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Specimen Mislabeling- Help!

Posted

Specializes in ER/trauma center.

We've been going from bad to worse with the number of mislabelled lab specimens in my ER lately. Does anyone have things they have done to

stop this problem? We had been giving verbal warnings for 1st occurence, then if a 2nd, nurse had to give an inservice to 10 staff members and have specimen reqs cosigned for 1-3 months, and if a 3rd time, written counseling that goes in their file and possible reassignment.

Well, over the past several months our numbers have increased!

Most staff have never had any, but we don't know what to do. We have upped the ante by skipping verbal warning, and now have held back some RNs from advancing into our acute/trauma area. But its a big patient safety issue, we're tearing our hair out trying to stop it. We are a busy ED/trauma center undergoing construction and constantly closing rooms/ areas, etc. so a pretty stressful environment even physically. Our policy is to label specs in the room at the bedside, but we keep having problems

anyway, often with unlabelled specs being sent.

RN's draw all labs when IV is started, ( phlebotomy is only for AM labs for admit pts holding in the ED. ) Any suggestions?

(Besides assigning the evil=doers the next dozen 'toxic sock' patients?)

Thanks!!:monkeydance:

bill4745, RN

Specializes in ICU, ER. Has 15 years experience.

How many patients does a nurse usually have? It sounds as if you are very understaffed and everyone is hurrying. If something as basic as putting the right label on a specimen is hard to do, it worries me that many other bad things are going on that you are not aware of.

Most policies will indicate labelling labs at the bedside, or they should. I realize I may be nit picking here, but are they REALLY checking the labels with the arm band? I just noticed that you mentioned labelling at the bedside, but did not mention checking the arm band. BOTH have to be done to ensure accuracy when labelling labs, and my guess is that those who are mislabelling are not checking the labels with the arm band.

Also completing the task without interruption or stopping to "guickly do something else." Usually when mistakes like this are made, it will usually be because:

1. not following policy

2. allowing the task to be interrupted

3. trying to do too many tasks at the same time

BillEDRN

Specializes in ED, critical care, flight nursing, legal.

My initial thoughts are in alignment with the other posters, in respect to the premise that your staff are probably too busy, and stretched too thin in regards to staffing. However, you must also look at other contributing factors, like do you make it convenient to create the requisite stickers before the nurse heads into the room to draw blood/start IVs? What happens when a patient arrives and the nurse immediately follows him/her into the room and is then required to draw blood/start IVs? Does someone else have the responsibility to make and deliver the required labels?

In short, you need to look at the systems issues, both during the construction period, and afterwards to eliminate those processes that create difficulties in labeling the specimines at the bedside. For example, does each nurse have their own label maker (adressograph, or whatever your facility uses)? Are labels generated by lab personnel only after the order is entered? Whatever the cause, you need to identify it then make it "easy" for the nurses to comply. All too often, the "system" is set up in such a fashion that complying with stated goals is nearly impossible. Because of this, nurses often try to "work around" the difficulty, and in doing so, make mistakes.

S.T.A.C.E.Y, LPN

Specializes in Emergency. Has 2 years experience.

How simple is your labelling system? I just started at a new ED, and their labelling system is WAY more complicated than the last ED I was at. At the previous ED all specimens were labelled with the same computerized labels, and the strip of labels was always taken into the room with the patient, before blood draws to be affixed as soon as the tube was full. The new ED has several different types of labels for different types of tests, coming from different printers, with some tests needing a seperate form to complete, and I have seen nurses several times just draw the blood and hold it before picking up all their labels/paperwork from the various locations. Seems like way too much work to me...

So....long story short, how simple is your labelling system?

Have you considered that the problem may not be with the nurses? Had a similar problem where I worked before, with lab saying our CBC's were all clotting. Problems got worse and worse despite policy reviews with the nursing staff. To make a long story short, when they investigated further, it was found that lab was losing samples and mixing them up or just mixing up the lables and slips. Then to cover themselves, lab was using the excuse"The CBC clotted" or "the nurse mislabled the sample".

purple1953reading

Specializes in ER OB NICU.

In the hospital here, the clerk who does the admitting paperwork, takes the info, prints out the card and a whole sheet of about 60 labels is affixed also. All the nurse, tech, ward clerk who ever had to do is take those with the chart, and stick them on. They are preprinted, so unless they mix up the whole chart with another patient, the labels are correct. PLUS check with the braclet, as it is the product of stamping the card on it, or affixing one of the stickers.

Thank you to the other posters who've inquired about the labeling SYSTEM in place. Do you really think punishing nurses is going to solve the problem? All you're doing is creating even more stress for the nurses by threatening them with punishment. That makes for a great work environment. I don't get why some managers always first assume the problem is with the nurses when usually it's the environment and the systems in place.

We just started a new computer charting system that is terrible - crashes, loses information, totally inefficient, multiple screens that take forever to come up. Anyway, our mgmt keeps hounding us about how our charting is insufficient, etc. Uh, maybe if there was a better system, you wouldn't have so many problems? Never had that problem when the SAME nurses where charting on paper. So what changed? The system! (And I have nothing against computers - I've computer charted at other hospitals with no problem.)

Sorry, I digress.

Regarding how we label specmens - when a pt is admitted or even checked in, labeled stickers are automatically generated and go into their chart. The stickers - and a blank lab order sheet - go along with the patient just like their armband does. So when the nurse has to draw blood, the stickers are already there with the pt. All the nurse has to do is put the stickers on the tube, date and initial it, fill out the lab order sheet, stick it all in a bag and off it goes to the lab.

HeartJulz

Specializes in My first yr. as a LVN!.

read req., gather all tubes, label before draw....

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Start making it a two person check....

Sweetooth

Dallas_RN

Specializes in Trauma Administration/Level I Trauma. Has 13 years experience.

Most policies will indicate labelling labs at the bedside, or they should. I realize I may be nit picking here, but are they REALLY checking the labels with the arm band? I just noticed that you mentioned labelling at the bedside, but did not mention checking the arm band. BOTH have to be done to ensure accuracy when labelling labs, and my guess is that those who are mislabelling are not checking the labels with the arm band.

Also completing the task without interruption or stopping to "guickly do something else." Usually when mistakes like this are made, it will usually be because:

1. not following policy

2. allowing the task to be interrupted

3. trying to do too many tasks at the same time

Agree 100%, label at bedside and problem solved. If the labels aren't prited yet, leave blood at bedside until you have labels (which is not long in most cases)

sumas8

Specializes in ER/trauma center.

I am the one who posted this question. Thanks to all for replying. I agree it may be a 'systems' problem, but not sure. When a pt is registered in our ER within minutes 2 pages of labels w. attached arm bands are printed, so in almost all cases we can bring labels into the room. We often draw bloods (especially in acute/trauma) before labs are actually ordered or reqs are printed. In that case, the tubes are labelled at the bedside and placed in a ziplock bag awaiting the reqs.

We have a computerized patient safety network, (PSN) so the lab enters one whenever there is an error. Many times the nurse swears they did not send an unlabelled specimen, but we have no way to prove it. The lab just calls and asks them to send another spec and req. We also have the lab calling at times and saying "you didn't send a red top" or whatever when we know we did, and then it mysteriously appears down there. If it is a case of the tube labels not matching the reqs, we can usually verify that, but not always.

Also it is not so hectic here (although occasionally of course) that one cannot take a 15 second time out to verify correct labels, and it should never be. Our staffing is usually pretty good.

And I agree (thanks) with pointing out being punitive to staff does not make it a hospitable environment to work in. Actually I think we are pretty management-friendly here, but we felt we needed to do something- we are having up to 10 per month, where we used to have 1-3/month. Its too serious a thing to not do anything.

When we are discussing w. staff when they have their 1st event, we review the process- bringing labels in, etc. - if you don't have labels or not enough, leave tubes in pts room and go out and get them, and of course double check the reqs to tubes before sending.

As I said, most staff has never had any, and also some of us question the lab techs reports. Thanks for everyone's input- these forums are great! I will keep looking into the system, but some of our nurses have 3 mislabellings- that's just careless work, and too dangerous to work in an ED....

I am sorry that you are going through this with your staff. It sounds very frustrating; however, I am sure the nurses are not intentionally leaving the labels off of the lab draws. After all, that only creates more work for the RN by having to recollect the specimen...

Sounds to me like your perspective is not from the staff nurses' perspective - not that that's a bad thing...but in this instance you should really seek out the staff nurses' advice. Pick their brains. Maybe you could even set up a "Task Force" of staff RNs to nit-pick and address this issue thoroughly. This would not only address the problem at it's root, but it would make any necessary changes more acceptable by the staff since they wouldn't be changes "forced" on them by management.

[banana]Just my $0.02.[/banana]

EmerNurse, BSN, RN

Specializes in Tele, ICU, ER. Has 6 years experience.

I agree with those that said to look at the system. I can't tell you how many times the lab has called, wanting a "redraw red and green" on a patient because they specimen's "hemolysed" or even worse, "you never sent the green top". Umm.. we draw a rainbow on everyone. So many times folks are blamed for stuff that they know they sent/did right.

To be fair, there are a couple of people who occassionally just don't think. Here's a clue for those people. Do NOT put the UA in the SAME bag as the blood tubes - when that UA opens in the bag, you've ruined it all (ick).

Pearlgirl

Specializes in Medical/Surgical, Intermediate and Home Care. Has 21 years experience.

Just provide a pen and ask the patient to write their name, and DOB when he/she gives the sample. Get the sticker later, whether it's the actual order sticker, or a generic patient sticker from the chart. if the patient themselves at least writes their name in a grease pencil, problem solved.

We are making this task much harder than it needs to be.

sumas8

Specializes in ER/trauma center.

Thanks for your thoughts- (they really are worth more than 2 cents..)

We do have some active committees w. staff on them, and this falls under our CQI, but you are right- we should get some staff specifically on this problem. The problems are multifaceted- sometimes the error report from the lab occurs after the staffer has gone home, by the time they hear of it it may be few days later and who can remember? I'm wondering if we can ask the lab to send us back up (we have a pneumatic tube system) the unlabelled tube, because we don't believe them sometimes- maybe they just lost it or something! But a few staffers have admitted being short one label and putting all tubes in a baggie, and sending them forgetting to get an extra label first. I appreciate everyone's input- I'm going to share at our CQI meeting next week and see if we can come up with a new/different approach. I am not without staff perspective, I've been in leadership a bit over 6 months, and worked here 6 years prior so I know how our specimen/label system operates and know how when it is crazy/hectic is all the more reason to take a few seconds out to verify everything is correct.

Thanks all !

RunnerRN, BSN, RN

Specializes in Emergency Room.

I have 2 thoughts (I'm too ADD right now to read all the replies, so apologies if these have been hit already)

1) When the pt is registered, have several "ER Hold" labels printed off. In our dept, you can either order specific tests, or you can order an ER hold. Either way, labels print off which are affixed to the tubes and send. We have found that having the labels available when you go into the room can decrease mislabeling.

2) The other thing we have available is a Typenex band. I'm sure every facility has something similar - it is a yellow band that has a number and a carbon copy label for pt name, and a bunch of stickers with the same number. These are hand-labeled at the bedside, and placed on the pt. Then when blood is given, you double check the specimen TnX # with the armband #. Well, we started using the stickers that come attached to the band to label any blood that is drawn before labels are available. That way, the TnX # on the tube is also on the armband.

Interesting note - we had a scary mixup last year with mislabeled blood for a Type and Cross. A pt ended up getting several transfusions of wrong type blood due to a labeling error. After we had a whole process change with the Typenex bands, we noticed that more nurses were printing off the ER hold labels and taking them into the room with them, instead of being forced to write out a Typenex band.

If any of the above doesn't make sense, let me know. I haven't slept much the last few days, so my verbal skills aren't the best!! I will say that knowing the severe repercussions that could result from having mislabeled specimens changes many a nurses practice in my dept.

Just read your post and I have a suggestion. My suggestion is to have the nurses to write the pt's name and room number or pt's last 4 digit of ss# on the label of the tube in ink. That way if the blood got sent with out a label it is easy identifiable.

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