A blood banker wrote that it is her institution's policy to hand-write a patient's identifying information directly on the sample tube label for all specimens that may lead to compatibility testing. The pre-transfusion sample tubes have a pre-applied label that is applied to the tube by the tube manufacturer, and these labels are firmly affixed. An exception to this policy has been made for Surgery; they can use computer-generated imprinted labels which they place over the pre-existing tube labels. While these computer-generated labels do stick well enough not to fall off, their adhesive is not permanent enough to prevent the labels from being peeled off. Some of the technologists at the inquiring blood banker's institution are concerned about computer-generated imprinted labels being placed erroneously on the wrong specimen, only to have the label peeled off and replaced with a new label, after an error in specimen or patient identification is discovered. The laboratory does not return specimens to the clinicians/nurses when an error in labeling is discovered, and it is documented that the specimen was rejected and the reason for the rejection. The rejected specimens are stored for a few days in case there is a question about the rejection or if follow up is needed; eventually the specimen is discarded. The inquiring blood banker reports that she has not been witness to someone peeling off a label and placing new identification on the tube, but she is aware that this has happened in the past, so she wants to know if there are rules or regulations that prohibit the removal of a specimen label and the application of a new label. She also wants to know how other institutions prevent inadvertent testing of mislabeled or inappropriately relabeled samples?

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Ira A. Shulman, MD
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