4 WELCOME

4 Two Significant Stats 70 % 40%

3 Errors in the Stat Lab: 2007 Plebani M, Carraro P. Clin Chem; , 746 tests performed 393 questionable results (0.7%) 160 confirmed laboratory errors (0.3%) 46 caused inappropriate pt. care (.01%) 24 of these were analytical errors (52%) These data reflect ‘mistakes’ after those runs with QC rejects were omitted from the tally.

Sample Collection - Venipuncture Proper patient identification Length of time tourniquet is applied Proper antiseptic to cleanse site Proper tube; Proper amount of blood Proper order of draw Proper mixing of blood with anticoagulant 4

A PPLICATION F LOW  Orders Sent from LIS to Server  Orders distributed to Handhelds  View Collection List / Select Patient-Review Inventory (tubes/tests), Patient History, & Open vs. Collected Draws  Scan Bracelet - Positive Patient ID  Collect Specimens  Print Barcode Specimen Labels at Bedside  Route Specimens to Lab  Collection Data Transferred to LIS  Received-In Specimens are Scanned

Print Label at the Patient’s Bedside After specimen is collected, user is prompted to ‘SCAN CONTAINER’ Specimen label prints when correct container bar code is scanned using the BD Vacutainers. Label applied by aligning notches when using BD Vacutainers Strong, Oscar

Reviewing Patients with Open Orders W-440-A (Allen, Angelo) W-442-A (Rodriguez, Carlos) W-444-B (Johnson, Kimberly)

Viewing Patients with Open Orders W-444-B (Johnson, Kimberly) Blue PT, PTT Red BMP

Some (not all) of the Icons These icons merely indicate a specimen This icon indicates an incomplete order This icon indicates a missed order – could not be completed at this time.

Some (more, not all) of the Icons This icon indicates a completed order This icon indicates a stat request This icon indicates a timed sample that is incomplete at this time

Scanning the Patient’s Wrist Band Please ID the Patient by scanning the correct field Johnson, Kimberly DOB Age Sex Bed F W444B MRN MHC3579B FIN Incorrect PT ID ! The PT bar code on the wrist is scanned to give the Medical Record Number. The bar code did not match the patient’s financial ID

Order of Draw 1.Blood culture tube 2.Sodium citrate (light. blue) 3.Serum tubes (w/ or w/o clot activator, w/ or w/o gel separator) 4.Heparin tubes (green) 5.EDTA tubes (lavender) 6.Glycolytic inhibitor (gray) 7.Revision reflects increased use of plastic tubes 8.Plastic red top tubes (serum) contain a clot activator that may interfere with coag. testing 9.Glass non-additive red top tubes may still be drawn before the coagulation tube 13

14 Delta Checks Absolute Delta Hemoglobin 11/10/ /11/ ? % Delta Creatinine 08/12/ /13/ %  33% Johnson and Stelmach Clin. Lab News September, 2007

15 Delta Checks Absolute or % Delta BUN If < 19.9 mg/dL 10 mg/dL >20 40% Consider the time between samples, e.g. 7 d for BUN Johnson and Stelmach Clin. Lab News September, 2007

16 Follow up of rejected data Once a value is NOT auto-released, it must be verified. Repeated? Discussed with clinician? Compared with other data Same patient – different time Same patient – different tests

17 Advantages Increases physician confidence Ability to Increase Volume without Increasing Staff Enables Further Technologist Development in Manual Areas Provides for Consistent Release of Results Reduces TAT and costs Reduces frustration

18 Thank you !