Reduce ID errors with 24/7 phlebotomy
There are ways to minimize labeling errors. Top strategies include bar coding technology, firm policies and procedures, and accounting for the human factors that can prompt errors. Research also suggests that establishing a 24-hour, seven-days-a-week phlebotomy service can reduce errors by leaving blood draws to the people best trained and focused on the task.
Ana K. Stankovic, MD, PhD, MSPH, vice president of medical and scientific affairs and clinical operations with BD Diagnostics, based in Franklin Lakes, NJ, conducted research that involved reviewing more than 3.3 million specimen labels from 147 laboratories.1 Labeling errors were identified at a rate of 0.92 per 1,000 labels. Two variables were statistically associated with lower labeling error rates: laboratories with current, ongoing quality monitors for specimen identification; and institutions with 24/7 phlebotomy services for inpatients.
Most institutions had written policies for specimen labeling at the bedside or in outpatient phlebotomy areas (96% and 98%, respectively). Stankovic and her colleagues concluded that establishing quality metrics for specimen labeling and deploying 24/7 phlebotomy operations might contribute to improving the accuracy of specimen labeling for the clinical laboratory.
"Dedicated phlebotomists are much better because they are better trained and they are not distracted by needing to do a hundred other things," Stankovic says. "We see hospitals transitioning back to dedicated phlebotomists because they are finding that the front-end costs are offset by the back-end costs of errors, redraws, and other problems."
In addition, patient specimens should include two distinct identifiers, and one should be a number, Stankovic says. For example, the label can include the patient's name and birth date, or name and Social Security number. Using both will help eliminate confusion when patients have similar names, she says.
Another common error occurs when a nurse prints labels at the nursing station, leaves the labels there, and then goes to a patient room to retrieve a specimen. The nurse comes back with the specimen and grabs the wrong label. "The better way is to print the label at the nursing station, take the one label with you to the patient's room, confirm the identification is correct, and place the label on the specimen at the bedside," she says. "An even better solution is to use a specimen management system with a device that prints the label at the bedside, which can be combined with bar coding on the patient's wrist band."
1. Wagar EA, Stankovic AK, Raab S, et al. Specimen labeling errors: A Q-probes analysis of 147 clinical laboratories. Arch Pathol Lab Med 2008; 132:1,617-1,622.
Ana K. Stankovic, MD, PhD, MSPH, Vice President, Medical and Scientific Affairs and Clinical Operations, BD Diagnostics, Franklin Lakes, NJ. Telephone: (201) 847-4376. E-mail: Ana_Stankovic@bd.com.