While every phlebotomist knows the proper steps to identify a patient and properly label specimens, even the most diligent phlebotomist can be distracted or interrupted during patient ID and specimen labeling, and errors can occur. Specimen identification errors have been reported to occur at rates of up to 5%.1
There are many reasons why errors happen. The process of generating and sorting batch specimen labels prior to collection is problem-prone; labels of different patients may be inadvertently grouped together, or a label may be misplaced. Handwriting on specimen tubes can be illegible. Additionally, at many hospitals, phlebotomists are not the only staff members who collect specimens; nurses, patient care assistants, and other staff such as IV therapists routinely collect samples. Because specimen collection is just one of their many job functions, it is easy to see why mislabeling errors can be even higher in specimens they collect.
While it may be easy to understand why mislabeled specimens occur, the errors aren't easy to accept. No one wants to compromise patient safety, but based on research by Valenstein et al, adverse events result from one out of every 18 specimens with patient identification errors alone. When extrapolated to all U.S. hospital-based laboratories, this equates to more than 160,000 adverse events annually.2
Accurate diagnoses and appropriate treatments depend largely on the test results laboratories provide to clinicians. The Centers for Disease Control and Prevention reports more than 7 billion tests per year are run in U.S. laboratories, and the results of those tests contribute to approximately 70% of all medical decisions.3 Accurately labeled specimens are crucial to patient safety.
How barcode specimen collection helps
Fortunately, barcode specimen collection can virtually eliminate patient identification and specimen labeling errors during collection by removing all of the potential failure points. Wireless and barcode technology bring positive patient identification (PPID), positive specimen identification, and real-time specimen label printing to the bedside.
Here is how it works. The collector (phlebotomist, nurse, etc.) carries a portable label printer and a handheld computer capable of scanning barcodes. Nurses often opt to use laptops on mobile carts instead of handheld computers. The patient draw list displays on the screen. The collector scans the patient's barcoded wristband and documents the second identifier the patient provides. Once the patient's ID is positively confirmed, barcoded specimen labels print at the bedside. Specimens are then collected, labels are affixed, and the labeled tubes are scanned to complete the collection process. Patients and specimens are positively identified. The use of pre-printed labels for multiple patients is eliminated. Because collection date, time, and user automatically print on labels, illegible handwriting is eliminated, too.
Successful implementations of barcode specimen collection occur most frequently at hospitals that offer staff the right fit in terms of hardware. So look for software that can run on handheld devices or PCs, including laptops on mobile carts.
Examples of success
Norman Regional Health System in Norman, Oklahoma, is a multi-facility healthcare organization serving the needs of patients throughout south-central Oklahoma. More than 550 specimens were collected the first two days after go-live with barcode specimen collection, and 100% were compliant with proper labeling. Janet Johnson, Director of Nursing Informatics, who led the implementation, reported, “We had no mislabeled specimens in any of the areas using barcode specimen collection the very first month after go-live.”
Howard County General Hospital in Columbia, Maryland, (part of Johns Hopkins Medicine) needed a solution that could remove all potential failure points, particularly since the hospital uses a decentralized collection model where all specimens are collected by nursing staff. Monthly data was collected for a full year after implementing barcode specimen collection. The result was zero mislabeled specimens in all of the areas using the new system (Table 1).
Table 1. Total mislabeled specimens
Fast, accurate test results are an important facet of patient safety. Barcode specimen collection improves turnaround time in addition to providing positive patient and specimen identification. An audit of stat orders at Phelps County Regional Medical Center in Rolla, Missouri, confirms this. Prior to implementing barcode specimen collection at Phelps, order-to-collection times for select stat chemistry and hematology tests ranged from 24 to 28 minutes. Within the first month after the implementation, turnaround times for the same tests dropped to 15 to 17 minutes, exceeding their target goal (Figure 1).
Figure 1. Order-to-collection times
In a recent survey of laboratorians conducted during an online webcast event hosted by Iatric Systems, more than 80% of survey respondents indicated that the Emergency Department (ED) is a significant source of mislabeled specimens at their facilities. The Wall Street Journal recently reported that a high percentage of medical errors and related malpractice suits originate in the ED, and that diagnostic errors account for 37% to 55% of the cases.4 Barcode specimen collection can reduce those errors, even in the midst of a fast-paced ED.
In fact, implementing barcode specimen collection in the ED to help reduce errors was a patient safety initiative at Greater Baltimore Medical Center (GBMC), according to Lois Lorenz, Lab Customer Service and Phlebotomy Manager at GBMC. “Our committee tried all kinds of campaigns to educate our ED staff on positive patient identification and the importance of labeling specimens at the bedside, but the number of errors wasn't really decreasing.” So GBMC implemented barcode specimen collection in April 2009, and the last two calendar years have been error-free (Figure 2).
Figure 2. Implementation of barcode specimen collection at GBMC
The Journal of Emergency Nursing reported that Southern Maine Medical Center in Biddeford, Maine, implemented barcode specimen collection in the ED in March 2010. The article reports that since that time the ED has not had a mislabeled specimen.5
Other benefits of barcode specimen collection include increased physician satisfaction, improved phlebotomist productivity, better rapport between laboratory and nursing, fewer automation line rejections, reduction in phone calls, and improved patient satisfaction. First and foremost, though, barcode specimen collection improves patient safety. Eliminating patient identification and specimen labeling errors isn't just something to imagine. With barcode specimen collection, it is a reality today.
- Wagar EA, et al. Specimen labeling errors: A Q-probes analysis of 147 clinical laboratories. Arch Pathol Lab Med. 2008;132:1617.
- Valenstein PN, et al. Identification errors involving clinical laboratories: a college of American pathologists Q-Probes study of patient and specimen identification errors at 120 institutions. Arch Pathol Lab Med. 2006;130:1106.
- Boone DJ. Making the laboratory a key partner in patient safety. Presented at: Quality Institute Conference 2003. http://wwwn.cdc.gov/cliac/pdf/Addenda/cliac0903/O_QI.pdf.Accessed February 15, 2012.
- Landro L. Hospitals overhaul ERs to reduce mistakes. The Wall Street Journal. May 10, 2011. http://online.wsj.com/article/SB10001424052748703859304576307060330715004.html. Accessed February 10, 2012.
- Granata J. Getting a handle on specimen mislabeling. Journal of Emergency Nursing. 2011;37:168.
Linda Trask, BS MT(ASCP), is Manager of Laboratory Solutions at Massachusetts-based Iatric Systems, Inc., and has implemented barcode specimen collection at more than 125 hospitals across the U.S. and Canada.
Estelle Tournas, BSBA, is a Product Marketing Manager at Iatric Systems, Inc.