At the Bedside
Objectives
1. Identify the appropriate procedure for collecting and
labeling specimens.
2. Define patient identification requirements at sample
collection time.
3. Identify ways to comply with specimen labeling
requirements in the event no computer-generated labels
are available (computer system is down or specimens in
Triage area before orders are entered.)
4. Understand the accountability process associated with a
mislabeled specimen.
At the
Bedside
• In order to ensure patient safety we must double
check and label specimens, medications, blood or
expressed breast milk while At the Bedside.
• Doing this At the Bedside allows us to compare
the product to the ID band and ensure we are
providing the right service or treatment to the
right patient.
Lab Specimen
Labeling
• The first topic we will address is lab specimen
labeling.
– Labeling lab specimens At the Bedside facilitates
quality patient care by decreasing the chances of a
labeling error.
– Labeling errors can result in multiple sticks,
infections, increased length of stay and other
negative patient outcomes.
Patient Identification
Process
• Ask the patient to state identifying information. Patient
identification includes any two of the following (See SA 30-10.05,
Patient Identification):
• Patient name
• Date of birth
• Medical Record Number
• Last four digits of the Social Security Number
• Government-issued photograph identification (e.g., driver’s
license)
• Photograph (taken in Vanderbilt Psychiatric Hospital)
• Security photograph taken in Newborn Nursery
One Person Specimen
Labeling Process
All Non Blood Bank Specimen
Blood Bank Specimen
Patient’s full name (first and last)
Patient’s full name (first and last)
Patient’s Medical Record number
Patient’s Medical Record number
VUnet ID of specimen collector is
required on the label of all specimen
containers.
VUnet ID of phlebotomist is required on
the label of all blood bank specimen
containers AND the Date is required on
all blood bank specimen containers.
VUnet ID of phlebotomist is required on
the requisition that accompanies all
specimen containers.
VUnet ID of phlebotomist is required on
the requisition that accompanies all
blood bank specimen containers.
Two Person Specimen
Labeling Process
When two people perform specimen collection, the
first person is the “specimen collector” and performs
the specimen collection and the second person is the
“labeler” and labels the specimen. Both people
must be present when the specimen is collected and
each person is responsible for performing positive
patient identification.
Two Person Specimen
Labeling
All Non Blood Bank Specimen
Blood Bank Specimen
Patient’s full name (first and last)
Patient’s full name (first and last)
Patient’s Medical Record number
Patient’s Medical Record number
VUnet ID of labeler is required on the
label of all specimen containers.
VUnet ID of labeler is required on the
label of all blood bank specimen
containers AND the Date is required on
all blood bank specimen containers.
VUnet ID of labeler is required on the
requisition that accompanies all
specimen containers.
VUnet ID of labeler is required on the
requisition that accompanies all blood
bank specimen containers.
Safe Specimen Labeling
• For any specimen, there are necessary items that
need to be present on the label and they must all be
correct or the specimen will be rejected.
• EVERY individual tube, container, specimen sent to
the lab must have a label applied to it (not loose in
the bag).
• All specimen or blood samples received in the lab
without a label applied will be rejected.
• All labels & requisitions must be examined to
determine if all information necessary is present &
correct.
Helpful Tips:
Infection Control
Areas with Nurse Servers (Cabinets)
1.
Gather supplies-do not forget:
–
Patient specimen label
–
Biohazard/STAT bag
•
Leave in Nurse Server until needed
2.
Perform hand hygiene
3.
Don isolation PPE
4.
Enter Room
5.
Identify patient and confirm correct lab
specimen label
6.
Draw and label specimen
7.
Place labeled specimen in nurse server
8.
Doff isolation PPE
9.
Perform hand hygiene and exit room
10. Place labeled specimen from nurse server in
biohazard/STAT bag with verified patient
requisition
11. Perform hand hygiene
12. Send specimen
Helpful Tips:
Infection Control
Areas with Isolation Carts
1.
Gather supplies-do not forget:
–
Patient specimen label
–
Biohazard/STAT bag
•
Leave on Isolation Cart until needed
2.
Perform hand hygiene
3.
Don isolation PPE
4.
Enter Room
5.
Identify patient and confirm correct lab
specimen label
6.
Draw and label specimen
7.
Place labeled specimen on isolation cart
8.
Doff isolation PPE
9.
Perform hand hygiene
10. Place labeled specimen in biohazard/STAT bag
with verified patient requisition
11. Perform hand hygiene
12. Send specimen
Label Placement
Non Blood Bank
Specimen Cup
Non Blood Bank
Specimen Tube
Non Blood Bank
Specimen Bullet Tube
• Please place label on the tube as illustrated above.
• Place label lengthwise on the tube just below the cap. The label does not
overlap itself, protrude from the sides of the tube, or extend onto the tube
stopper (cap).
Label Placement
Blood Bank Specimen Tube
Blood Bank Specimen
Bullet Tube
• Please place label on the tube as illustrated above.
• Place label lengthwise on the tube just below the cap. The label does not
overlap itself, protrude from the sides of the tube, or extend onto the tube
stopper (cap).
Downtime Procedure
• If the computer system is unavailable, a handwritten label
must be used. The following information is obtained from
the patient’s chart and recorded on the label:
1.
2.
3.
4.
5.
Patient’s last name
Patient’s first name
Medical record number
Blood Bank Specimen require VU netID and Date
All Non Blood Bank Specimen require VU netID
• The information must match the corresponding information on the
specimen label or the specimen will be rejected.
Outpatient
Identification
• In outpatient collection services, the patient does not always wear an
identification band. Patient identification must occur at the point of
specimen collection using active identifiers.
• Perform an active identification: Ask the patient to state their first and
last name and date of birth. Compare this information with the provider’s
order for the test and the label.
• Collect specimen
• After specimen collection and/or venipuncture: Ask patient to repeat
their first and last name and date of birth. Double-check this information
with the provider’s order for the test and the label. Label in the presence
of the patient.
Take Note! If there IS NOT an exact match,
DO NOT collect the sample until the discrepancy is resolved
Specimen Labeling
Error Tracking
• Mislabeled Specimens: discrepancy of patient identification
information between label, requisition, and/or order.
• Unlabeled Specimens: no label on specimen
• Omissions: no MRN, Name of Patient or VU netID on
specimen.
• In the event of a labeling error, lab personnel must
notify the person in charge of that nursing unit.
• Lab Manager or designee will document details of
the incident and enter the error into Veritas.
Accountability Process
• 1st mislabeled specimen: Data presented to staff member
• 2nd mislabeled specimen: Individual discussion with staff members
identified by VUnet ID.
• 3rd level – Informal counseling – documented discussion of verbal warning
regarding patient safety issue.
• 4th level – Written Warning with Performance Improvement Counseling–
Requires retraining on lab labeling processes.
• 5th level – Final Performance Improvement Counseling – Employee may
not be safe to handle patient blood samples following remediation and
counseling processes.
•
Note: If the time expires on a PIC or Final PIC, the Manager will re-start the process at level 3
and document informal counseling as a verbal warning. It is acknowledged that employees
who continue to cycle back through the process in a repeated fashion may be exhibiting a
pattern that indicates unsafe behavior to handle specimen.