Safety in the Pre-analytic Phase

The courier suddenly became sleepy in the middle of his daily driving route. It was cold outside and he had all of the windows in the vehicle closed. He also had filled his cooler with four pounds of dry ice, and it was sitting in his back seat.

There was no education at the hospital for specimen collection staff regarding proper label placement on collection tubes. Since the CBC analyzer would not accept tubes with labels that were too long, the lab techs kept a razor blade handy to slice off extra label paper. It wasn’t long before someone cut their finger.

The phlebotomist completed the outpatient collection, but the large elderly patient was unable to stand up from the chair without assistance. The phlebotomist bent at the waist and attempted to lift the patient to standing. The back muscle pull that followed kept the phlebotomist out of work for two weeks.

Every laboratory professional understands the value of quality in the pre-analytic phase of laboratory testing. If you have ever worked where phlebotomy has been decentralized and is no longer overseen by the laboratory, you may have experienced the many pitfalls due to inadequate specimen collection techniques. Laboratory professional by nature want to provide good diagnostic results, and compromised specimens hinder that resolve. Sometimes, however, the aspects of safety that are important during the pre-analytic phase of lab testing get overlooked.

Needle safety and ergonomics should be considered during blood collection from patients. Using a needle with an attached safety device and activating it as soon as possible are important steps in needle stick prevention. Make sure there is a sharps disposal container near the point of collection or wherever needles are used so that the potential hazard can be eliminated quickly. When collecting blood, be sure to raise the bed height (or the arm height if in a chair) so that excessive bending is avoided. Use a chair or a task stool to sit on while performing the collection to maintain a better posture throughout the procedure. Never attempt to lift patients by yourself, always ask for help. Thousands of back injuries occur every year in healthcare due to avoidable patient lifting errors.

For many laboratories, couriers are a vital part of the pre-analytic process. They bring specimens from clients and other labs, and their safety should be considered as well. Teaching dry ice safety is vital if it is used, and both couriers and lab staff need to be taught how to handle it appropriately. Dry ice sublimates (or changes to gas from a solid state), so it should never be placed into a sealed container, or the building pressure from expansion will cause the container to explode. Couriers should never place more than one pound of dry ice inside a vehicle, and the windows should be opened when transporting it to create good ventilation. The gas created from dry ice quickly reduces the oxygen content in the air, and the elevated Carbon Dioxide levels can quickly cause unconsciousness or even death. Never place dry ice leftovers in the sink for disposal. While it might be fun to run water on it to see movie special effects, the cold temperatures can burst sink pipes and even make the entire sink fall out of place.

If specimens for analysis arrive in the testing area, and they frequently aren’t ready for analysis- for instance the labels aren’t placed properly- go to the source of the error to make corrections. If inappropriate labeling is a constant problem, staff will create work-arounds to get the work done, and some of these work-arounds may not be safe. Poorly-labeled samples may prompt a lab tech to remove gloves in order to adjust the sticky labels, and that should never occur. The use of sharp blades may be another work-around, and staff injuries can occur. Be sure to explain to specimen collection staff the importance of proper labeling. Turnaround times are delayed, but staff safety is also a concern.

Lab Quality and Safety are often related, and rarely is it more so than during the pre-analytical phase of testing. Proper collection, labeling, and processing are all vital in order to provide high quality lab results, and that is the crux of what laboratorians wish to do. The same can be said for laboratory safety: that pre-analytical process can’t be done well without proper safety considerations. Safety events here will create staff injury, turnaround time delays, and potential errors with test results. Make sure staff understand the impact of good quality as well as safety in the pre-analytical phase.

 

Scungio 1

Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

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