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Managing Preanalytical Processes for Patient Safety

Terry Jo Gile, MT (ASCP), MA Ed
Contributing Editor

Positive patient identification (ID) is a major put by healthcare accrediting bodies for the past few years. Until recently, the costs associated with hardware and software were beyond the reach of the average hospital or laboratory. Today there are multiple vendors with devices that can be integrated into a facilitys IS requirements with ease. Some systems are better for small facilities, while others are best for larger institutions. It is important to compare each vendor with particular requirements so that an informed decision can be made. Studies show that 46 percent of laboratory errors take place in the preanalytical phase and 68.2 percent of preanalytical errors occur from specimen collection (Plebani M, Carraro P. Mistakes in a stat laboratory: Types and frequency. Clin Chem 1997;43:1348-1351). Errors occur every day in every healthcare facility worldwide. Sometimes, unfortunately, these errors prove fatal. How can a facilitys staff and administration prevent these errors? The technology is here with wireless, simple-to-use patient ID systems. The decision boils down to features and cost. So how do you determine which product works in your facility?

Evaluate the Existing Process:

Donald Berwick, professor at Harvard School of Public Health, Boston, and patient safety advocate, says, "Understanding your process first can lead you toward choosing technology as a solution." Two things to consider for process compatibility are the laboratory information system (LIS) interface and system management. A patient safety system should be able to interface with the existing laboratory information system (LIS) to update collection information. A system that will generate a comprehensive management report will help assess the impact the system has on reducing collection errors. Knowing how your workflow operates is the first step in selecting a device that will capture the patient's demographic information through the armband's barcode. Some important questions to ask are:

  • Does the employee's ID badge have a barcode system to identify the person collecting the blood?
  • Is the patient's armband on an arm or leg that can be used for ID?
  • Does the handheld system use wired or wireless synchronization to communicate between the bedside unit and the server?
  • Is end-user training included in the cost of the equipment on all three shifts, seven days a week?
  • Does the product reduce collection time, and has this been documented?

Use a Unified Procedure that Includes the Specimen:

Paula Santrach, MD, director of phlebotomy at Mayo Clinic, Rochester, MN, notes, "Simplify procedures. Sometimes, ID procedures get complicated, or differ by location or department. We used to have two different procedures, one for blood bank specimens and one for other specimens. It helped us to simplify it into a single procedure. You can harm a patient with a wrong blood draw for a chemistry specimen just as you can for a blood bank specimen." To prevent these issues, a proper system is needed for the blood tube label. Some questions to ask are:

  • Are the labels printed at the bedside?
  • Do they have the proper bar code on them?
  • Is there a mechanism within the system to prevent one patients labels being accidentally placed on another patients tubes?
  • Is there a label design that allows labels to be placed correctly on the tube (vertically down the side as opposed to spiral around the tube or attached like a flag waving in the breeze)?
  • Does the laboratory staff have to re-label the tube when it arrives at the testing area?
  • How much time and tech cost is involved in the re-labeling of the tube?

Educate Staff for Increased Compliance:

Cecelia Wright, MBA, MT (ASCP), gro up manager for phlebotomy and specimen processing for ARUP Laboratories at University of Utah Hospitals and Clinics, Salt Lake City, finds that communicating and reinforcing hospital policies and procedures on specimen collection was not enough to reduce rejection rates for nurse phlebotomy.

"You have to explain to nurses the reasons behind the procedures. Nurses and laboratory personnel have different mindsets and incorrect assumptions about each other, Wright says. "Lab staff incorrectly assumes that all nurses understand the reasons underlying the order of draw and specimen rejections. There is a better compliance with specimen collection policies and procedures when nurses and other specimen collectors understand why you need to do things a certain way."

A consistent method of collection that everyone adheres to eliminates shortcuts that have been instilled into the staff culture for years.

An Example of an Effective Solution:

Several products on the market can be used for patient ID. One such product is the BD id Patient Identification System, by Becton, Dickinson and Company (BD), Franklin Lakes, NJ, which requires that the phlebotomist scan her ID badge and scan the patient's armband. The device indicates the collection details, such as the number and types of tubes, and order of draws. The phlebotomist completes the process by scanning the tubes, printing the labels and applying them to the tubes while still at the bedside. The system can be wired or wireless and effectively communicates between the handheld device and the server. The server is updated frequently, allowing the lab and nursing floor to track the location and status of the specimen.

Why is this important? First, more efficient collections result in fewer venipunctures for patients. The technology confirms at the bedside that the right tube is collected for the tests ordered and eliminates the need for a lab-applied third label. According t o data published by BD, costs associated with re-labeling a specimen are around 75 cents. Multiply that by the number of specimens that require re-labeling, and the cost can be astronomical. The opportunity for error increases substantially if the wrong label goes on a tube while being re-labeled.

Additionally, it streamlines the lab accessioning process, which is extremely labor intensive and costly. It interfaces with the LIS to update collection information, providing collection status from the nursing floor. It will produce management reports that will assess the reduction of collection errors, although most errors are eliminated.

Streamlining the preanalytical process helps to identify opportunities for reducing or eliminating preanalytical error. A true patient ID system can save money in the long run.

Terry Jo Gile, MT(ASCP)MA Ed. "The Safety Lady" has over 40 years experience as a certified medical technologist. As President of her own consulting firm, Safety Lady, LLC, she is a world renowned speaker and consultant who helps organizations create safety savvy laboratories.

See below, and visit our comprehensive Patient Safety and Patient ID product listing for more patient safety solutions:

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