Lab Labeling--help!

Specialties Emergency

Published

I am on a committee to find ways that our ED's can reduce lab labeling errors. The powers that be are interested in a way to keep labels practically on the patient at all times. I am wondering if anyone has any practices in place that have been helpful to their departments or if anyone is using the label makers that print off of the armbands. Any and all suggestions or comments would be greatly helpful!!!!!

Thanks so much!:p

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Labels should be taken to the bedside and applied as soon as the blood is drawn, not the blood being taken over to where the labels are printed. That is where most of the errors occur.

Is yoir staff actually responsible for signing off on the label as well, not just date and time that it was drawn, but a full signature as well?

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Specializes in Emergency.

I am not sure who makes it but the hospital I currently am on assignment at uses a system where when the patients stamper card is printed a second is used to make the pts wrist band. Then a embosser is used to make lables at the bedside. We are required to label specimins at the bedside. This makes it virtually impossible to miss label anything. About the only way it happens if when someone stamps labels and then leaves the room prior to putting the stickers on the tubes.

Rj

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our current practice is to label at the bedside after confirming 2 patient identifiers (ie name and birthday). however, there are still a great number of staff who bring the specimens out of the room and do it at the desk. we require staff initials, time and date.

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Specializes in Nephrology, Cardiology, ER, ICU.

We use pre-printed labels that you obtain BEFORE you see the patient - take them with you to the bedside and then label at the bedside. That's the only way to ensure you are correct. There is also a bar coding system which we are moving to.

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our current practice is to label at the bedside after confirming 2 patient identifiers (ie name and birthday). however, there are still a great number of staff who bring the specimens out of the room and do it at the desk. we require staff initials, time and date.

That is where your problem is, there is no guarantee that they will not put the wrong set of labels on the blood, or even forget who they drew it on. Labels need to be applied at the bedside by the person that drew the blood. And the ones that are incorrect, and have a nurse's initials on it, then that nurse needs to get penalized. If they are not paying attention to what they are signing, then it becomes their responsibility.

What happens if a procedure is done, based on that result, only to find out that it belonged to another patient?

You need to get your Risk Manangement involved in this, and as quickly as possible.

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Specializes in Infection Preventionist/ Occ Health.
Labels should be taken to the bedside and applied as soon as the blood is drawn, not the blood being taken over to where the labels are printed. That is where most of the errors occur.

Well stated! I (and most Medical Technologists) are sticklers for follwing proper procedure when performing phlebotomy. In addition to labeling at the bedside, two patient identifiers should always be verified. If the patient is conscious, ask them to state their full name and birth date and compare this information to the lab labels. If the patient is not conscious, it is permissible to directly compare the labels to their armband and then collect the specimens. If a relative or friend is in the room, they can also help you to properly identify an unconsious patient. The laboratory should be consistently rejecting specimens that are not properly labeled (including date, time and initials or ID # of the RN or PCT) to prevent adverse outcomes.

I recently had two different PCT's come into my laboratory with the patient labels in one hand and UNLABELED specimens in the other. In another case, I received a blood bank specimen without the date. When I called the PCT down to the lab to add the date and fill out an affidavit, she enteredthe laboratory with the patient blood bank ID band still in her hand! Can you guess what happened? That's right, the specimens were immediately pitched into the biohazard container. We cannot take any chances as far as patient safety is concerned. I know of at least three cases at my hospital where laboratory results on the incorrect patient were released to the floor and treatment was initiated due to specimen collection errors. I know of a few other cases where contaminated line draws resulted in inappropriate treatment.

Here are some case studies:

http://www.webmm.ahrq.gov/case.aspx?caseID=50

http://www.asq.org/mgg/healthcare/20040727patientdies.html

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Using the plastic card embosser as the patients armband is really easy. The labels can be made immediately- as long as the patient is registered...and done at the bedside. The labellers on the other hand sometimes disappear and are often jamming, but I have recently been at 2 hospitals that print the labels after the orders, often long after the labs have been drawn. The nurses there label the labs at the bedside and the labs stay in the pt room until the order is written. It's a long process and I think a lot of errors ocur there...

I'm all for the bedside label gun...It's useful for all sorts of things, especially in situations where one thinks no specimen is going to be taken (maybe a pelvic) and then the MD decides to get one, voila, use the label gun to make some and there is no waiting for some sort of label to print when the secy gets time to enter it.

We also sign date and time the label.

One hospital I was recently at has a very distressing system- pt labs are drawn, one set of generic labels is placed on the labs, Then, labs are ordered and specific labels printed out that have to go over the top of the other labels...Well, turns out people were just leaving blood in the rooms even after discharging patients and so the lab would peel off one label only to discover the RN had inadvertendly labeled someone elses blood. That hospital was a disaster.

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Labeling at the bedside is the best way to prevent errors. I've found though that many nurses draw the blood, stick the tubes in their pocket and carry them around until the lab printer produces the label- VERY bad practice on several levels!! I hate to start writing people up for something like this, but I'm not sure what else to do as just discussing it with them doesn't seem to work!

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Labeling at the bedside is the best way to prevent errors. I've found though that many nurses draw the blood, stick the tubes in their pocket and carry them around until the lab printer produces the label- VERY bad practice on several levels!! I hate to start writing people up for something like this, but I'm not sure what else to do as just discussing it with them doesn't seem to work!

Try doing a cost estimate of the errors that are caused by lab mislabeling. Then post the error rate for your unit on a weekly or monthly basis. Post the costs of these errors, as well as potential bad outcomes. Talking will probably not help, but showing some tangible financial and health related issues created by the practice may encourage them not to do this.

Also consider that they are having to wait for the labels. DO they have aplace other than their pocket to put the blood at all? Perhaps a clear poly box in each room that is cleaned after each patient could be used to place blood and urine specimens until the labels print. Still room for error, but , better than riding aorund in a pocket which is against infection control standards also.

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Try doing a cost estimate of the errors that are caused by lab mislabeling. Then post the error rate for your unit on a weekly or monthly basis. Post the costs of these errors, as well as potential bad outcomes. Talking will probably not help, but showing some tangible financial and health related issues created by the practice may encourage them not to do this.

Also consider that they are having to wait for the labels. DO they have aplace other than their pocket to put the blood at all? Perhaps a clear poly box in each room that is cleaned after each patient could be used to place blood and urine specimens until the labels print. Still room for error, but , better than riding aorund in a pocket which is against infection control standards also.

Thanks, good ideas. I have shared with them the financial and patient-outcome ramifications of mislabeling. The clear box idea sounds interesting. The labels print pretty quickly after the order is entered, so unless it's a stat I think they should not draw until they have the label in their hand.

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Specializes in NICU, PICU, PCVICU and peds oncology.

We have sheets of pre-printed labels at the patient's bedside. The information is verified by the nurse at the beginning of the shift. I like to label my tubes at the bedside just before filling them. Our policy for anything the blood bank will be involved with requires 2 nurses or a nurse and physician to identify the patient and the specimen, and to sign, date and time the requisition and the specimen label. Each time a patient is grouped or cross-matched a new "blood bank band" is applied with a unique identifier number on it, and the old one is removed and discarded. Then when we check blood products, the BBB number must match the label on the bag or the blood product is returned unused to the blood bank. (And reams of paperwork gets filled out.)

We use these labels for a multitude of things besides labelling lab specimens. We put them on the kids' toys, pacifiers, blankies, sippy cups, Eyelube tubes, specialized feeds and so on. We put a label on a business card with the unit information on it and highlight the patient's chart number; anyone phoning for information must give the person answering the phone that chart number before information can be given. That's how we safeguard their personal information.

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