Labeling blood and other samples at the time they are collected improves patient safety and helps prevent a host of problems related to misidentification—including many of the estimated 160,900 adverse events that occur in U.S. hospitals annually because of sample identification errors. There is a strong and growing body of evidence within medical literature that creating specimen identification labels on demand at the patient bedside with a mobile printer can significantly reduce errors. A Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) National Patient Safety Goal (NPSG) for 2006 is to use two patient-specific identifiers whenever taking blood or other samples from a patient, and to label the sample collection container in the presence of the patient. Producing specimen labels at the patient bedside and encoding patient identification in a bar code satisfies both the JCAHO NPSG and Health Insurance Portability and Accountability Act (HIPAA) requirements. This white paper explains the point-of-care specimen labeling process, documents its benefits, outlines equipment and computer system requirements, and provides tips for successful implementation.
Identifying the Problem and Opportunity
Improved patient safety and care are the main reasons to implement mobile specimen collection labeling. Misidentified samples create a serious risk to patient safety by leading to misdiagnosis and inappropriate treat- ment. The case of Linda McDougal, a Wisconsin woman who underwent an unnecessary double mastectomy because her biopsy sample had been confused with another, drew national attention to the problem of sample identification errors and their consequences. McDougal’s experience is dramatic, but not isolated. Each year more than 160,900 adverse events occur in U.S. hospitals because of sample identification errors according to one study, which also found that one in 18 sample identification errors leads directly to an adverse event.
Another study found 5.8 percent of phlebotomy samples are mislabeled. It is becoming increasingly clear that sample identification is a problem with serious patient safety consequences. Misdiagnosis, unnecessary treatment and wasteful tests all result from sample misidentification. There is also a significant financial impact—sample errors lead to redraws, retesting and additional treatment that cost hospitals an estimated $200 to $400 million per year.
Why Label at Collection?
Accurate labeling at the point of care can prevent many specimen identification errors and resulting problems. Specimen labeling errors accounted for 55.5 percent of identification errors in a study conducted by the College of American Pathologists. Specimen labeling, the most common error, occurred more than twice as much as the second-most common cause. By accurately identifying samples, hospitals can eliminate a leading source of identification errors.
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. For example, prior to converting from central printing to bedside specimen labeling, the staff at The Valley Hospital in Ridgewood, N.J., identified 63 steps in its phlebotomy collection process where errors could occur. Labeling specimens at the patient bedside eliminated 44 of these steps from the process. After Implementing the bedside labeling system, The Valley Hospital reported zero misidentified patients and specimens, zero incorrect specimen containers, and zero unnecessary phlebotomies after six months and 8,000 phlebotomies.
The hospital also analyzed specimen identification errors and found that carrying multiple labels into a patient room was the leading cause of specimen mislabeling. Labeling away from the bedside was the second-leading cause.
The reasons for creating processes to prevent specimen labeling errors are clear. So is the value of bedside labeling for specimen identification. Numerous other studies and anecdotal results have shown the practice to be highly effective. The Valley Hospital had no identification errors on the first 8,000 phlebotomy samples that were collected after bedside labeling was implemented. Becton Dickinson reported two hospitals that installed its BD.id system for positive patient identification and specimen collection and conducted studies that found nearly a 100 percent reduction in specimen collection errors. Many other hospitals and laboratories have reported significant error reductions related to bar code- based patient and specimen identification and point-of-care labeling.
There are three essential components to a successful point-of-care labeling system: a mobile computer (which may include a bar code reader) that provides access to real-time draw orders and patient records; a printer that can be conveniently used at the patient bedside; and label media that will remain affixed to the sample container throughout all testing and storage processes.
Getting Started With Bedside Labeling
Wireless network coverage is not strictly required for bedside specimen labeling but can greatly improve the process. With wireless connectivity, phlebotomists and other caregivers get real-time notification of cancellations, new test requests, patient moves and other changes. The result is a reduction in unnecessary procedures and trips to the central lab for assignment updates. Wireless connectivity also enables activity performed at the point of care to be instantly recorded in the patient’s electronic medical record or other computer system.
Bar coded patient wristbands are not required for point-of-care labeling, but can significantly enhance error reduction by facilitating a convenient, accurate positive patient identification. JCAHO compliance requires that at least two patient identifiers be used whenever blood samples are taken and medications or blood products are administered. A bar-coded wristband can provide two forms of identification in one easy-to-access place by encoding the patient name and medical record number.
Here’s how a typical bedside specimen labeling procedure works. Draw orders are downloaded to mobile computers that are issued to the nurses or phlebotomists who collect the specimen sample. At the bedside, the patient is identified, ideally by bar code scanning. The patient ID is matched against a draw order on the mobile computer to verify that a sample is required and the correct patient is being tested. Confirmation can come from checking a record stored in the mobile computer, or through a wireless network connection to a central patient record system. After receiving instant confirmation of the patient identification and sample order, the sample is collected. The mobile computer or network immediately directs the printer to produce an ID label, which is applied to the sample container. Printing labels on-demand, one-at-a-time virtually eliminates the possibility of applying the wrong label to the specimen.
Improve the Patient Experience With Bedside Labeling