquet on longer than 1 minute can increase the potassium.  A clot in a specimen will decrease the platelet count and increase the protime.  Hemolysis will increase the potassium, AST, and ALT. It can be caused by : –Exposure to heat –Excessive mixing/shaking –Pulling hard on syringe plunger or forcing blood into tubes. –Poor needle placement in vein

9. Transporting the Specimen When transporting the correct specimen on the correct Patient with the correct labeling keep in mind: Securely close specimen tubes or containers to prevent leakage during transport. Securely close specimen tubes or containers to prevent leakage during transport. Place specimen in a plastic Biohazard Bag for transport or delivery with the requisition in the outside pocket. Place specimen in a plastic Biohazard Bag for transport or delivery with the requisition in the outside pocket. Care is to be taken to not contaminate the outside of the container or bag. If the biohazard bag becomes contaminated, place into a secondary biohazard bag prior to delivery to the laboratory with the requisition in the outside pocket. Care is to be taken to not contaminate the outside of the container or bag. If the biohazard bag becomes contaminated, place into a secondary biohazard bag prior to delivery to the laboratory with the requisition in the outside pocket. Specimens sent in the pneumatic tube system must be double bagged in two plastic Biohazard Bags with the requisition in the outside pocket. Blood cultures can only be sent through the tube system if placed in special leak proof carriers. Specimens sent in the pneumatic tube system must be double bagged in two plastic Biohazard Bags with the requisition in the outside pocket. Blood cultures can only be sent through the tube system if placed in special leak proof carriers. All specimens shall be delivered to the laboratory within the specified delivery time in order to insure specimen integrity for the particular analysis to be performed. All specimens shall be delivered to the laboratory within the specified delivery time in order to insure specimen integrity for the particular analysis to be performed.

10. Last, but not least!! You must always use the highest standards of practice:  Wash your hands upon entering a patient’s room.  Explain to the patient what you are doing and who you are.  Provide privacy for the patient during the process.  Obtain the specimen using your PPE.  Remove PPE and wash your hands before leaving the patient’s room.  Put the room back in order when you’re done (i.e., call light in place)  Make the patient comfortable.  As the patient if they need anything or if you can do anything for them.

11. Summary  All specimens sent to the LRHS Department of Pathology (Laboratory) shall be properly Collected, Labeled and Delivered.  Reference: Laboratory Services Manual for Nursing Services, Department of Pathology and Clinical Laboratories Department of Pathology and Clinical Laboratories Lake Regional Health System, Osage Beach, MO Lake Regional Health System, Osage Beach, MO

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