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by Chris Sullivan November 08, 2019 As healthcare providers, we are committed to protecting patients. However, mistakes can happen in the course of care, especially during specimen collection. Sample mishandling, mislabeling and contamination are all risks, as are incorrect patient identification and results reporting. Such scenarios lead to rejected specimens and repeat lab work – in a best-case scenario. Worst case? “Wrong site” surgeries or misdiagnoses, often for multiple patients. Needless to say, mistakes during specimen collection, transport and testing frustrate patients and providers. Though the errors typically come at a much greater cost than simple inconvenience. For the hospital, the consequences are often financial. The bill for redraws, retesting and additional treatments required in the wake of errors can ring up around $400 million annually for hospitals. However, mistakes by medical care teams can be physically, mentally, emotionally and financially injurious. Given that one study found a whopping one-third (37%) of specimen labeling errors lead to adverse events, it’s no wonder that risk-averse healthcare providers have strict procedures for specimen collection, handling and processing centered firmly on “identification.” For example, most facilities focus their processes on these three steps: 1. Patient ID confirmation – The patient’s name, date of birth and other personal identifiers are confirmed multiple times. Typically, this occurs before the order is retrieved and before the actual draw, at a minimum. 2. Proper patient-specimen correlation – The responsibility usually falls on the phlebotomist to confirm the right label is put on the right vial per the order – and that the right type of specimen, and the right patient’s specimen, is then collected using that vial. 3. Accurate corroboration of specimens, results and patient records – The method by which test results are documented and verified in patient records may vary by medical facility. However, lab management processes are always dependent on the patient identifiers provided by the label affixed to the specimen container. In outpatient labs, it can be easy to ensure proper patient and specimen ID via patient-supervised specimen labeling and multiple other “checkpoints” during the collection process. For example, verbal verification of a patient’s ID may occur at check in and then again with the phlebotomist immediately prior to the draw. And the check-in clerk may print the labels that will be affixed to the specimen collection tubes and ask the patient to confirm that the information printed on the labels is accurate, even requesting a signature-based acknowledgement in some cases. The phlebotomist may then ask the patient to review the label information once again, often after it is affixed to the blood vial or specimen container. (Note the two “checkpoints”.) However, point-of-care specimen collection can be tricky business in hospitals, outpatient surgery centers and even long-term care facilities for a host of reasons. The lack of patient lucidity or mobility are among the biggest; phlebotomists don’t always have the luxury of patient involvement in the ID verification process. Distractions from attending nurses, doctors or visiting family members are some of the others. Even the sheer volume of patient intakes and STAT draws in emergency care settings – or the volume of routine in-patient lab requests that must be completed in a single day – can trigger a more urgent pace of action and an uptick in errors. In fact, some phlebotomists who are called to fulfill an urgent lab order may not even print the label before making the draw, much less follow a two-step verification process to ensure that the patient’s identity matches the information on the label that they (will eventually) apply to the vial…likely after they leave the room. That is why healthcare leaders need to make it a priority over the next 12-18 months to assess and address potential “points of failure” in the point-of-care specimen collection process! Following these three steps and investing in three specific mobility tools – a mobile computer, mobile printer and quality labels – will make it easy to reduce high-stakes errors during point-of-care specimen collection: STEP ONE: MAKE IT MANDATORY TO LABEL SPECIMENS AT THE POINT OF CARE As I’ve already alluded to above, the “lowly” label can make a life-changing difference in the course of patient care. Its presence and accuracy on a vial or container – prior to specimen collection – can help to achieve an accurate diagnosis. On the flipside, its absence or errors can increase the risk of a delayed diagnosis or misdiagnosis. Knowing that, any acute or non-acute care facility that collects blood or other labs should immediately refine its processes to require specimen labeling at the point of care, if it’s not already required. The more time and distance between when labels are produced and when they are applied, the greater the chances they will be put on the wrong sample. Of course, part of that process should entail multi-authentication of a patient’s identity to ensure accurate specimen labeling and reporting: If the patient is alert, following the process used in outpatient labs may be best, with the patient verbally providing key identifiers, visually confirming the accuracy of label information and providing final verification that the specimen container was labeled properly. If the patient is not alert, his or her wristband should be used to confirm patient ID. The phlebotomist should then ask another staff member – perhaps a nurse – to visually inspect and confirm the accuracy of the label information and specimen labeling at the time of collection. Or, you could go with the third option, which I believe is the best one: utilize barcoded patient wristbands and specimen labels to automatically (and most accurately) verify the patient matches the specimen every single time, even if the patient is awake. STEP TWO: MAKE IT EASY TO LABEL SPECIMENS AT THE POINT OF CARE Anything you do to reduce the risk of human error in specimen labeling will likely pay off, process refinement included. Although, compliance is the key to achieving desired outcomes. You have to make it as simple and foolproof as possible to label specimens collected at the point of care with 100 percent accuracy amidst all the chaos that could be occurring at the time of the draw or in the course of the day. That is why automating the specimen labeling process at the point of care has proven to yield the most benefits for healthcare providers, including BJC Healthcare’s Barnes-Jewish Hospital in St. Louis, Missouri. As Todd Clements, manager, clinical information systems (CIS), Barnes-Jewish Hospital, explained in a recent interview, common distractions such as busy corridors and urgent calls away from the bedside can lead to errors in simple tasks such as vial labeling. You also have to remember that phlebotomists working in hospitals, urgent care centers and many non-acute facilities are moving from room to room for hours on end. Tethering them to a “central station” to retrieve orders or print labels multiple times a day is just going to slow them down and ultimately compound the sense of urgency to move through their tasks more hastily. (Not all orders they draw in a day are submitted before their shifts, which means not all labels can be batch printed before they set out on their rounds.) Empowering the phlebotomist – or a member of the nursing staff – to pull up a lab order on a smartphone-like mobile computer, scan the patient wristband to verify identity and then generate the labels right there at the point of care using a mobile printer can do wonders for specimen collection process compliance. When asked about how the automated point-of-care labeling solution was received at Barnes-Jewish Hospital, Clements replied: “I think the staff like it because it protects them and the patient and our institution from errors that can happen with manual processes.” The mobile computers used by Barnes-Jewish Hospital at the point of care have proven to capture scans reliably regardless of the barcode label’s condition – crinkled, shiny, poorly printed, curved around a patient wrist – or sensor-to-code orientation. So, clinicians can scan with confidence without disturbing a sleeping patient to get a better line of sight. And the mobile printer they use at the point of care can generate labels with visual cues for rush labs, such as a vibrant red line in a designated “priority” label zone that the lab will quickly see when they receive the sample. Meaning, the simplicity and automatic verification of patient-specimen-label makes it easier to avert common collection-related “crises” at the point of care while also improving improve lab management. STEP 3: MAKE SURE THAT THE LABELS APPLIED AT THE POINT-OF-CARE WILL STILL BE READABLE WHEN THEY FINALLY MAKE IT TO THE LAB FOR TESTING From the time a label is printed to the time the collected specimen is tested and recorded, that vial (and label) has likely been handled by multiple people and come into contact with multiple fluids and other contaminants, including ammonium, hydrogen peroxide, common disinfectants such as isopropyl and ethyl alcohol and possibly even bleach. It may have also been exposed to extreme temperature changes during transport and storage along with other environmental fluctuations. If the label isn’t durable enough to withstand those contacts or survive handling and becomes unreadable by the lab technician for any reason, then the sample could be rendered useless. Zebra supplies expert Craig Swanson spoke extensively about the variables that must be considered when selecting a label in this recent blog, and we have a great fact sheet that details the factors impacting specimen collection label selection. So, I will refer you to those resources to inform your decision. Just know that if you discount the role of the label in your printing solution, or opt for a “discounted” label to try and save some money, then the effectiveness of your point-of-care specimen collection solution will be diminished. So will your return on investment (ROI) for any technologies used to facilitate this process. In fact, you may end up spending more re-running tests. My advice? Follow the lead of Barnes-Jewish Hospital and invest in a quality mobility solution that enables you to execute your (improved) point-of-care specimen collection process with speed, accuracy and confidence. The money you spend now will be well worth it in the long run, as Barnes-Jewish Hospital can attest. That investment will also have a near immediate – and far-reaching – impact. The same tools used for bedside specimen collection can be used for many other clinical mobility applications. Reference Sullivan, Chris. “How to Reduce Errors, Increase Speed During Specimen Collection: Zebra Blog.” Zebra Technologies, 8 Nov. 2019, https://www.zebra.com/us/en/blog/posts/2019/three-steps-three-mobile-technologies-to-improve-specimen-collection.html.