Dear all,
The National Blood Service demands that specimens
for Blood Transfusion are hand labelled and signed by the person taking the
blood. Specimens bearing pre-printed labels will not, under any
circumstances, be accepted. The reasons for this are, as I understand it, to
make the person who has taken the blood think about the identity of the
patient who they have just bled and avoid making a gross error of
identification.
Evidence shows that there is a high risk of gross
mis-identification of patients (i.e. labelling Jones' specimens with Bloggs'
labels) when pre-printed ("Addressograph") labels are used, cf. the story on
the mailbase of the specimen labelled as p1 of 2!. (I can tell a similar
story. Called to the lab. reception area one night by the duty BMS to sort
out a specimen labelling anomaly, a Paediatric SHO turned up with a sheet of
pre-printed labels. They were, of course, for a completely different patient
than the one in question! QED).
Pre-labelling (either hand written or by use of
pre-printed labels) of blood tubes is also "outlawed" as a dangerous
practice, although it undoubtedly happens, particularly when staff other
than trained phlebotomists take blood specimens.
Apart from the problems that pre-printed labels
cause with centrifugation, analyser transport chains and obscuring the
contents (quantity and quality thereof), there is a more worrying argument
put forward by people who wish to justify the "two tier" approach of hand
written BT sample labels, and acceptance of pre printed labels on other
specimens for Biochemistry and Haematology. This is something along the
lines of "you can kill someone if the wrong blood is transfused, but it's
not so serious if the wrong Haematology etc. results are obtained". I would
beg to differ in the extreme. I am not disputing that fatal or at least
serious damage can be caused to a patient by errors made in Transfusion
samples, but equally, great harm can be caused to patients by acting on
results from the wrong patient, or indeed, not acting. I would question
whether any of us could defend a system that embodied such double standards.
Little work has been done to quantify the number of
specimens accepted by laboratories that are either from the wrong patient or
are in some other way mislabelled. We reject approximately 2% of specimens
because of specimen labelling and / or patient identification errors. But
from the work that has been done, the proportion is probably far higher than
many of us would like to believe.
Of course we live in the real world. There ARE
problems with hand labelling of specimens. Legibility, time, small labels
(especially on paediatric specimen tubes) etc. But why is there never time
to do the job properly, when time can always be found to do it again?
Our Trust has instituted a policy that requires hand
labelling of all specimens, with a minimum of family name, forename, dob and
hospital number. Specimens with pre-printed labels will not be accepted. In
making this change, we have had to accept that the number of MINOR errors
(e.g. surname spelled with one letter incorrect) has increased, but this is
the price that we have had to pay for avoiding GROSS mis-identification
errors. We have also had to compromise with our Paediatricians regarding the
use of labels (although when our phlebotomists take specimens from children,
they seem to have no difficulty in hand writing the labels......)
But, we are a relatively small specialised Hospital,
with no A and E, and little or no GP work, and thus it has been "easier". (a
relative term, I can assure you. Our specimen reception staff take
considerable abuse from the members of staff who have made errors). Trying
to institute a policy such as ours in a busy teaching or district general
hospital with an A and E and large GP population could be a nightmare. And
there is still the problem of identifying out patients. Many clinicians can
tell stories of calling for Mr. Brown to come forward, only to discover
later that it was Mr. Smith who they were dealing with, Mr. Smith either not
understanding / hearing properly, or just wishing to jump the queue to take
what he believes is his rightful place. (I can assure you, this has
happened).
I am told by a Consultant Haematologist colleague
that when he explains why he is questioning his patients about their
identity, despite having known them for some time, they are very happy that
they are being identified correctly.
I would respectfully suggest that those laboratories
accepting specimens having pre-printed labels are condoning an unsafe and
dangerous practice.
The solution to all this is a system for correct
patient identification, (are there any DOH guidelines / rules?), proper
systems of staff training and awareness, and, ultimately, some sort of
electronic system for patient identification and specimen labelling at the
bedside.
See Lyn Sharman's wake up article in the ACB
Newsheet November 1999, David Guthrie's article in the Bulletin of the
RCPath. page 19, July 2003, and just in, NEJM, June 2003, vol. 348 no. 25 p
2526 and p 2570.
Best wishes,
Chris
Chris Royle
Laboratory Manager,
Clinical Biochemistry and Haematology Departments,
Royal Brompton and Harefield NHS Trust,
Royal Brompton Hospital,
Sydney Street,
LONDON
SW3 6NP
phone: + 44 (0)20 7351 8413
fax: + 44 (0)20 7351 8416
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