And what do your Trust lawyers say about the patient who is sent by the GP to have a blood test at the Hospital - unfortunately the phlebotomist fails to label the sample before slipping it into the sample bag, the lab ruthlessly bins the sample and sends a 'sample not labelled - analysis not done' report to the GP who rightly becomes incandescent - especially when it is found that the patient had significant renal impairment and a dangerously high K on ACE inhibitors. I have received different advice on this subject in the past. Reporting a result with a  warning comment/disclaimer at least gives the possibilty of alerting a physician to a serious and possibly life-threatening abnormality, which can be quickly acted on after urgent confirmation. Such policies should be based on a careful consideration of risks & benefits - clearly a sample for cross matching, for example, will be subject to much more stringent identification requirements. 

Huw Griffiths
Huddersfield Royal Infirmary

--
Huw Griffiths

>>> <[log in to unmask]> 03/15/00 08:52 >>>
WE have received legal advice from our Trust lawyers on this very question. THey have informed the Chief Exec, who told us that under no circumstances are we to accept unlabelled samples because any resultant  error would be indefensible. This even extends to me having to have stand up arguments with distraught paediatric Harpies [SHO's in demonic form] when they have sent two unlabelled samples of identical appearance demanding that we analyse them and they will decide which baby they applied to [the fact that one baby was the child of a consultant probably raised the tension levels as well]. We refused.

***************************************************************************************
Prof. T. Reynolds,
Clinical Chemistry Dept,
Queens Hospital,
Belvedere Rd.,
Burton-on-Trent,
STAFFS,
DE13 0RB.
---------
Tel:  +44 (0)1283 511511 ext. 4035
Fax: +44 (0)1283 593064
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-----Original Message-----
From:	c=GB;a=NHS;p=NHS NATIONAL INT;dda:RFC-822=acb-clin-chem-gen-request(a)mailbase.ac.uk; 
Sent:	Tuesday, March 14, 2000 6:57 PM
To:	c=GB;a=NHS;p=NHS NATIONAL INT;dda:RFC-822=r.forrest(a)sheffield.ac.uk;
Cc:	c=GB;a=NHS;p=NHS NATIONAL INT;dda:RFC-822=acb-clin-chem-gen(a)mailbase.ac.uk;
Subject:	Re: Analyses on non ideal samples.

What will happen if inappropriate medical decision taken based on the
results from an inappropriate sample as per the locally standardised
methodology? Will the lawyers spare this ?inapproprite action of
measuring a wrong sample? Though measuring on a sample different from
the ideal one may be ok for an humanitarian purpose/s, will this be
spared from a medicolegal point ? I was told a recent incident where the
lab was sued because of the release of the result from an
inappropriately labeled sample, though the result went with a note
documenting the improper label. The blame was put on the lab for
accepting the sample for analysis (on the assumption that the
performance of the analysis indicates validation by the Scientist for
the measurement). 
So the current medicolegal system  should answer this question as per
me.
Regards
Vivek
Dewsbury General Hospital
Dewsbury


On Tue, 14 Mar 2000, Robert Forrest wrote:

> What are peoples views on the analysis of non ideal samples? I have just
> been reviewing the  papers in a Coroner's case (not local) where a clinical
> sample collected in life was submitted promptly to a clinical chemistry
> laboratory for an ethanol assay in a LiHep tube and was reported as "Sample
> not suitable for analysis". Ideal sample or not, that result would have made
> the difference between writing an opinion that would have been helpful to
> the Court and the somewhat iffy one I had to write.
> 
> The reflex rejection of a less than ideal sample may not always be
> appropriate. Intellect should be the touchstone. Protocols and SOPs are
> guides and nothing more.
> 
> Robert Forrest
> 
> 
> A R W Forrest LLM, FRCP, FRCPath,
> Professor of Forensic Toxicology
> University Dept of Forensic Pathology
> Medico-legal Centre
> Watery Street
> SHEFFIELD
> S3 7ES
> UK
> 
> Voice +44 (0)114 2738721
> Fax    +44 (0)114 279 8942
> 
> 




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