Sample and form errors
Studies have shown that up to 80% of laboratory errors occur in the pre-analytical phase. Such errors can have a detrimental effect on patient care. Users can significantly reduce the error rate by ensuring that all aspects of sample collection are carried out correctly.
A recent audit showed that in one month almost 500 samples had some kind of incorrectly, inadequately or ambiguously filled in details on the label or request form. Samples with these issues run the risk of being delayed, results not being sent to the correct place or discarded entirely.
WebICE
When using the ICE system please ensure the labels on the sample bottles are put on length ways and straight otherwise the instruments cannot read them and the results will be delayed.
For a comprehensive user guide on how to correctly label a specimen bottle please see the blood bottles labelling user guide.
Labelling
All staff must positively check the identification of the patient on admission and prior to sample collection.
Positive identification involves asking the patient their full name, date of birth and/or address. In the case of positively identifying children, this must be carried out and confirmed with the parent or guardian or adult with the responsibility for the child or young person at that time e.g. teacher, foster carer, social worker, etc. These details must be cross-referenced with either the HCR’s, school register, nursing notes or an identity band worn by the patient. In the absence of the patients HCR’s, identification must be confirmed with the patient or in the case of confused, unconscious patients a relative, friend or relevant member of staff e.g. nurse or carer.
Asking a patient to confirm a date of birth or a name verbalised by a member of health care staff is not positive identification.
If the patient cannot verify the information on their identity band, (this includes, but is not limited to patients who are unconscious, confused, sedated, very young or who have a learning disability) then a parent, guardian, carer or responsible adult must verbally confirm that the information on the identity band is correct.
Sample
| Essential | Desirable |
|---|---|
| NHS, CHI or H&C Number (Northern Ireland) | Date and time |
| Patients full name or unique coded identifier | Nature of sample |
| Date of birth and/or hospital number |
Request form
| Essential | Desirable |
|---|---|
| NHS, CHI or H&C Number (Northern Ireland) | Clinical information (sometimes essential depending on tests requested) |
| Patients full name or unique coded identifier | Date and time sample collected (sometimes essential depending on tests requested) |
| Date of birth | Patients address including postcode |
| Patient location | Hospital number |
| Requesting clinician full name | |
| Investigations required | |
| Gender |
Use of NHS, CHI or H and C number (Northern Ireland)
The use of the NHS, CHI or H&C Number on paper and electronic patient records is a mandatory requirement included within the NHS Operating Framework 2008/9. Patient data should be used to identify the sample up to the point where an NHS or CHI Number is allocated whereupon this becomes the primary identifier.
Where applicable, the source and site of the sample must be stated on both the specimen container and request form. When several samples from the same patient are to be collected, including multiple pieces of tissue or slides, they must all be clearly identified on the specimen container and request form. Any deviation from the established collection procedures shall be clearly recorded.
Action regarding samples received with insufficient or incomplete minimum patient identification acceptance criteria
Samples or request forms received without the minimum essential identification criteria may be rejected without analysis or referred back to the requesting practitioner. The laboratory standard operating procedure instructs that laboratory staff MUST NOT amend details on the sample.
In cases where an inadequately labelled request form is received with a sample from a patient who is not easily accessible for a repeat then the sample may be processed at the discretion of the senior biomedical scientist in accordance with the local protocols. The report will show a clear disclaimer detailing the shortcomings of the sample and/or request and alerting the requesting practitioner to take responsibility for the results, and for any action taken as a result of the report.
Action regarding samples received with insufficient requesting location and requesting clinician criteria
Samples or request forms received where the requesting clinician or requesting location cannot be determined, either from missing information, illegible information or ambiguous information will be processed but the location and/or clinician will be marked as UNKNOWN. This will lead to results not being sent to the intended recipients.
Results
All results should be available on Path or ICE (except blood transfusion results) within 10 minutes of the results being authorised (please note the specimen turnaround times on the relevant department pages). Ensuring correct details are on the request forms and specimens will help to improve turnaround times. A minimum of three patient identifiers are required but it is requested all fields are completed to ensure the highest data quality is maintained. The tests required should have the appropriate box ticked on the form. Please ensure that the correct boxes are used for requesting unlisted tests and for entering of clinical details. Please note:
- It is essential all handwritten forms are legible.
- It is essential that three patient identifiers are on both the sample and request form.
- Failure to comply with the above points will result in either a delay in testing or possible rejection.
- Please ensure the correct request form is used. Blank printable templates for histology and cytology requests can be obtained from the cellular pathology section of the site.