Labeling Loggerheads

Dear Center for Phlebotomy Education:

I have a real problem here. Our nursing staff is giving the lab pushback on their demand that tubes not be sent to the lab without their labels attached, They claim as long as the labels are in the same bag as the tubes, there's no reason why the lab staff can't label them. The nurse manager and lab manager are at loggerheads. What should we do?

Our response: 

Someone needs to step up and deal with this decisively before interdepartmental warfare breaks out. We suggest a summit between nursing and laboratory management including hospital administrators and medical directors so all parties can plead their case. On the one hand, the laboratory staff has to understand the unrelenting pressure the nursing staff is under every day, and how a simple act of labeling a tube shouldn't be an issue.
     On the other hand, the nursing staff needs to realize they are violating the standards and a Joint Commission requirement by not labeling tubes in the presence of the patient. They need to understand labeling the tube is part of the procedure, and if you can't complete the procedure, you shouldn't start it. The nursing staff also has to realize asking the laboratory personnel to label a sample they did not draw is no different than asking the nurse to administer a syringe of medication she didn't prepare. Both can have catastrophic results.

This never should have gone this far. There must be more at the core of this dispute than an unwillingness to label samples. Since patient death is one of the risks of sample misidentification, this disagreement is likely a symptom of some deeper, yet unresolved, issue. Time spent excavating the seeds of this resistance has to be invested before a patient becomes the victim. There may be a history between the two managers or a festering dispute that's getting in the way. Address the underlying issues and this one should evaporate on its own. If the two parties can't/don't vent their frustrations, including those deep and unrelated, their superiors or surrogates need to step in and resolve this where they are incapable.

Ultimately, the laboratory is responsible for the quality of the samples it tests, and should have the authority and administrative support to enforce its policies for collecting blood samples even when those individuals are under the authority of another department. Without coming to a mutual understanding that the samples must be labeled in the presence of the patient, the only alternative you have is to discontinue phlebotomy as a procedure nurses perform at your facility.