An Optimistic Outlook: Advances in Phlebotomy Promise Improvement: New and Improved Methods and Technologies Show Promise of Resolving Patient ID and Specimen Collection Problems with Typical Populations as Well as Drug Addicts

Article excerpt

It has been reported that 160,000 adverse patient events occur annually due to patient misidentification or specimen labeling errors committed by the clinical laboratory. (1) "These errors pose a threat to the very lives of those who have entrusted their care to us," says Dennis J. Ernst, MT(ASCP), director, Center for Phlebotomy Education, Inc., Corydon, IN. "Additionally, patient identification errors rob laboratories of their credibility, reliability, productivity and morale."

Today's Biggest Problems

In light of this, three laboratory professionals were asked to identify today's biggest problems regarding patient identification and blood specimen collection and then to discuss how new and improved methods and technologies have brought improvement to these problematic areas. In addition to Ernst, contributors include Roslyn Yomtovian, MD, clinical professor, pathology (transfusion medicine) Case Western Reserve University, and National Veterans Administration Quality Scholar Fellow, Case Western Reserve University and the Louis Stokes V A Medical Center, Cleveland, OH, and William J. Monteforte, MD, FCAP, laboratory medical director, Providence Regional Medical Center Everett, Everett, WA.

Problem #1: Non-laboratory professionals are drawing samples in decentralized environments.

Solution #1: Facilities that recentralize phlebotomy back to the laboratory have far fewer occurrences of patient misidentification, states Ernst. Decentralized phlebotomy has largely failed as a staffing strategy. Its threats to patient care have been widely reported to include false positive blood cultures, decreased specimen quality and higher rates of misidentified patients and mislabeled tubes. As a result, more patients are treated, diagnosed and medicated according to someone else's test results.

Problem #2: Patients who cannot identify themselves verbally are not given ID bracelets in the emergency department.

Solution #2: Facilities that immediately put an ID bracelet on all emergency department patients are less likely to have wrong-blood-in-tube errors, Ernst says. Even if the patient's name is not known, a temporary identifier is critical to ensure that the right patient sample is collected.

Problem #3: The wrong bracelet or erroneous information is put on the bracelet and the collector fails to confirm the patient's identity verbally.

Solution #3: Barcoded ID bracelets that can be scanned prior to sample collection go a long way to reduce patient misidentification, but when the wrong bracelet is attached to the patient it is ineffective in reducing errors, Ernst maintains. Thus, it's critical for the collector to seek verbal confirmation from the patient, a requirement The Joint Commission recently rescinded in its 2010 National Patient Safety Goals. When patients are unable to communicate, a caregiver or family member should be solicited for the confirmatory information on behalf of the patient. Studies have shown that up to 16 percent of arm bracelets can have erroneous information. Skipping this critical step is taking a chance with the patient's life.

Problem #4: Some facilities don't adhere to or enforce Clinical and Laboratory Standards Institute's (CLSI) protocol for proper patient identification.

Solution #4: Because The Joint Commission is eliminating active patient involvement as a requirement prior to obtaining a laboratory sample, Ernst says that facilities have to make sure that they aspire to the higher standards of CLSI and the College of American Pathologists (CAP) in order to fully protect their patients from bracelet errors.

Problem #5: There is a lack of uniform standards by major accreditation organizations.

Solution #5: Electronic verification with barcoding or a radio frequency identification device (RFID) will improve the ill process by providing a confirmation of the patient's ID, says Dr. Yomtovian. …