2.50
Hdl Handle:
http://hdl.handle.net/10755/324162
Category:
Abstract
Type:
Presentation
Title:
Mistaken Identity: Mislabeled Specimens in the Emergency Department
Author(s):
Howard-Carpenter, Stacie; Mallette, Stephanie; Sewell, Jane
Author Details:
Stacie Howard-Carpenter, MHA, MSN, RN, CEN, email: showard-carpenter@aultman.com; Stephanie Mallette, MSN, RN, CEN; Jane Sewell, BSN, RN, CEN
Abstract:
Evidence-based Practice Abstract - EbP Poster Award Winner Purpose: To improve patient safety by decreasing the number of mislabeled specimens in the Emergency Department. In 2012, the emergency department had 39 variances related to mislabeled lab specimens. Design: In the Fall of 2012 a multidisciplinary process improvement team was assembled to analyze the current process for labeling specimens in the emergency department. The goal of the team was to provide recommendations which would decrease the number of mislabeled specimens in the emergency department. Setting: The setting for this quality improvement project is an urban 59 bed level II trauma center with 86,000 patient visits in 2012. Participants/Subjects: All employees that work in the emergency department and obtain lab specimens were participants in the quality improvement project. The emergency department employs registered nurses, licensed practical nurses, paramedics and emergency room techs who all obtain and label lab specimens for patients. Methods: A rapid improvement project team was assembled to address the incidence of mislabeled specimens in the ED. The team included employees from lab, emergency department, blood bank, and information technology. The process for obtaining and delivering specimens was analyzed by the team. Problems identified during the critical analysis included: the two patient identifier procedure is not consistently followed by staff, the disciplinary process for errors was not consistently followed, and all blood bank specimens are hand labeled. Several interventions were identified by the team which could impact the number of mislabeled specimens in the emergency department. The interventions included education on mislabeled specimens added to yearly skills sessions, one on one education with employees for all variances related to mislabeled specimens, and consistent follow-thru with the disciplinary process. In addition, it was recommended that all hand written labels be checked with a second staff member. The interventions were implemented in the Fall of 2012. Results: In 2012 the emergency department had 39 mislabeled specimens, 35 occurred prior to the interventions being put in place in the emergency department. In the first two quarters of 2013 the emergency department had 4 mislabeled specimens, an 86% decrease from 2012. The literature states laboratory data significantly contributes to clinical decision making thus this improvement may impact not only patient safety but patient outcomes. Implications: The interventions put in place to improve mislabeled specimens in the emergency department can be utilized in any emergency department in the country. Patient safety is a top priority and any measures that can be put in place to improve it should be considered.
Keywords:
Mislabeled Specimens in ED; ED Specimen Errors
Repository Posting Date:
4-Aug-2014
Date of Publication:
4-Aug-2014
Conference Date:
2014
Conference Name:
2014 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Phoenix, Arizona USA
Description:
2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleMistaken Identity: Mislabeled Specimens in the Emergency Departmenten_GB
dc.contributor.authorHoward-Carpenter, Stacieen_GB
dc.contributor.authorMallette, Stephanieen_GB
dc.contributor.authorSewell, Janeen_GB
dc.author.detailsStacie Howard-Carpenter, MHA, MSN, RN, CEN, email: showard-carpenter@aultman.com; Stephanie Mallette, MSN, RN, CEN; Jane Sewell, BSN, RN, CENen_GB
dc.identifier.urihttp://hdl.handle.net/10755/324162-
dc.description.abstractEvidence-based Practice Abstract - EbP Poster Award Winner Purpose: To improve patient safety by decreasing the number of mislabeled specimens in the Emergency Department. In 2012, the emergency department had 39 variances related to mislabeled lab specimens. Design: In the Fall of 2012 a multidisciplinary process improvement team was assembled to analyze the current process for labeling specimens in the emergency department. The goal of the team was to provide recommendations which would decrease the number of mislabeled specimens in the emergency department. Setting: The setting for this quality improvement project is an urban 59 bed level II trauma center with 86,000 patient visits in 2012. Participants/Subjects: All employees that work in the emergency department and obtain lab specimens were participants in the quality improvement project. The emergency department employs registered nurses, licensed practical nurses, paramedics and emergency room techs who all obtain and label lab specimens for patients. Methods: A rapid improvement project team was assembled to address the incidence of mislabeled specimens in the ED. The team included employees from lab, emergency department, blood bank, and information technology. The process for obtaining and delivering specimens was analyzed by the team. Problems identified during the critical analysis included: the two patient identifier procedure is not consistently followed by staff, the disciplinary process for errors was not consistently followed, and all blood bank specimens are hand labeled. Several interventions were identified by the team which could impact the number of mislabeled specimens in the emergency department. The interventions included education on mislabeled specimens added to yearly skills sessions, one on one education with employees for all variances related to mislabeled specimens, and consistent follow-thru with the disciplinary process. In addition, it was recommended that all hand written labels be checked with a second staff member. The interventions were implemented in the Fall of 2012. Results: In 2012 the emergency department had 39 mislabeled specimens, 35 occurred prior to the interventions being put in place in the emergency department. In the first two quarters of 2013 the emergency department had 4 mislabeled specimens, an 86% decrease from 2012. The literature states laboratory data significantly contributes to clinical decision making thus this improvement may impact not only patient safety but patient outcomes. Implications: The interventions put in place to improve mislabeled specimens in the emergency department can be utilized in any emergency department in the country. Patient safety is a top priority and any measures that can be put in place to improve it should be considered.en_GB
dc.subjectMislabeled Specimens in EDen_GB
dc.subjectED Specimen Errorsen_GB
dc.date.available2014-08-04T13:28:36Z-
dc.date.issued2014-08-04-
dc.date.accessioned2014-08-04T13:28:36Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationPhoenix, Arizona USAen_GB
dc.description2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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