Specimen labeling errors have long been a serious problem for clinical laboratory managers. In most cases, the culprit has been the static, manual process involved in specimen labeling. Phlebotomists and nurses have had to work off a wad of pre-printed labels, and details have had to be filled in by hand. Errors have been inevitable despite everyone’s best efforts: specimens labelled with the wrong patient name, missing draw times, illegible initials from whoever drew the specimen, among other pitfalls. The consequences for patients can be serious, or even deadly.
Today, systems are available that enable barcode specimen collection with bedside label printing, and they are game-changers. This solution eliminates labeling errors while saving time during collections and in the lab. It provides intelligence about the collection process not previously available (or at least not without enormous effort). It is an approach that is easy to use and has been proven to work in hundreds of hospitals in a variety of clinical settings.
Barcode specimen collection can be used by nurses, phlebotomists, respiratory therapists, and other healthcare professionals who are qualified to draw blood samples or collect other specimens. It is being used successfully on inpatient units, in ICUs, and emergency departments. The only requirement is that specimen collection be under the management of a laboratory information system (LIS).
Clinical laboratory directors who are considering moving to a barcode collection solution naturally have many questions. Here are some thoughts about what to look for, the options and capabilities available, and the process improvements that lab directors can expect from barcode specimen collection.
How it works
Barcode specimen collection uses three hardware components: a barcode scanner, a label printer, and a handheld device or PC for viewing order information and entering relevant comments.
The collection process provides positive patient identification and links a barcode on the patient’s wristband with orders in the LIS. Orders, alerts, and instructions appear in real time on the user’s handheld device or computer screen. The approach is simple, streamlined, and most important, accurate. A qualified staff member typically performs the following steps:
- Scans his or her ID badge to log in and identify him- or herself as the collector
- Performs positive patient identification by scanning the patient’s wristband and asking for a second identifier
- Prints collection labels at the bedside
- Collects the specimens based on the draw order and instructions on the screen
- Puts labels on each tube
- Scans the labeled tubes again to confirm that the specimen labels match the patient.
When the process is finished, the system applies a collection timestamp and collector ID automatically. The collection information flows directly into the LIS to await specimen arrival. When the specimen arrives, the staff member scans the specimen barcode to document the laboratory receipt timestamp and tech ID or places samples on an automation line that receives them into the LIS. Testing can begin immediately.
The impact on safety and efficiency is dramatic both at the point of care and in the lab. Users only have labels associated with the patient they’re working on, ensuring the label matches the right patient. Rather than having to struggle to remember the number, color caps, and draw order, users are guided by on-screen instructions every step of the way. Rather than having to scribble initials and draw times, an often-forgotten step, users benefit from the data being printed on labels the moment they are produced and electronically transmitted to the LIS. This further eliminates manual data entry steps when the tubes arrive in the laboratory, and streamlines workflow by speeding specimens to the analyzers and results to physicians.
Hardware flexibility and compatibility
Users need to be provided with the right tools for the job. Phlebotomists typically use a dedicated handheld device for specimen collection, with an accompanying printer. Nurses appreciate the convenience of a solution that runs on the same device they already use for medication administration—a scanner associated to a laptop on a mobile cart or bedside computer. (This also means that the printer is the only hardware the hospital has to buy.) Lab directors should look for a solution that
supports multiple hardware options to provide the best fit for the workflow of all caregivers who collect specimens.
The barcode specimen collection solution should also provide software functionality that enhances the collection process and can be customized to fit specific caregiver workflows. Here are some must-have capabilities:
- Handling instructions. The solution should display special handling instructions and requirements defined in the LIS. This helps eliminate specimen rejections and the resulting testing delays and patient inconvenience of an additional needle stick.
- STAT notifications and alerts. The solution should provide the ability to define and send real-time messages to selected users (including STAT orders, add-ons to existing orders, and cancellations). This reduces phone calls and allows staff to prioritize or re-prioritize workloads and avoid unnecessary venipunctures.
- Look-back/look-ahead (“smart draw”). The solution should display previous collections for the patient to avoid venipuncture when a previously collected sample can be used for testing and issue warnings of upcoming draws so they can be combined when appropriate. These features are more important now than they were in the past, as many physicians enter their own orders in the hospital computer system; the practice of a unit secretary coordinating all physician orders for a patient into a single collection time is becoming less common.
- Automated reporting. Information that would otherwise take hours or days to assemble with manual procedures can now be at the laboratory manager’s fingertips. The solution should provide a suite of management reports to document details about phlebotomist activity, such as sign-in date/time, missed draws, patient draws per phlebotomist, number of patients drawn each hour, responsiveness to stat orders, etc. It should also log individual draws and document issues that could affect patient care, such as incomplete draws, reasons for uncollected specimens, and other relevant data.
Flexibility to modify workflow
Sometimes it’s necessary to modify the collection process to handle urgent scenarios, such as traumas or codes. In situations where specimen collection may occur prior to order entry, positive patient identification can still be used to ensure that every specimen that goes to the lab is linked to the correct patient. In these cases, the patient wristband is scanned to generate the correct number of demographic labels for the number of samples(s) collected. The labels include patient information as well as the collection date, collection time, and nurse initials. Tubes are properly labeled at time of collection and matched to the patient.
Process improvements: a few examples
Barcode collection solutions prevent errors, save time, and provide other benefits in a variety of settings. Here are just a few examples.
- Making life easier in the emergency department. ED nurses have many tasks, and accurate patient identification and specimen labeling should be an easy part of their busy workflow. However, in the high-stress environment of the ED, details such as how many tubes are needed, which color cap should be used, the order of draw, and whether to keep a specimen on ice can be difficult to remember. At Southern Maine Medical Center in Biddeford and Sanford, Maine, a barcode solution keeps track of those details for nurses. It prompts clinicians if they forget any steps, and saves nurses from having to re-stick patients. The software is installed on bedside computers in the ED, running on the same device nurses already use to enter notes, vital signs, medication, and other inputs.
- Hardware flexibility. At Norman Regional Health System in Norman, Oklahoma, clinicians have a choice of devices to fit the collection setting. Phlebotomists use handhelds or stationary computers, depending on whether they are on the floor or in an outpatient exam room. Nurses primarily use mobile workstations on wheels (WOWs) but use handhelds in isolation rooms, since the devices can be bagged and disinfected after use.
- Faster turnaround time for STAT orders. Barcode specimen collection improves turnaround time for STAT orders in addition to providing positive patient and specimen identification. An audit of stat orders at Phelps County Regional Medical Center in Rolla, Missouri, illustrates 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 implementation, turnaround times for the same tests dropped to 15 to 17 minutes, a 40 percent reduction in STAT turnaround time.
- Specimen credibility and lab manager peace-of-mind. The ability to display draw order and specimen handling instructions at the point of care enables busy staff to “get it right” the first time. This is especially helpful for nurses, who no longer have to call the lab to find out what order to draw, what tubes to use, and how many are needed.
- Managing a team of phlebotomists. Patient orders can be viewed and sorted by priority, floor, room number, scheduled collection time, and other criteria. Supervisors can easily monitor to see who needs help, perhaps for missed draws, or when there are several new STAT orders on the same nursing unit.
The question of adoption
Implementing new technology always comes with uncertainty, and barcode specimen collection is no exception. Managers are sometimes unsure of how systems will be received by phlebotomists and nurses, who in some cases have spent decades collecting specimens using preprinted labels. When staff see the ease of use of barcode specimen collection, the time it saves, and its capacity to protect them from making labeling errors, however, it is our experience that they not only accept it; they embrace it.