Vol. 20 •Issue 15 • Page 26
Best Practices in Bedside Specimen Labeling
Use these strategies to improve patient safety and staff productivity.
Every year, patients in U.S. hospitals experience more than 160,900 adverse events as a result of sample-identification errors. Yet that figure represents only 5.5 percent of all yearly specimen errors.1Additional sample identification errors may not lead to adverse events, but they can produce misdiagnoses, unnecessary treatments, wasteful tests and significant financial impact. In fact, the resulting redraws, retests and additional treatments cost hospitals an estimated $200 to $400 million per year.2
There is, however, a direct, effective way to drastically reduce specimen-label errors: barcode labeling of blood and other samples at the time they are collected, in the presence of the patient, using a networked PDA device or mobile PC and a mobile printer. Indeed, many hospitals have eliminated the potential for these errors by producing barcode labels at the patient bedside.
Point-of-care (POC) labeling has the added benefit of meeting criteria established by The Joint Commission. Specifically, point-of-care labeling helps hospitals meet two of The Joint Commission’s National Patient Safety Goals for 2008:
- using at least two patient identifiers when collecting blood samples and other specimens; and
- labeling containers used for blood and other specimens in the presence of the patient.
Time and Distance
In most hospitals, the majority of specimen-label errors can be attributed to the common practice of bringing multiple preprinted labels into a patient’s room. Printing and affixing specimen labels away from the POC is the second-leading cause. The reasons are simple: the longer the time between printing a label and affixing it to the specimen container, the higher the chance the label will be put on the wrong sample. Likewise, the greater the distance between where a label is printed and where it is applied to the sample, the greater the risk of error.
Printing labels on-demand, one-at-a-time goes a long way toward eliminating the possibility of applying the wrong label to the specimen container. The experience of Valley Hospital, Ridgewood, NJ, is typical of many hospitals that have adopted bedside specimen-container labeling.
In the first 6 months of bedside specimen labeling, Valley registered no patient or specimen misidentifications, no incorrect specimen containers and no unnecessary phlebotomies.3Valley’s experience, which represents more than 8,000 phlebotomies, indicates these results are sustainable over the long term.
More Time for Patient Care
Bedside specimen labeling does not alter the fundamental processes used by phlebotomists and nurses when drawing samples, but it does eliminate many nonessential, unproductive tasks: frequent trips to the lab to access updated draw orders; redrawing samples when orders change; sorting sheets of labels and carefully matching them to sample containers; and the like. Bedside barcode labeling, by contrast, enables clinical staff to focus more on patient care and less on retrieving and sorting orders and labels.
A typical bedside specimen-labeling procedure begins when draw orders are downloaded to the PDAs or mobile computers issued to phlebotomists and other staff members who collect specimen samples. At the bedside, staff members identify the patient by scanning the barcoded wristband generated upon admission. The patient ID is matched against a draw order on the mobile device, which verifies a sample is required and the correct patient is being tested. Confirmation can come from checking a record on the mobile computer, which can connect wirelessly to the laboratory information system.
After receiving instant confirmation of the patient identification and sample order, the sample is collected. The mobile device or network immediately directs the printer to produce an ID label, which is applied to the sample container.
A Real-World Example
Hamilton Medical Center, Dalton, GA, uses an automated phlebotomy specimen collection system much like the one described above. The 282-bed hospital implemented the system because it wanted to improve patient safety by requiring two patient identifier checks prior to sample collections, ensure samples were labeled accurately and give staff members accurate test request information at the time of draw.
Phlebotomists now use wireless handheld computers and mobile printers to manage collection rounds.
As expected, the system has produced highly accurate sample identification and reduction in redraws. The most important benefit of all, however, has been the resulting improvements to patient safety. By printing labels one-at-a-time at the point of care, Hamilton has virtually eliminated the possibility of applying the wrong label to the wrong specimen. Moreover, turnaround times have improved, and redraws are also down, helping to lower the overall cost of care.
Automating specimen collection at the bedside has also produced significant time savings—45 minutes per day—for phlebotomists. Computerized management has also reduced the number of variables phlebotomists must handle at the patient bedside, resulting in improved workflow.
What’s more, new draw orders are communicated directly and instantly to handheld devices, so phlebotomists do not need to return to the central lab to get assignments.
Point-of-Care Labeling Essentials
There are four essential elements to a successful POC labeling system:
- A PDA or mobile computer (which may include a barcode reader) providing access to real-time draw orders and patient records;
- A printer that can be conveniently used at the patient bedside;
- Label media that is durable and will remain readable and affixed to the sample container throughout all testing and storage processes; and
- A barcoded patient wristband that verifies patient ID at the point of care.
While wireless network connectivity is not strictly required for bedside specimen labeling, it can give phlebotomists and other caregivers real-time notification of cancellations, new test requests, patient moves and other changes. A wireless capability thus reduces canceled procedures and trips to the central lab for assignment updates.
Turning to printers, the importance of selecting the right mobile printer cannot be overstated. High-quality specimen labels produced at the bedside are the tangible link between automation and real-world clinical processes. Moreover, there can be neither specimen accuracy nor benefits to patient safety without durable labels and consistently excellent print quality.
Because high scan rates are essential to the success of specimen identification, label readability is the most important consideration when selecting a printer for specimen labeling. Bar codes, text and graphics must be clear and long lasting to provide accurate identification from the time of collection all the way to final disposal or storage. Thermal printers, which were developed specifically for barcoding applications, are capable of producing compact, highly readable and durable bar codes ideal for placement on small vials or sample containers.
Printer ease-of-use is also important. Mobile printers can be worn on belts or shoulder straps and can also be mounted on carts. Weight becomes an important consideration if the printers will be carried or worn. So does the ability to perform after being dropped on the floor multiple times. Printers should be user-friendly, controls and indicators should be accessible, and changing media (e.g., rolls of labels) should be convenient. Printers should also be fast enough to produce labels on-demand without inconveniencing the phlebotomist.
Patient Safety Comes First
Of the many compelling reasons to consider implementation of bedside barcode labeling, the improvement to patient safety is paramount. Yet POC labeling has many other advantages, including increased productivity and improved workflow for the phlebotomists and nurses who collect blood and other samples. By reducing the number of unnecessary tests and diagnoses, POC labeling also saves hospitals precious financial resources. As early adopters have discovered, printing and applying specimen-container identification labels at the point of care delivers benefits that patients, staff and administrators can readily appreciate.
Cristina De Martini is global practice leader, healthcare, at Zebra Technologies and a member of the HIMSS Auto ID Task Force.
1. Identification errors involving clinical laboratories: A College of American Pathologists Q-Probes study of patient and specimen identification errors at 120 institutions. Arch Pathol Lab Med. 2006;130(8):1106-1113.
2. Reducing Specimen and Medication Error with Handheld Technology, presented at 2001 HIMSS Annual Conference and Exhibition.
3. Bologna LJ, Mutter M. Life after phlebotomy deployment: Reducing major patient and specimen identification errors. J Healthc Inf Manag. 2002 Winter;16(1).