Quality is a broad term that encompasses various aspects of nursing care (Montolvo, 2007). The National Database of Nursing Quality Indicators [NDNQI] is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level (Montolvo, 2007). Nursing’s foundational principles and guidelines identify that as a profession, nursing has a responsibility to measure, evaluate, and improve practice (Montolvo, 2007). The purpose of this paper is to analyze the ‘mislabeled specimen’ indicator for an inpatient rehab unit and devise an action plan based on best practices to decrease the incidence of mislabeled specimens. Analysis of the data
According to Dock, (2005) accurate specimen identification is a challenge in all hospitals and medical facilities. Ensuring that specimens are correctly identified at the point of collection is essential for accurate diagnostic information (Dock, 2005). A mislabeled specimen can lead to devastating consequences for a patient (Dock, 2005). Specimen misidentification can be serious, resulting in misdiagnosis and mistreatment (Dock, 2005). For the second quarter of FY09, the rehab unit met their target of zero mislabeled specimens. The third quarter yielded two actual mislabeled specimens with a variance of two. The fourth quarter actual was one with a variance of one. The first quarter FY10 showed an actual of one and variance of one. For the FY09 the rehab had a total of four mislabeled specimens. This indicator was chosen because of the magnitude of this medical error. Nurses, administrators and laboratory personnel must collaborate and create ways to decrease the mislabeling of specimens.
Nursing interventions to decrease the number of mislabeled specimens and improve actual indicator scores are: 1) Ensuring proper identification of patient 2) The use of electronic technology and 3) Bedside labeling. Each of these interventions will positively impact patient outcomes and reduce errors. According to The Joint Commission [TJC], proper patient identification is best practice for decreasing mislabeled specimens (The Joint Commission as cited by Sims, 2010). National Patient Safety Goal [NPSG], 01.01.01 states that healthcare providers should use at least two identifiers to identify patients. For example, the patient’s full name and date of birth is used to properly identify a patient (The Joint Commission, 2014). According to Kim et al., (2013), developing a standardized specimen handling system has the potential to reduce errors. Figure 1. Steps to properly identifying a patient for specimen collection.
Figure 1. Essential specimen handling steps. Blue items are physician-specific responsibilities; pink items are nursing staff-specific responsibilities. Adapted from “Standardized Patient Identification and Specimen Labeling: A Retrospective Analysis on Improving Patient Safety,” by Kim JK; Dotson B; Thomas S; Nelson KC; Journal of the American Academy of Dermatology, 2013 Jan; 68 (1): 53-6. The strongest intervention to reduce labeling errors is the addition of barcode technology (Brown, Smith & Sherfy, 2011). The use of automated patient identification and specimen collection techniques can be an additional safety net for routines that are vulnerable to error, especially when coupled with strong systems designs (Brown et al., 2011).
Brown et al (2011), found that the clinical applications of electronic and information technology support can assist in the identification, control, and reduction of error rates throughout the process. According to the World Health Organization [WHO] healthcare providers should encourage the labeling containers used for blood and other specimens in the presence of the patient (World Health Organization, 2007). This would suggest labeling specimens at the patient’s bedside or before leaving the room. Nurses should never label specimens before collection as this could lead to serious errors. Summary
In summary, NDNQI indicators serve as a schoolmaster that holds nursing accountable to practice. An analysis of ‘mislabeled specimens’, found that an inpatient unit had a total of four incidents for FY09. While this does not seem like a great deal of errors, any one error could have detrimental consequences. The plan of action based on best practices is to properly identify the patient, using electronic technology, and labeling specimens at the bedside.
Brown, J.E., Smith, N., Sherfy, B.R., (2011). Decreasing mislabeled laboratory specimens using barcode technology and bedside printers. Journal of Nursing Care Quality, (26)1, 13-21. Retrieved from http://sfxhosted.exlibrisgroup.com/waldenu?genre=article&issn=10573631&title=Journal%20of%20Nursing%20Care%20Quality&volume=26&issue=1&date=201101 Dock, B. (2005). Improving the accuracy of specimen labeling. Clinical Laboratory Science, 18(4), 210-2. Retrieved from http://search.proquest.com/docview/204803914?accountid=14872 Kim J.K., Dotson B; Thomas S; Nelson KC; Journal of the American Academy of Dermatology, 2013 Jan; 68 (1): 53-6. Retrieved from ent%20identification%20and%20specimen%20labeling%3A%20A%20retrospective%20analysis%20on%20improving%20patient%20safety.&spage=53&sid=EBSCO:rzh&pid=
Montalvo, I. (2007). The National Database of Nursing Quality Indicators (NDNQI). Online Journal Of Issues In Nursing, 12(3). Retrieved from http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/detail/detail?vid=50&sid=909dc60d-9c0d-474c-a02e-2e8f9df097e1%40sessionmgr4003&hid=4104&bdata Sims, M. (2010). The Joint Commission clarifies key compliance issues. MLO: Medical Laboratory Observer, 42(4), 72. Retrieved from http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=54&sid=909dc60d-9c0d-474c-a02e-2e8f9df097e1%40sessionmgr4003&hid=4104 The Joint Commission, (2014). National patient safety goals. Retrieved from http://www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf World Health Organization. (2007). Patient safety solutions. Retrieved from http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution2.pdf