Specimen Management

1. Specimen Management

3. The result of any laboratory test is only as good as the sample received in the laboratory

4. The Problem You have arrived for work and notice a specimen on the counter with a requisition to perform smear & culture. The requisition form had the patient�s name, and ordering physician and stated that the specimen was sputum. Upon examining the specimen, you notice that there is about 1ml of a clear fluid. How would you proceed? What additional information would you want? Time of collection Urine is a good growth medium and NH3 is a by-product of bacterial growth Because urine is a specimen easily collected (if not a catheterized specimen or suprapubic puncture), request a second specimen be collected. Corrective actions � who collected specimen and assure proper collection procedures are reviewed/implementedWhat additional information would you want? Time of collection Urine is a good growth medium and NH3 is a by-product of bacterial growth Because urine is a specimen easily collected (if not a catheterized specimen or suprapubic puncture), request a second specimen be collected. Corrective actions � who collected specimen and assure proper collection procedures are reviewed/implemented

5. Specimen Management Specimen Collection Specimen Transport Specimen Handling Specimen Referral Specimen Storage Specimen Disposal

7. Impact of Specimen Management on Patient Care Essential to accurate laboratory diagnosis Directly affects patient care and patient outcome Influences therapeutic decisions Impacts patient length of stay, hospital costs, and laboratory costs Influences laboratory efficiency

8. Pitfalls Saying �Yes� to everything Accepting every specimen Afraid to say �No� to physicians Someone with sufficient authority MUST support laboratory policy Good lab practice � Patients first! Having no boundaries for technical issues Often times it will be necessary to work with the Medical Director to establish laboratory policies. The Medical Director must be a supporter of the laboratory.Often times it will be necessary to work with the Medical Director to establish laboratory policies. The Medical Director must be a supporter of the laboratory.

9. Pitfalls Lead to Errors Resulting In: Delays in getting test results Unnecessary re-draws/re-tests Decreased customer satisfaction Increased costs Incorrect diagnosis / treatment Injury Death Specimen collection errors lead to incorrect test results (e.g. contaminated specimens), patient discomfort (e.g. redraws), and in a few cases, death (e.g. mis-identified transfusion patients). Specimen errors significantly reduce the quality of care in an institution and increase costs. Because specimen errors cause fewer deaths and malpractice suits than medication errors, they are less well-studied and researched.Specimen collection errors lead to incorrect test results (e.g. contaminated specimens), patient discomfort (e.g. redraws), and in a few cases, death (e.g. mis-identified transfusion patients). Specimen errors significantly reduce the quality of care in an institution and increase costs. Because specimen errors cause fewer deaths and malpractice suits than medication errors, they are less well-studied and researched.

10. Specimen Collection Procedures Should include instructions for: Positively identifying the patient before collecting a specimen Required specimen for each requested test Preparation of patient Type of collection container, required volume, timing Preservation of specimen, e.g., transport media Proper specimen labeling Special handling instructions, e.g., refrigeration

11. Laboratory Handbook Compilation of documents that must be made available to all specimen collection areas Must be understood by all laboratory staff Includes: Name and address of laboratory Contact names and telephone numbers Hours of operation List of available tests Specimen collection procedures Specimen transport procedures Expected turn around times (TAT) How stat requests are handled May be referenced in the Quality Manual

12. Test Requisition Patient identification Clinical data, where indicated Contact info for requesting physician or authorized individual Tests requested Time and date of specimen collection Source of specimen, when appropriate

13. Specimen Collection: Laboratory Responsibilities Verify completeness of test request Verify integrity of the specimen Determine adequacy of specimen Appropriately labeled, legible identification Determine if appropriate specimen was submitted for requested test Identifier of the collector, e.g., phlebotomist, patient Enforce procedures for handling sub-optimum specimens Specimen rejection criteria

14. Specimen Rejection Criteria: Unlabeled specimen Insufficient patient information Hemolyzed specimen Wrong tube drawn Wrong specimen submitted Inadequate volume for the amount of preservative Insufficient quantity Prolonged transport

15. Specimen Handling

16. Specimen Handling Handle all specimens as if infectious Use tracking system for all specimens: Accession / logging process Confirm actual receipt of specimens Date and time of specimen receipt Track aliquots � traceable to the original sample

17. Specimen Handling Establish procedures for handling: Stat / urgent requests Delayed testing, e.g., storage, separation of serum/plasma from cells Leaking containers Contaminated forms Preservation of specimens

18. Specimen Transport Train personnel in appropriate safety and packaging procedures Package and preserve specimens appropriately Transport specimens at appropriate temperature Determine acceptable transport time Determine mode of transport Courier, ambulance, clinic/lab staff Adhere to the International Air Transport Association (IATA) regulations

19. The Dangerous Goods Regulations Covers: Packaging Labelling Packages Packing Instructions Documentation Training Are updated annually by IATA Dangerous Goods Regulations The Dangerous Goods Regulations are released annually by IATA (International Air Transport Association), and are available from the Civil Aviation Department in your country. They are referenced in the resources area of the manual. In order to assure that dangerous goods are packaged safely and with uniformity the Dangerous Goods Regulations apply to their transport. Packaging must conform to the regulations. Labelling requirements are specific. Instructions for packing the goods are detailed. Training is the foundation of a safe system for the transportation of dangerous goods The regulation states �no person shall handle, offer for transport or transport dangerous goods unless (a) is trained; or (b) is performing those activities under a trained person. . ." Dangerous Goods Regulations The Dangerous Goods Regulations are released annually by IATA (International Air Transport Association), and are available from the Civil Aviation Department in your country. They are referenced in the resources area of the manual. In order to assure that dangerous goods are packaged safely and with uniformity the Dangerous Goods Regulations apply to their transport. Packaging must conform to the regulations. Labelling requirements are specific. Instructions for packing the goods are detailed. Training is the foundation of a safe system for the transportation of dangerous goods The regulation states �no person shall handle, offer for transport or transport dangerous goods unless (a) is trained; or (b) is performing those activities under a trained person. . ."

20. Specimen Referral Record: Tests / specimens referred Date of referral Name of person referring test Monitor / Track, and Record: Turnaround time Results delivery (from referral lab, to requestor) Problems with referral

21. Specimen Storage Establish policy What should be stored? Determine retention time Determine storage location Consider ease of access Assure proper storage conditions Indexing of specimens By day of receipt or accession number

22. Specimen Storage Serum Banks: Establish tracking procedures Encourage use of information technology Maintain an organized, accessible storage system Monitor freeze/thaw cycles

23. Specimen Disposal

24. Specimen Disposal Develop policy for disposal of medical waste Establish and follow disinfection procedures Comply with local regulations Include policy of disposal of rejected specimens Appoint someone with oversight responsibilities Establish a schedule to review all stored specimens

25. Summary: Avoiding Pitfalls Remember good laboratory practice Patients first! Train all personnel responsible for collecting, handling, storage, transport of specimens Monitor rejection log Routinely communicate with customers Update handbook, procedures when methods change

26. The Problem You have arrived for work and notice a specimen on the counter with a requisition to perform smear & culture. The requisition form had the patient�s name, and ordering physician and stated that the specimen was sputum. Upon examining the specimen, you notice that there is about 1ml of a clear fluid. How would you proceed? What additional information would you want? Time of collection Urine is a good growth medium and NH3 is a by-product of bacterial growth Because urine is a specimen easily collected (if not a catheterized specimen or suprapubic puncture), request a second specimen be collected. Corrective actions � who collected specimen and assure proper collection procedures are reviewed/implementedWhat additional information would you want? Time of collection Urine is a good growth medium and NH3 is a by-product of bacterial growth Because urine is a specimen easily collected (if not a catheterized specimen or suprapubic puncture), request a second specimen be collected. Corrective actions � who collected specimen and assure proper collection procedures are reviewed/implemented

27. Questions Who ordered test? Contact to determine suspected agent. What additional information would you want on the requisition form?

28. Additional Information Who ordered test? Contact to determine suspected agent. What additional information would you want on the requisition form? Date of sampling

29. Additional Information Who ordered test? Contact to determine suspected agent. What additional information would you want on the requisition form? Date of sampling Time of sampling

30. Additional Information Who ordered test? Contact to determine suspected agent. What additional information would you want on the requisition form? Date of sampling Time of sampling Age/sex of patient

31. Additional Information Who ordered test? Contact to determine suspected agent. What additional information would you want on the requisition form? Date of sampling Time of sampling Age/sex of patient Does the laboratory have specimen collection instructions for collection of sputum samples