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.

Safety unlabeled tubes

I would suggest contacting the hospital's compliance, safety or similar department. This violates standards at so many levels including JCAHO, CAP, CLSI and even local DPH in some States. In any hospital I have worked with, there is usually a Laboratory Administrator that acts as the compliance officer.

George Souza, 01/06/2022 15:52:31

labeling

All specimens should be labeled at bedside or with patient sitting in the chair. Everyone is under a lot of stress but nurses and upper nursing staff needs to be educated on our guidelines and what we can't do. That could cause a serious mislabel along with death of mislabeling etc.. Educate with the you tube video of proper labeling that was created with Dennis Ernst.

Tamera Cooley, 01/06/2022 15:55:14

MD

Frightening. I don't want to rely on those nurses for my medical care....

Jeanne Lumadue, 01/06/2022 15:57:11

I guess you could tell the nursing staff to hire a good lawyer. It's only a matter of time when someone gets the wrong test results and is misdiagnosis and dies. It's all about PPA errors and eliminating them....

William E Johnston, 01/06/2022 15:59:41

Phlebotomist

I see a lot of the labeling confusion. I tell the nurses I can’t label or date & time with your initials if I didn’t draw the patient. Since it’s from a picc line neither one of us drawn the patient is the answer I get all the time. I let them know I understand that but as phlebs we are not allowed to touch picc lines. So than the “argument” starts only I won’t argue. I’ll stop before it starts & tell them let me call my lab director & see what he wants me to do. When they here me say it than their answer is never mind it’s going to take to long. Just give me the labels. 🤷🏻‍♀️ Sorry but I don’t make the rules. 🤷🏻‍♀️ That’s my solution 😁 don’t know about anyone else.

Sarah Harjo, 01/06/2022 16:32:31

Each tube needs to be labeled - end of discussion.

Blair, 01/06/2022 16:35:47

Certified Phlebotomist

This should not be an issue take responsibility for your work, leaving labels

For someone else to place is against all standards. If your going to draw it label it properly. Everyone one is under pressure in the medical field. Create to much room for errors, labs get resulted, does anyone check after labels on tube if there is a mistake.

Patricia Brunet , 01/06/2022 19:03:39

This should not be an issue take responsibility for your work, leaving labels

For someone else to place is against all standards. If your going to draw it label it properly. Everyone one is under pressure in the medical field. Create to much room for errors, labs get resulted, does anyone check after labels on tube if there is a mistake.

Patricia Brunet , 01/06/2022 19:04:12

Certified Phlebotomist

If you draw it label it. To many mistakes can be made. So when offices draw tides and send into lab they have not placed labels on the tides they are hand written, so know one should be allowed to draw blood in the office if they can’t properly label tides and that’s what happens,so if your going to make issues out of everyone drawing labs then everyone should be putting labels on the specimens.

Patricia , 01/06/2022 19:12:11

Specimen labeling

I think there is a huge opportunity here to help patients realize that they are receiving quality care! I, as a patient, am not comfortable if the phlebotomist/individual does not label my specimen in my presence. Also, the CPT code representing the procedure and being billed/paid for includes labeling the specimen. What if the specimen collection person sends more than one patient's specimen? Or multiple transport bags are opened at the same time. It reminds me of the times when I went to draw a patient and their ID band was attached to the bed and not the patient. Some nursing staff may think that this is not a big deal but proper patient identification, proper handling of a specimen and the need to reject hemolyzed specimens is essential for patient care. Inaccurate laboratory results, no matter the cause, can kill people. Even a properly Identified patient can carry risks. I worked for a VA hospital once and came across a patient whose wrist ID was different than their dog tags. There was no procedure that endured me to compare dog tags with a wrist ID but I guess a goo Medical Technologist pays attention to detail. As it turns out the patient had the wrong hospital ID attached to their wrist. Bottom line, the person obtaining the specimen is responsible for proper patient identification and also responsible for proper specimen identification and handling of the specimen. If they don't have the time to do that call the lab!

Marti McCall PhD, 01/06/2022 21:17:33

Labeling Tubes

I have been lab supervisor of my students for multiple 9Health Fairs in the CO area. The students are clearly instructed that the tubes must be labeled completely in front of the patient (as they hold gauze and pressure to the blood draw site).

I understand that the nursing staff is under a lot of pressure but so are lab staff too. After all the lab has to analyze the specimens that the nursing staff generates, accurately.

Tubes must be labeled by the person who draws the specimen to complete the procedure accurately. I agree with the analogy of injections must be administered by the person who draws up the medication.

Cat, 01/06/2022 22:13:17

Working for the common goal

Dawit kussale, 01/06/2022 22:14:57

Working for The common Goal

I can understand the frustration seen on both sides of the departments, but there should be a better way of dealing or communicating to achieve the desired objective of saving life as both departments are working under the same umbrella which is health. All this issues boils down to working under pressure which has to be dealt with human resource hiring more staff to make the working environment less stressful. As to who labels the tube there should be no compromise, the person who collected blood should label it in the presence of the patient, making sure that the right demographic and the right patient. Let don't forget it is a team work.

Dawit Kussale, 01/06/2022 22:25:28

Phlebotomist (of many years)

I feel for all the nurses; the hospitals being super short handed of Nursing staff. However you never know what would happen, for a slight mistake in a flash of a moment. Really something critical could happen, that could mix up a patient’s tubes or tube of blood & that is a critical, & or deadly decision to make in so many ways! No reasons or excuse for not labeling a patients name on any blood tubes or anything else! Maybe add ER Tech in a ER or phlebotomist in that department! Just a suggestion! I know money appears to be short with, the Nurses, on hand medical staff workers/ patient care, but safety comes first!

Joanne , 01/06/2022 23:52:15

Label the sample at the point of draw

All samples must be labelled by the person who draws the samples at the point of taking ,no later

This is one of the top rules for patient safety

Samples without a label attached and filled in correctly should not be processed end of

wini, 01/07/2022 12:57:20

reject unlabeled samples

If the sample is a blood or urine or an easily re-collectable culture, the lab should have a policy to reject unlabeled samples. The policy should also contain what is the process for those samples that are irretrievable that are received unlabeled.

Cheri, 01/07/2022 13:24:03

Certified Phlebotomist

If you draw it label it. To many mistakes can be made. So when offices draw tides and send into lab they have not placed labels on the tides they are hand written, so know one should be allowed to draw blood in the office if they can’t properly label tides and that’s what happens,so if your going to make issues out of everyone drawing labs then everyone should be putting labels on the specimens.

Patricia , 01/07/2022 14:01:28

Phlebotomy Coordinator

Very nicely put. Exactly what needs to be done and quickly. Nursing staff should never be allowed to bully phlebotomists and the administration is ultimately responsible if something happens. Thanks ale care of this problem now. No time to wait.

Jona Han Dobler, 01/07/2022 18:59:45

Certified phlebotomist

Unlabeled tube is not safe I was taught to label all tube there more problems come with unlabeled tube

Patricia a jones, 01/19/2022 17:21:55