Dear Center for Phlebotomy Education,

We have samples coming in from a wide variety of outreach locations, (Home Health, Nursing Homes, Doctors' Offices etc.). Some of the samples have printed labels and others have hand written labels. We have worked on this process for a long time and have implemented check points and even the "Final Check" (last 3 numbers) but we still have ID errors with specimen relabeling. I would like to hear from you all about what works and what does not. What should we do?

Our response: Your relabeling necessity is introducing an opportunity for error into the process. The problem is not that samples are being relabeled improperly, it's that they have to be relabeled at all. So we really need to talk about process improvement to eliminate the need for relabeling before something catastrophic happens.

Some research into the current labeling practice is necessary to assess why tubes require relabeling. Your goal needs to be to eliminate all relabeling. Start by establishing your benchmark percentage on how many draws require your staff to relabel. You have to know the magnitude of the problem in order to gauge progress. Your ultimate goal is zero.

You should also log the reason relabeling was necessary, and the name of the individual who labeled the sample originally. Attack the problem where it lives most of the time with aggressive in-services and remedial training. When you do, you'll have to be careful how you present it. The individuals in remedial training have to know this is a process problem, not a people problem. If they sense you feel they are the problem, you've lost their cooperation. Instead, explain how the process is broken, the consequences and potential outcomes, and the plan to fix the process through them and with them. Cooperation is essential, and you only have one chance to present your solution properly.

You shouldn't need administrative support for this unless you run into resistance. Process improvement is rarely resisted, so present it professionally and you should be able to win the day for your patients.

Don't forget to track progress toward your goal, and report it to all those involved in the strategy. People tend to rally behind positive momentum. Employee feedback is required so that everyone sees the progress, or lack thereof. Rewarding every individual's diligence is another essential component of process improvement. 

This is a huge problem with potentially devastating consequences when not aggressively attacked. You are to be commended for wanting to eliminate your relabeling issues.

Got a challenging phlebotomy situation or work-related question? Email us your submission at [email protected] and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)