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Acceptance and Rejection of Samples and Requisitions
- To ensure that samples and requisitions are accurately identified with the required information.
- To define the acceptance criteria and rejection criteria for samples and requisitions for optimum patient safety.
Requisition
A document, paper, or electronic, that contains information that accurately identifies the patient and the tests that the physician has requested.
Sample
a representative part is taken to typify the whole. A sample is taken to show or to determine the character of the whole.
Examples of samples that are received in the Laboratory for analysis are blood, urine, feces, and body fluids.
Acceptable Labeling Criteria for Samples
- Each sample container shall identify the patient uniquely and the information is legible and indelible. - - All primary collection containers and their aliquots shall have a unique label which one can audit back to full particulars of patient identification, collection date, specimen type, etc.
- The following elements shall be included in the primary container:
1. Patient’s last and first name
2. Medical record number or date of birth
3. Collector’s initials and ID number, if applicable
4. Date and time of collection
5. Source and site, when applicable
Additional Acceptable Criteria for Samples
1. Samples shall be contained in an appropriate container tube for the test requested.
2. The volume must be sufficient for the test requested.
3. The sample shall be transported and/or handled correctly for the test requested.
4. Samples should not be leaking, spilled onto the outside of the container.
5. Other conditions, such as clotting, hemolysis, contamination may render the sample unacceptable.
6. Samples shall be accompanied by a requisition with identical patient information.
Rejection of Requisitions Course of Action
A new requisition will be submitted if the acceptance criteria are not met.
|
Step |
Action |
|
1 |
The staff member who
rejects the requisition will request a resubmission from the generating site |
|
2 |
If a sample was submitted
with the requisition, the sample will be handled in such a manner as to
preserve the sample for the testing requested |
|
3 |
Once the new requisition
is received it will be evaluated to determine if it meets acceptable
criteria. |
|
4 |
If the requisition meets the acceptable criteria the sample will be processed for testing. If it does not step 1-3 will be repeated. |
Rejection of Samples Course of Action
• Laboratory personnel can handle minor corrections such as date and time of collection, and the source and site, if applicable.
• Samples that are not unique or difficult to obtain will be recollected when the acceptance criteria are not met. Refer to the section “Recollection of Samples”
• Samples that are unique or difficult to obtain that do not meet the acceptance criteria will require that the physician, or designee, to be notified.
1. A Clinical Laboratory Scientist (CLS) will contact the physician, or designee and inform them of the reason for the unacceptability of the sample.
2. The physician, or designee, may request test analysis and can approve the re-labeling of the sample by the person who collected it if the sample was mislabeled or unlabeled.
NOTE: If there is a time delay in contacting the physician or designee, preserve the sample integrity for the tests ordered, including if necessary, performing the analysis. If the analysis is performed the results cannot be released until the physician, or designee has approved the sample.
Samples that are unique or difficult to obtain that do not meet the acceptance criteria, continued
|
If… |
Then… |
|
the physician or designee
requests test analysis or relabeling of the sample |
document on the report the
reason the results are questionable and the name of the physician, or
designee, who authorized testing or re-labeling |
|
The physician or designee
does not request a test analysis or re-labeling of
the sample |
refer to the section
“Recollection of Samples” |
Recollection of Samples
Samples that are not unique or difficult to obtain will be recollected when the acceptance criteria are not met. Samples that are unique or difficult to obtain that do not meet the acceptance criteria and the physician, or designee, have not approved for analysis will be recollected.
INPATIENT SAMPLES THAT THE LABORATORY DID COLLECT
|
Step |
Action |
||||||
|
1 |
Notify the nursing unit
the reason the test will not be performed and inquire if they want it
re-drawn. |
||||||
|
2 |
Credit the test(s) that
cannot be performed entering the comment as to why the sample was
unacceptable, the name of the person notified, and if the sample will be
redrawn or not. |
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3 |
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Specimen Rejection Criteria
- Pre-analytical specimen integrity is extremely important to the final result reported by the laboratory. All specimen requirements as noted in the individual sections of this manual should be strictly followed.
- The most current specimen collection containers are identified on the patient Cerner lab label.
Criteria for specimen rejection.
To ensure patient and employee safety, specimens falling into any of the categories listed below will not be accepted by the Laboratory for examination:
• Unlabeled specimens
• Improperly labeled specimens (no date and time of collection, no initials of collector).
• Improperly collected specimen (as defined below).
• Specimens showing gross evidence of contamination.
• Situations that make the identity of the sample or the validity of the results obtained unreliable.
• Specimens that have leaked or have specimens on the outside of the container (except for irreplaceable specimens such as CSF, surgical specimens, etc.).
Additionally, specific criteria are in place for selected sections of the Laboratory:
• All specimens must have the date and time of collection.
• There must be an adequate specimen for the tests ordered.
• All specimens for culture, coagulation, and urinalysis must arrive in the laboratory within one hour of collection to assure specimen integrity.
• Specimens that require delivery on ice, but which arrive at room temperature.
• Non-sterile specimens which should be sterile collections.
• Hemolyzed specimens will be rejected (testing interference, inaccurate results).
Blood Bank - Criteria for rejection
• All Blood Bank specimens must have the correct name and medical record numbers, including full last name and first name and the medical record number.
• All Blood Bank specimens must have the signature of the person collecting the specimen (vs-the initials, which are satisfactory for all other sections) and have date and time of collection.
• Specimens collected at sites other than NWH are not accepted for compatibility testing. Only blood typing and antibody screening were accepted.
Hematology / Coagulation - Criteria for rejection
• Under filled CBC tubes will be rejected (incorrect ratio of blood to anticoagulant).
• Clotted specimens for Hematology will be rejected.
• Lavender top tubes received for CBC >greater than 48 hours after collection (CBC specimens received > 24 hours may not be acceptable for Differential WBC counts).
• Under filled coagulation tubes will be rejected (incorrect ratio of plasma to anticoagulant)
• Overfilled tubes will also be rejected for the same reason.
• Blue Top tubes for PT > 24 hours after collection.
• Blue Top tubes for PTT > 12 hours after collection.
• Coagulation or Hematology specimens that are clotted.
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