Readers Respond

March 1, 2011

Always stress proper patient ID, specimen labeling

I read the Clinical Issues piece, “Advances in Technology Improving Safety and Efficiency in Blood-sample Draw” by Ana Stankovic, MD, PhD, MSPH, in MLO
(Vol. 23, No. 1, January 2011, pages 18-20) with interest. I do not disagree with Dr. Stankovic's comments about the need for using the right equipment and having the appropriate skills to
properly collect blood samples. I also agree that “… blood-sample collection continues to be a major focus of laboratory activity ….”

I was disappointed that the only mention related to specimen labeling was in the section of the article dealing with capillary blood-collection systems.
I realize that the point of this article was to discuss technology used in blood-sample collection, but I believe any discussion of blood-sample collection is an opportunity to
emphasize the importance of accurate patient identification and proper specimen labeling. Using the best techniques, and correct equipment and supplies has no value if the specimen is mislabeled.
Mislabeling occurs all too often; and even with the best delta systems, they are not always detected. Proper patient identification and labeling should be “Job #1” for anyone collecting a blood

I feel any discussion of blood-sample collection technology, safety, and efficiency, should (must) include a comment on the absolute requirement for proper
patient identification and specimen labeling. This can not be emphasized enough.

—Ellis M. Frohman, MA, MT(ASCP)SBB

Director, Department of Laboratories

Barnes-Jewish Hospital

St. Louis, MO

Dr. Stankovic's reply: You raise an important point related to patient identification and accurate labeling of blood samples.
While there is no clear-cut agreement on ID requirements, a systematic solution that includes a collaborative effort between product manufacturers and clinicians to reduce errors in patient
ID and specimen labeling would be beneficial in addressing this issue. Innovative technology may play an important part in these endeavors. For example, last year BD introduced a new
microcollection tube that can accommodate a full-size label. This makes it possible to collect low-volume blood samples in a tube that can easily capture required patient information and
minimize potential labeling errors. As you state, efforts to improve patient ID and sample labeling must be a priority in healthcare in the years ahead. We will all need to play an active
role in setting and maintaining the highest possible standards to reduce the incidence of errors that can have a direct impact on healthcare costs and patient outcomes.

—Ana K. Stankovic, MD, PhD, MSPH

Worldwide Vice President, Medical Affairs

BD Diagnostics – Preanalytical Systems

Suspicions aroused by “new” program

Re: “Form an Effective Compliance Program” (Liability and the lab, January 2011, page 24), I am suspicious that this “new” program is simply going to add
administrative burdens to the laboratorians and new opportunities for fees for the lawyers. If you remember, CLIA was originally supposed to ensure that clinic-based mini-laboratories were
technically competent and did not bill for work not done, and PAP smears were being over-read by AP (pathologists) so as to not miss cancers. The first thing that happened was that POLs were
exempted, and [those of us in] hospital labs had a new alphabet agency looking over our shoulders with [its] nebulous rules and confusing regulations — many of which apparently conflicted with
the FDA, OSHA, CAP, AABB, and you-name-it existing agencies. It only took the original CLIA '67 a few years for CLIA '88 to actually become beneficial to the “real” labs
(I apologize if this offends anyone's sensibilities). We are all aware that Medicare fraud is a massive problem — we have read about it in everything from
the AARP The Magazine to Readers Digest. As a taxpayer, I want every dollar spent appropriately, but this “new” program has the potential for
being as massive as and more expensive than HIPAA. In the real world of defensive vs. diagnostic medicine, where the tech (and the clinician) on the front line
may now have to weigh the possibility of being sued if an “extra” test is not done against the risk of being charged with doing (and billing for) that extra test,
for which he/she may not know if it was indicated until after it is run, I can see more of our best and brightest going to law school instead of med-tech school.

—Chuck Millstein,
MBA, MT(ASCP),CLDir(NCA), Retired

Virginia B. Evans' reply: The Health Care Fraud and Abuse Control program is one of the few government programs providing
a strong return on investment (ROI); that is, $6 ROI for every $1 spent investigating healthcare fraud. With this kind of return, it is not likely investigators will go away. Prudent businesses
understand reduction of risk through compliance is critical to their long-term success.

Not so fast with the foot poke

In “Challenges of the Oncology Draw” (January 2011, page 22), Andra Hill correctly states that in the case of a patient with a double mastectomy, a collector
cannot draw blood from either arm without permission from the ordering physician.

What is concerning is Ms. Hill then advises “Sans approval, do a foot poke” suggesting that a puncture to a foot vein can be performed without consulting with,
or getting approval by the patient's physician.

MLO readers should be reminded that the Clinical and Laboratory Standards Institute (CLSI) states in its venipuncture standard (H3-A6) that
alternative sites, such as ankles or lower extremities, must not be used without the permission of physician because of the potential for medical complications including phlebitis, thrombosis,
and tissue necrosis.

In the case of a patient who has had a double mastectomy, the take-home message is that any collection performed requires physician permission.

—Lisa O. Ballance, BSMT(ASCP), CLC(AMT)

Director of Online Education

Center for Phlebotomy Education, Corydon, IN

MLO welcomes letters to the editor. We ask that you include a phone number for verification. While we prefer to publish the writer's name, we will publish a letter with “name withheld by request,” but our editorial staff must have the writer's name confirmed for our fi les. MLO reserves the right to edit any letter for style and length.