Specimen Labeling Requirements
All
specimens (including but not limited to blood, urine, other body fluids, smears
and tissue) submitted to the SLCH Laboratories for analysis must follow the collection
process for identification of the patient and be properly labeled.
Specimens
are considered properly collected according to the following criteria:
·
Specimens
are labeled at the point of collection.
This must be done by the
person obtaining the specimen.
·
The
unique identifiers obtained from the patient or the patient=s arm band must match those on the
requisition and the specimen label (See Patient Identification Policy).
Specimens
are considered properly labeled according to the following criteria:
·
Specimens
are labeled with the patient=s first and last name and another
unique patient identifier, i.e.…
§
Medical
record number
§
Date
of birth
§
Social
security number
§
Financial
number
·
Specimens
for trauma patients may be labeled with an alpha numeric identifier and do not
require a second unique
identifier. Patient identification for
trauma patients shall remain unchanged for the first 24 hours of the patient’s
admission.
·
Blood
Bank specimens require the above information as well as date of collection, and
initials or signature of the individual drawing the specimen.
Patient’s requiring a red blood cell transfusion shall have a current
specimen from the current admission and a second confirmatory ABO/Rh type. The second confirmatory ABO/Rh type can be
from either a past or current admission but must be collected independently
from the current specimen. Specimens with trauma number designations may
only be used for compatibility testing for 24 hours provided the requests for
transfusion use the Trauma Number. After
24 hours, a new specimen shall be collected for compatibility testing upon
updating the patient’s demographics.
·
Specimens
will be considered unlabeled or mislabeled and not acceptable for analysis if
any label requirements are missing, illegible, or inaccurate.
·
Each
separate tube or container collected must have it=s own label affixed to the specimen
(one label around two tubes is not acceptable).
After
correctly identify the patient with the above unique identifiers, staff
collecting the specimen may use the small labels generated by the Cerner
Laboratory Information System for labeling non
Blood Bank Specimens.
IMPROPERLY LABELED
SPECIMENS SUBMITTED FOR ANALYSIS:
Specimens will be considered unlabeled or mislabeled and not
acceptable for analysis if:
·
There
is no label on the specimen.
·
The
patient's name and/ or unique identifier (Medical record number, financial
number, Date of Birth, social security number) is missing
from the specimen container.
·
The
unique identifiers on the labeled specimen do not match the unique identifier
of the labels in the biohazard specimen bag.
Blood and Urine Specimens
A nurse, physician, PA or APN from the submitting location
will be notified that a specimen was received improperly labeled and the
specimen must be recollected. Unlabeled/ mislabeled specimens, whether
inpatient or outpatient, may not be labeled after receipt in the laboratory, if
the submitting location is not agreeable to recollect the specimen, then the
patient=s physician must call the Laboratory Medical Director on call (pager
790-0312). Under unusual circumstances,
the Laboratory Medical Director may then allow testing of the specimen.
Other Body Fluids or Specimen Types
Any other body fluids (i.e. CSF, synovial, pleural,) or any
other specimen type (BAL bronchoalveolar lavage, bone marrow, surgical
specimen), received without proper labeling will not be accepted for
testing. Due to the invasive nature of
the collection of these specimen types, Central Receiving will contact the
Laboratory Medical Director on call (pager 790-0312) to notify the ordering
physician that the specimen submitted for analysis was improperly labeled. Under unusual circumstances, the Laboratory Medical
Director may then allow testing of the specimen.
Blood Bank Specimens
Improperly labeled blood specimens received by the
Transfusion Service for blood typing, type and screen, and/or compatibility
testing will not be accepted. The Transfusion Service will notify the
submitting location that the specimen must be recollected. Please see the
criteria listed under properly labeled specimens. Specimens lacking initials and/or date of
collection will be rejected and must be redrawn.
Pathology Specimens
Improperly labeled tissue specimens received in formalin,
Michel=s fixative or Bourn=s fixative will be held until a
physician properly verifies that patient=s identification, in person, in the Surgical Pathology
Laboratory. The final pathology report
will indicate that the specimen was initially received with improper
identification and the name of the physician who verified the identification
before processing and examination.
The quality of results from
laboratory testing depends greatly on the proper collection and handling of the
specimen submitted for analysis.
Correct patient identifier,
preparation, specimen collection, specimen packaging and transportation are essential
factors It is important that
all specimens and request slips be
properly labeled with the name of the patient, date of birth, collection date,
time, and the origin (source
or body site) of the specimen, when
applicable.
If there is any doubt or question
regarding the type of specimen that should be collected, it is imperative that
St. Louis Children’s Hospital Laboratory be called to clarify the order and
specimen requirements.
Specific specimen requirements for
each determination, including specimen volume are provided in the Alphabetical
Test Listings section.
To avoid additional delay and
inconvenience, please make sure that you have submitted at least the quantity
specified for the test requested.
Phlebotomy Collection
House Rounds
Monday – Friday: 0600, 0830, 1030, 1230, 1430, 1700, 2000, and
2300
Saturday and Sunday: 0600, 0830, 1030, 1230, 1630 and 2100
Monday – Friday: 0400 – 2300
Saturday and Sunday: 0500 – 2300
Page as needed
NO Phlebotomy Services provided on all midnight shifts
(2230-0400)
This
priority is given to all routine tests, which can be drawn on routine
phlebotomy rounds. When ordering tests in Care Manager, choose the prompts
“lab”, “routine” to have tests ordered with this priority. All of these tests
will be assigned to a phlebotomy collection list. The system will automatically
assign the test(s) to the next appropriate collection list. Collection lists
print 10 minutes prior to round times. This 10-minute period
is referred
to as the “CUT OFF TIME”. During this time, any orders that are placed will not
appear on the collection list for that set of rounds.
|
Example: |
It is 10:20 a.m. and you order routine
tests. The next round time is 10:30 a.m. These tests will not appear in
phlebotomy until the 12:30 p.m. collection list is generated, this is due to
the tests being ordered during the “CUT OFF TIME”. |
This priority will indicate to the lab
that the test must be drawn STAT and resulted immediately. These orders will
print immediately in the phlebotomy department and will be performed and
reported STAT.
When an order is placed with a
priority of STAT, please page the phlebotomist assigned to your floor.
|
Floor |
Pager |
|
|
|
|
In
House Phlebotomy |
424-8940 |
|
Neonate |
424-9095 |
|
Barnes-Jewish |
790-0684 |
These are defined as blood work that
must be drawn at a specified time. (These tests must be given the priority
of TIME lab collect so they will print immediately in the phlebotomy department
and not appear on the collection list.) The specific draw time must also be
entered for these tests.
NOTE: Peak drug levels must be ordered as unit collect.
24-Hour and Timed Urine Collections: St. Louis Children’s Hospital provides 24-hour urine
collection containers.
Use the following procedure for the
correct specimen collection and preparation.
• Warn the patient of the presence of
potentially hazardous preservatives in the collection container.
• Instruct the patient to discard the first-morning
specimen and to record the time of voiding.
• The patient should collect all
subsequent voided urine for the remainder of the day and night.
• Collect the first-morning specimen
on day two at the same time as noted on day one.
• Please mix well before aliquoting and
provide the total volume of the 24-hour urine collection.
See special instruction section
“Urine Preservatives” for multiple collections.
Random Collections: For routine analysis and microscopic evaluation, have
the patient void into a clean container.
The specimen should be capped, labeled, and refrigerated until courier
pickup time. A clean-catch or midstream specimen is preferred. The patient
should first void a small amount of urine which is discarded. Some of the urine
should then be collected in a clean container before voiding is completed.
If delays are anticipated in sending
the specimen to the laboratory, a portion of the specimen should be aliquoted
into a grey urine culture transport tube (boric acid) should any culture work
also be desired or indicated.
Health and Safety Precautions
All specimens should be handled as if
they were infectious. The greatest dangers to health care workers exposed to
blood and body fluids are the Human Immunodeficiency Virus (HIV) and Hepatitis
viruses. St. Louis Children’s Hospital has an extensive safety policy, which
adheres to the Occupational Safety and Health Administration (OSHA) Standard on
Bloodbourne Pathogens. All specimens are handled as if they are infectious.
All specimens should be properly
sealed prior to being transported. Leaking containers pose a health hazard. Do
not submit needles attached to syringes . Safety regulations specify that only specimens in proper
containers are submitted to be transported to the testing laboratory. All specimens should be placed in a specimen
bag when transported to the laboratory.
Specific instructions for storage and
shipment of specimens for individual test are listed in the Alphabetical Test
Listing.
October 2009