Question: Do you label at the patient’s side without fail?

Blood tubes and patient labels are like a bride and a groom at the altar. If they leave before being joined together as one, they cannot be considered to belong to each other. 

Once blood samples are walked away from the patient without being labeled, they should be discarded, redrawn, and labeled in the presence of the patient. This is not only a requirement of the CLSI venipuncture standard, but also of The Joint Commission. CLSI also mandates the labeled tubes be compared to the patient's identification band or shown to the patient for confirmation that they are labeled correctly. This step is especially necessary when carrying labels for multiple patients into every room to make sure the proper labels are attached to the samples drawn.

Consider the following statistics:

• 11% of transfusion deaths are caused by phlebotomists who misidentify the patient or the tube;
• patient-identification or specimen-labeling errors involving the laboratory cause 160,000 adverse patient events each year in the U.S.;
• only 16% of non-laboratory staff in one study were labeling tubes properly;
• up to 16 percent of identification bands have erroneous information.

When properly performed, every venipuncture procedure includes labeling the samples after the tubes are filled. It should be accomplished start-to-finish without interruption. If the procedure cannot be finished, including the tube-labeling step, it should not be started. Those who label tubes away from the patient's side are completing an interrupted procedure and are accomplices to a potentially catastrophic consequence. Facilities that establish a zero-tolerance policy for not labeling tubes at the patients' side provide the best protection against misidentified samples, transfusion-related deaths, and patient mismanagement.

Correct answer: I never leave the patient's side before completely labeling the samples and confirming they've been labeled correctly. I never label samples I did not collect.

That concludes our series of Eight Questions Every Phlebotomist MUST Answer Correctly. If you missed any of them, search the archives. If you want a PDF of the entire series, I've compiled all eight into one of our most popular downloads, "Eight Questions Every Phlebotomist Must Answer Correctly."

I encourage you to make these questions the topic of this month's staff meeting or in-service. By so doing, you'll reinforce concepts everyone must know and apply. Concepts that are likely in your own procedure manual already, or should be.