Appropriate labelling of blood collection tubes: a step ahead towards patient’s safety

Abstract

Laboratory diagnostics is a complex and multifaceted enterprise, developing throughout a multiple series of activities traditionally clustered within fi ve main phases, i.e., the pre-preanalytical, preanalytical, analytical, post-analytical and post-post-analytical. Although remarkable technological advancements, internal quality control, external quality assessment and/or profi ciency testing have enabled to consistently decrease the burden of errors in the central, analytical phase (1 -3) , several problems still plague other activities of the total testing process (4) . Reliable evidence attests that the vast majority of errors in the modern laboratory diagnostics occurs in the preanalytical phase, whereby a series of manually intensive procedures, not appropriately automated or non automatable, make blood collection inherently vulnerable to ambiguity and human faults (5, 6) . Results of several studies and surveys attest that most preanalytical errors are attributable to collection of samples of inappropriate quality (i.e., haemolysed, clotted, contaminated) or quantity (i.e., insuffi cient volume, incorrect blood to anticoagulant ratio). Although these preanalytical mistakes still jeopardise patient ' s safety when the samples are processed with generation of unreliable data, they are however straightforwardly detectable before test results are being released to the clinicians by either visual inspection of the sample or through technological aids such as the use of serum indices (7) . Misidentifi cation is an additional source of errors in the preanalytical phase, which is reportedly less frequent, but potentially much more hazardous. Identifi cation errors virtually affl ict each medical activity, whenever there is a direct interaction between the patient and a healthcare professional, either for diagnostic, clinical or therapeutic purposes.Identifi cation errors might occur with a signifi cant frequency in nearly almost diagnostic disciplines, including laboratory medicine (from approx. 1 % to 9 % of cases) (8) , transfusion medicine (from 0.7 % to 3.2 % ) (9, 10) , anatomic pathology (approx. 1 % ) (11) as well as radiology, where the frequency of incorrect patient data and side markers in a recent survey was found to be unpredictably higher (i.e., 18 % and 5 % of cases, respectively) than in other diagnostic disciplines (12) .

Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention

“…The Clinical and Laboratory Standards Institute (24) specifically place labelling blood collection tubes after sample collection in their guidelines, although the recommendation generally is that the tubes should be labeled in the presence of the patient (44). In this study the national guideline regarding general VBSC consisted of 10 pages and included information and point-by-point instructions (10).…”

Effects of sample transportation on commonly requested laboratory tests

“…Thanks to the increased awareness of the importance of improving quality in the pre-analytical phase, some technological developments and initiatives designed to improve the standardization and quality of operating procedures among phlebotomists have been introduced (12,13) . However, while the effects of time and temperature transportation on the quality of biological samples were recognized some decades ago, little evidence is available in literature on the effective compliance with current recommendations and requirements for transportation and on systems able to safeguard sample quality during transportation (14) .…”

Patient identification and tube labelling – a call for harmonisation

“…Standard operating procedures for phlebotomy may differ with local preferences and available technological resources in an institution [21]. EFLM WG-PRE recommends eliminating the requirement for tube labelling after collection.…”

“…Positive patient identification (PPID) refers to the correct initial identification of a patient and the absolute connection of all samples to that patient throughout the total examination process, including collection, analysis, and reporting [8]. The barcoded wristbands are increasingly worldwide used as a method for patient identification [21]. Both barcoding and radiofrequency identification could be used for electronic PPID.…”