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?)
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.
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).
Specializes in Medical/Surgical, Intermediate and Home Care.
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.
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.
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.
RedERRN
30 Posts
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]