Hospital laboratories have combatted the issue of mislabeled specimens for years, and in general they have done so with great success.1,2 Some hospital laboratories even have zero-tolerance policies in place today: phlebotomists strive to avoid any mislabeled specimens.
Unfortunately, not all specimens are collected by phlebotomists. Nurses and patient care assistants are examples of staff who sometimes collect laboratory specimens. While everyone is trained on how to properly identify patient and label specimens, even the most diligent staff can be distracted during the specimen collection process, and errors can occur.
Nurses have successfully reduced medication errors by using barcode scanners when they administer medications. Now, nurses at some hospitals use those same scanners during specimen collection, and the results have been overwhelmingly positive.
Some success stories
In November 2017, leadership at Mercy Medical Center in Baltimore, Maryland, reported significant reductions in mislabeled specimens—and reductions in collection turnaround times—in multiple areas where nurses collect laboratory specimens. Mislabeled specimens decreased by 85 percent after implementing barcode technology. In addition, collection turnaround times greater than 60 minutes decreased by an average of 27 percent across all areas. The areas involved included the ED, medical/surgical units, critical care, and maternal child health.3
Ahead of its time in 2010, Southern Maine Health Care in Biddeford, Maine, implemented barcode specimen collection in its emergency department, where it treats approximately 42,000 patients each year. Prior to the implementation, approximately 100 mislabeled specimens were reported annually. Post-implementation—from March 2010 to March 2011—its emergency department did not experience any mislabeled specimens. Southern Maine’s emergency department nurses also expressed a preference for using bedside PC computers as opposed to portable handheld devices.4
The U.S. Centers for Disease Control and Prevention (CDC) collaborated with several organizations in a review of the effectiveness of barcode specimen collection in reducing errors. This comprehensive report included several hospitals where nurses used barcode technology for specimen collection, and the report concluded that “barcoding is effective for reducing patient specimen and laboratory testing identification errors in diverse hospital settings and is recommended as an evidence-based best practice.”5
Ingredients for success
When we examine the examples given above, three common ingredients seem to be crucial for success:
Positive Patient Identification (PPID) using barcode technology. Barcode medication administration (BCMA) is now employed by nurses at nearly every hospital across the nation. Fortunately, the same barcode scanners nurses use for BCMA can be used for barcode specimen collection. Hospitals get extra return on investment by using existing hardware to ensure the right sample is collected from the right patient at the right time.
Real-time bedside label printing. Real-time bedside specimen labeling is critical for properly labeled specimens. It ensures that the nurse has specimen labels only for the patient from whom he or she is collecting, and it eliminates potential sources of error. For example, the old practice of printing specimen labels to a centralized printer is error-prone. It requires sorting of labels, which can result in mixing different patients’ labels, or misplacing a label for a needed test. Errors can also occur in that scenario when unused labels are left on the printer and accidentally picked up by the next patient’s nurse.
Flexibility in hardware. Providing hardware options that match various caregivers’ workflows is critical to successful user adoption. Highly mobile staff such as patient care assistants prefer smaller handheld devices that can fit in a lab coat pocket. Other caregivers use laptops mounted on mobile carts (also known as Workstations on Wheels, or WOWs). Some staff use stationary bedside PCs.
To summarize, barcode specimen collection that runs on a variety of hardware with real-time bedside label printing is the most effective recipe to help hospital staff eliminate mislabeled specimens.
How it works
Figure 1 outlines this simple yet powerful workflow:
- The nurse selects a patient from the draw list.
- The nurse scans the patient’s barcoded wristband and confirms a second identifier—in compliance with Joint Commission NPSG.01.01.01: Use two ways to identify patients.
- Labels print in real-time, at the bedside. Today, bedside label printers can be portable or stationary, and both versions can have very small footprints.
- The nurse collects the specimens according to onscreen instructions. Look for a solution that will display the correct draw order, and will display special requirements (for example, keep specimen on ice).
- The nurse labels each tube, scans each tube to confirm collection, and then sends properly labeled specimens to the laboratory for testing.
Reducing errors can save money in ways that might not be immediately apparent. As Anthony Kurec pointed out in these pages in 2016, “errors may cost a moderate-sized hospital just over $1 million a year in quality assurance investigations, blood redraws, repeat testing, and management oversight.”6 By reducing specimen labeling errors, barcode specimen collection can eliminate those quality assurance investigations, redraws, and repeat tests.
In addition, faster laboratory test result turnaround times can mean more revenue. A valuable 2010 article in Medical Design Technology reported that one hospital increased revenue by more than $1 million by improving laboratory test result turnaround times (TAT) after implementing barcode specimen collection. “The sample hospital reduced TAT from 65 minutes to 46 minutes per test. Taking advantage of one percent of the added capacity that was created by these time savings, the hospital netted about $1,028,600 in annual incremental revenue.”7 And faster turnaround times mean higher patient throughput in the emergency department. “The sample hospital reduced the length of stay per patient in the ED by 10 minutes each. Taking advantage of even 10 percent of the added capacity created by this time savings netted about $263,600 in annual incremental revenue.”7
The most important benefit of using barcode technology during specimen collection is improved patient safety. That said, if a hospital requires more than patient safety improvements to justify implementation of barcode specimen collection, its decision makers should consider the additional benefits noted above. Barcode specimen collection can improve laboratory test result turnaround times, save staff time, and most importantly, help nurses virtually eliminate patient identification and specimen labeling errors during the collection process by removing all the potential failure points.
- Morrison AP, Tanasijevic MJ, Goonan EM, et al. Reduction in specimen labeling errors after implementation of a positive patient identification system in phlebotomy. Amer J Clin Path. 2010;133(6):870-877. https://academic.oup.com/ajcp/article/133/6/870/1765950.
- Trask L, Tournas E. Barcode specimen collection improves patient safety. MLO. 2012;44(4):42-45. https://www.mlo-online.com/barcode-specimen-
- Saathoff A, McDonald R, Krenzischek E. Effectiveness of specimen collection technology in the reduction of collection turnaround time and mislabeled specimens in emergency, medical-surgical, critical care, and maternal health departments. CIN: Computers, Informatics, Nursing. 2018;36(3):133-139. https://insights.ovid.com/pubmed?pmid=29120913.
- Granata J. Getting a handle on specimen mislabeling. Journal of Emergency Nursing. 2011;37(2):168. http://www.jenonline.org/article/S0099-1767(10)00532-5/abstract.
- Snyder SR, Favoretto AM, Derzon JH, et al. Effectiveness of barcoding for reducing patient specimen and laboratory testing identification errors: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem. 2012;45(13-14):988-998. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518452/.
- Kurec A. Proper patient preparation, specimen collection, and sample handling are critical to quality care. MLO. 2017;49(1):22-24. https://www.mlo-online.com/proper-patient-preparation-specimen-collection-sample-handling-critical-quality-care.
- Feist K. Improving patient safety: Automating specimen collection and transfusion management reduces errors. Medical Design Technology. July 21, 2010. https://www.mdtmag.com/article/2010/07/improving-patient-safety-automating-specimen-collection-and-transfusion-management-reduces-errors.
Linda Trask, BS, MT(ASCP), serves as Director of Laboratory Solutions for Iatric Systems, Inc. Linda is a medical technologist and former administrative director with more than 20 years of hospital laboratory experience. She has implemented barcode specimen collection using Iatric Systems MobiLab solution at more than 200 hospitals across the U.S. and Canada.