In an age of technological advancement, phlebotomy remains a manual procedure, requiring critical decisions and human skills that will never be automated. The competent phlebotomist recognizes and prevents pre-analytic variables that may introduce error, fulfilling a vital role in the laboratory’s quality-management system. Because diverse interactions and specialized knowledge are required, the phlebotomist profoundly impacts patient care, patient relations, and the accuracy and efficiency of the laboratory’s path of workflow. Facilities striving for excellence in these areas should begin by examining the value they place on the phlebotomist’s role in the workplace. After all, that is where quality collections begin.

Phlebotomy – Patient Identification

The most potentially fatal pre-analytical error is improper patient identifi cation. This is basic but bears mentioning. Failure to properly identify patients can lead them to be treated, diagnosed, medicated, and managed according to another patient’s health status.

According to the Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) an inpatient should be asked to state her full name, address, birth date, and/or unique identifi cation number. The information provided must be compared with the information on the identifi cation bracelet, which must be attached to the patient, and the test requisition or computer-generated labels brought to the bedside. All discrepancies must be reported to the appropriate caregiver according to facility policy and resolved before collection.

What if the patient is unable to speak her name due to language barriers or the patient’s state of consciousness? The standards require a caregiver or family member provide the information on the patient’s behalf before drawing the specimen. This requirement is justifi ed in part by studies that show up to 16% of identifi cation bracelets contain erroneous information.Documenting the name of the verifi er is good risk management.

Emergency-room patients should be tagged with some sort of identifi cation even if it is only a temporary number. The following items are not acceptable substitutes for an identifi cation bracelet:
charts on the wall;
water pitchers;
bed tags; and
identifi cation bracelets not attached to the patient.

There is no substitute for either having a hard identifi er attached to the patient, having the patient speak her name, or having a caregiver verify the patient’s identity.

For outpatients, CLSI recommends having the patient state her name address, birth date, and/or unique identifi cation number and comparing that information with the requisition or forms the patient brings to the draw station. Neither inpatients nor outpatients should be asked to affi rm their name as in “Are you Jane Doe?” Patients who may be hard of hearing might misunderstand and respond “yes” just to be polite. A wiser solution is to ask the patient to tell you her name.

(Source : http://www.mlo-online.com/articles/0906/0906lab_mgmt.pdf)

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