Volume 36 Number 4 | August 2022

Developing Professionals Forum

Alex Shaw, MLS(ASCP)CM, Developing Professionals Forum Councilor-at-Large

Alex ShawLaboratorians play a vital role in patient safety. While direct patient contact is limited for laboratorians, we are just as important in being patient safety stewards as those in direct contact with patients every day. It is estimated that laboratorians in the United States process and test upwards of 10 billion laboratory tests annually. Each specimen sent to a clinical laboratory for testing comes from a patient, showing how crucial patient safety is for the lab.

Patient safety for laboratorians starts from the initial blood draw. The venipuncture procedure relies heavily on patient safety to ensure results are reliable for clinician interpretation. Proper patient identification, maintaining sterility to prevent venipuncture-related infection, and correct order of draw to prevent additive carryover are necessary for maintaining patient safety. One common possibility of venipuncture jeopardizing patient safety is incorrect order of draw. A textbook example is when a lavender EDTA tube is drawn before a light green lithium heparin tube. EDTA carryover will substantially increase potassium and decrease calcium. If not caught by laboratorians, clinicians may act on these erroneous results and cause serious harm to the patient.

“Patient safety is not only for those who interact directly with patients. Patient safety is for everyone involved in patient health.”

Patient safety for laboratorians does not end after the venipuncture is complete. Once received in the lab, specimen processers must examine each specimen, ensure two patient identifiers are present, visually inspect that the label hasn’t been tampered with, and review that the ordered tests are in their appropriate container(s). Each specimen goes through this triple check process for patient safety. If a label is missing the correct identifiers, laboratorians question the specimen integrity for patient safety. It is of utmost importance that the testing performed is for the correct patient so clinicians can review and act on improving patient health.

Laboratorians can also confirm that all other clinical staff uphold the importance of patient safety. Laboratorians manage their expected lists within their laboratory information systems to see what laboratory specimens have been released by clinical staff but have not yet been received in the lab. While this may seem tedious, and some clinical staff may think we are being nosy, it is an important feature to utilize as laboratory staff.

Consider this scenario: a clinical staff member releases a urine sample label to be collected for a patient and places it on a sterile container. Before the urine sample is collected, the patient moves to a new room. The clinical staff member forgets to move the labeled specimen to the patient’s new location. A new patient gets admitted to the now vacant room. The new patient also has an order for a urine sample collection. The clinical staff member taking care of the new patient grabs the sterile container labeled with the wrong patient label and collects the sample from the new patient. The clinical staff member sends the urine sample to the lab for testing, and the results get posted to the patient chart. The clinician acts on this information, but the actions taken are not supposed to be for that patient. Not following patient safety protocols is frightening in scenarios like this. Reviewing expected lists is helpful for laboratorians to help protect patient safety without being physically present with the patient.

Laboratory patient safety is most rigorous in transfusion services. Products issued from the blood bank may mean life or death for patients. To put emphasis on the necessity of patient safety in transfusion services, consider this example. A phlebotomist sends a type and screen to the lab but places the wrong patient label on the specimen. Testing shows that the specimen is A positive. The laboratory issues a unit of A positive red cells. The patient receiving this unit of A positive red cells is B positive. The patient experiences an ABO-related transfusion reaction and expires. The implications of improperly labeled specimens are so important for the blood bank. Because of the significance of scenarios like this, transfusion service laboratories have implemented many patient safety safeguards to prevent this type of scenario from happening.

Patient safety is not only for those who interact directly with patients. Patient safety is for everyone involved in patient health. The laboratory is a small piece in protecting patient safety and facility policies. Patient safety must be on the forefront of what we do because we ourselves are or will be patients at some point in our lives.

Alex Shaw is a Medical Laboratory Scientist at Allina Health Mercy Hospital – Unity Campus, in Fridley, Minnesota.

Learn more about the Developing Professionals Forum for student members of ASCLS.