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Citation
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HERO ID
507267
Reference Type
Journal Article
Title
Strict Adherence to a Blood Bank Specimen Labeling Policy by All Clinical Laboratories Significantly Reduces the Incidence of "Wrong Blood in Tube"
Author(s)
O'Neill, E; Richardson-Weber, L; McCormack, G; Uhl, L; Haspel, RL
Year
2009
Is Peer Reviewed?
Yes
Journal
American Journal of Clinical Pathology
ISSN:
0002-9173
EISSN:
1943-7722
Volume
132
Issue
2
Page Numbers
164-168
Language
English
DOI
10.1309/ajcpoja2jrvx0iwc
Abstract
Phlebotomy errors leading to incompatible transfusions are a leading cause of tranfusion-related morbidity and mortality. Our institutions specimen-labeling policy requires the collection date, 2 unique patient identifiers, and the ability to identify the phlebotomist. This policy, however, was initially strictly enforced only by the blood bank. In fiscal year 2005, following an educational campaign on proper specimen labeling, all clinical laboratories began strictly adhering to the specimen-labeling policy. Compared with the preceding 4 years, -in the 3 years following policy implementation, the incidence of wrong blood in tube (WBIT) and mislabeled specimens detected by the blood bank decreased by 73.5% (0.034% to 0.009%; P <= .0001) and by 84.6% (0.026% to 0.004%; P <= 0001), respectively. During a short period, a simple, low-cost educational initiative and policy change can lead to statistically significant decreases in WBIT and mislabeled specimens received by the blood bank.
Keywords
Mistransfusion; Specimen labeling; Wrong blood in tube; new-york-state; transfusion errors; improvement
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