AORN guidance statement: safe specimen identification, collection, and handling in perioperative practice settings

AORN Journal,  Oct, 2004  

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PREAMBLE: The purpose of this guidance statement is to provide a framework from which practitioners can develop and implement policies and procedures for safe specimen accountability via identification, collection, and handling in perioperative practice settings. These settings include traditional ORs, ambulatory surgery settings, physician's offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed. Specimen removal is an invasive and high-risk procedure that requires cautious attention to communication and identification of the patient, specimen type, and other information specific to the specimen. Attention should be given to the patient's cultural needs as they relate to specimen handling. Precautions and handling to protect the specimen and the individuals handling a specimen are identified.

In this document, the term OR is meant to include perioperative practice settings. The term specimen handling is meant to include identifying, collecting, labeling, preserving, storing, preparing for transport, documenting, and communicating. Specimens refer to blood, body fluids, tissue, or other specimen types removed from the patient, implanted, or reinfused, including those sent for pathological or gross examination, culture, and sensitivity or other studies.

A sample protocol is presented with the understanding that it ultimately is a facility's responsibility to develop and implement defined protocols specific to individual practice settings based on state regulations. A health care facility should establish a zero tolerance organizational philosophy about handling specimens outside of defined protocols from the viewpoint of the potential for systems failures and should seek systems solutions to prevent errors.

GUIDANCE STATEMENT

Health care facilities should incorporate a policy that identifies which people or job categories are responsible for specimen handling as well as processes required for each specimen type. A policy for safe specimen handling should identify a protocol for specimen delivery to the location of examination or use and acceptable methods of communication about the specimen before and during a procedure.

Health care facilities should develop standardized procedures for safe specimen handling in the OR to ensure patients remain free from injuries related to handling. Elements of safe specimen handling should include, but not be limited to,

* specimen containment;

* identification, including

** patient identification that uses at least two identifiers,

** tissue and specimen identification, and

** source identification;

* transferring specimens from the sterile field;

* transferring specimens to the point of use (eg, sterile field, person implanting);

* labeling specimen container(s) on and off the field;

* accurately identifying the chain of custody for the specimen;

* documenting

** laboratory requisition(s),

** in the patient's record,

** chain of custody, and

** verbal/written communication;

* verifying correct information (eg, specimen type, patient information) before transferring the specimen;

* storing and maintaining specimens until transfer;

* transferring or facilitating transfer of the specimen for examination; and

* using risk reduction strategies.

Specimen identification, collection, and handling are multidisciplinary tasks that require vigilant attention to detail so that each person understands the patient's needs, communication needs, and information about the specimen. Misidentification or mishandling can lead to adverse outcomes, including inaccurate or incomplete diagnosis, incorrect handling of the tissue, or the need for repeated procedures. Risk reduction can occur via the following.

* Provide personnel with appropriate and timely education related to specimen collection and handling and repeat competency validation as policies and procedures change.

* Develop procedures for reporting and responding to specimen collection and handling errors and near misses, as well as reviewing trends with a focus on error reduction.

* Modify work schedule requirements in the surgical setting to minimize the risk of fatigue-induced errors.

* Implement constraints to minimize risks related to specimen collection and handling. Constraints might include

** required audible verification (ie, read back) of patient identification, specimen type, and requirements for handling between personnel or departments at points of transfer;

** identified communication requirements when the pathologist is notified or a report is communicated to the perioperative setting; and

** labeling requirements for containers, requisition forms, and other documents.

* Incorporate forcing functions that might include required use of

** containers that eliminate exposure to formalin,

** supplies that improve patient identification and specimen labeling, or

** supplies that prevent mishandling of the specimen.