On January 1, 2018, I posted the outcomes of our December, 2017 Quick Question, “When is the correct time to label blood specimen tubes?” Subsequent to this posting, Dennis Ernst, Dave McGlasson, and I co-authored an editorial, “Labeling tubes before collection threatens patient safety,” in the February, 2018 issue of Annals of Blood. Below are links to our editorial, a counter-proposal editorial by Dr. Guiseppi Lippi, and an “arbitration” editorial by Dr. Emmanuel Favaloro.
Ernst, Fritsma, McGlasson, “Labeling tubes before collection threatens patient safety”
Lippi, Plebani, “Blood tubes should be labeled before drawing blood”
Favaloro: “Blood tubes should be appropriately labeled and checked by the patient before departure”
Here is a fourth article from the March, 2018 issue of Clinical Chemistry and Laboratory Medicine:
Dr. Lippi’s position and the Clin Chem and Lab Med article predicates the safety of prelabeling on the exclusive use of the ProTube, an automated tube-labeling device. The ProTube seems to resolve some of the concerns expressed in our February AOB editorial. However, I recently had a conversation with my friend and colleague, Donna Castellone, Supervisor, Special Coagulation and Hematology, New York Presbyterian-Columbia, whose blood collectors use the ProTube.The blood collectors often slip empty prelabeled tubes into their lab coat pockets, a practice that could lead to the type of undetectable mislabeling arror described in the article. Further, Ms. Castellone asserts that the time-stamp function adds an additional wrinkle. It seems that patients occasionally depart the drawing station just prior to venipuncture for various personal or scheduling reasons. The delay may extend to an hour or two. In this instance the specimen label indicates the arrival and not the actual draw time. This spoils the lab’s turn-around-time data, and more importantly, makes the specimen seem older than it really is, leading to premature disposal.
We continue to assert that we must follow North American practice standards and label tubes in the presence of the patient after the specimen is collected, and that we must ask the patient to confirm the specimen is theirs. Pre-labeling remains an unsafe practice.