Firstly, as the administrative department (admin) is the first to come in contact with the different specimens dispatched to us, we will reject any urine or stool specimens that have leakage. If a unsuitable specimen was sent for a test, we will either call the clinic and request for a new specimen and put the one that we have on hold or reject the specimen. This will be dependent on where the specimen is received from, whether it is from the hospital ward or external clinic. Sometimes, after the plain tube is spun, the technicians will reject the blood due to haemolysed specimen. If EDTA or Sodium Citrate tube is clotted, the technicians will also reject the specimen. All the rejected specimens requires a rejection form, which will either be passed to the admin staffs by the technicians or be written by the admin staffs. After a rejection form is written, the admin staff is to call the respective clinic to inform them of the rejection and note down the name of the person that we spoke to. This will than be commented in the system and the respective test affected will be deleted from the patients' record unless the patient is requesting for a package (a series of tests billed under the same code). For eg, "EDTA clotted (Bld Grp) - infrm __". The rejection form will be faxed over to the respective clinic and be photocopied. The original rejection form will be dispatch to the clinic on the following day while the photocopied copy will be filed in the file label 'Rejection of Specimen'. Then, we will find the request form for that patient and comment on the form as what we have commented in the system.
If an extra specimen is received or as mention previously, a wrong specimen is sent by the specimen is put on hold while waiting for the new specimen to arrive, we are to record the patient's particular, lab request number and type of specimen in the EXTRA BOOK. A comment both in the system and on the request form will look like this, "extra plain", and we are to state that the specimen is an extra by writing the word 'extra' on the specimen label that we printed.
If a further confirmation is required for a particular patient's test result, the technician will inform the admin staffs who will then call and inform the clinic. While informing the clinic, we are also supposed to inform them of the delayed test report the turnaround time for the send-out tests differ. The name of the person that we spoke to will be noted and a comment will be noted in the system like this, "HIV added - inf__" when the HIV antigen and antibody level is tested reactive in our laboratory.
Often, we received specimens that are wrongly labelled (with a different patient's name or a spelling error in the patient's name). We are required to call the clinic and request for a staff to come to our laboratory to label the specimen with the correct label and also give us a memo that tells us that the specimen belongs to the particular patient. The patient's particulars will then be recorded in a blue coloured file with the name of the person we spoke to from the clinic and clinic that the patient belongs to.
Any memo that is faxed over or passed to us will be photocopied. The memo must contain the signature of the person who wrote the memo and any amendment required must be stated clearly. The original copy will be filed in the monthly memo file while the copied one will be stapled to the request form. If a name or ID amendment is made, the technician must be informed to re-approve the result so that the clinic is able to view the result via the system.
Finally, regarding the pictures of the VDRL, I am still trying to get the permission from my lab manager to post them (We are very busy during work, so there is no chance for me to ask...). Hope my explanation is clear enough to let you guys have an idea of how the admin department work! XD
Hui Juan
0702012F
Hey Hui Juan,
ReplyDeleteGood to know you are doing so much PAPERwork.
Anyway, after rejection of sample, do you discard there rejected specimen away. or do you store it for a period of time first?
Cheers
Tiong Han
If a specimen leaks, the clinic will reject them and request for a new specimen to be taken.
ReplyDeleteWhat if a new specimen could not be obtained and the result is important? For example, the patient went oversea for a important work meeting and is unable to produce another specimen.
Will the clinic still go ahead with the tesing as it is only leaking?
Alvin
Hey Tiong Han,
ReplyDeletefor rejected specimens, we will store them for a period of time depending on the type of specimen it is. For urine, swab and stool specimens, we will store them for a week before discarding them while blood tubes are usually stored for up to 3 weeks.
Hi Alvin,
if the specimen leaks, the Laboratory will reject them and inform the clinic as well as request for a new specimen. The clinic will be the one to contact with the patient and decide if the patient is coming back for another specimen collection. The doctor is usually the one to decide if the test will still be proceeded with a new specimen or ignore the test request, but if in the case that the clinic is unable to contact the patient, we will still run the FEME test for stool and urine specimen.
Urine and stool are commonly rejected due to leakage of specimen from the containers. But if the clinic insist in proceeding with the test, FEME can still be done. For culture and sensitivity, we will usually not proceed with the test unless the clinic really insist after we have explained the possibility of getting false positive result from the test as the specimen has been contaminated from the containing plastic bag which is non-sterile.
For blood tubes, they are usually rejected due to contaminated, lysed or clotted specimen. Hence, even if the test is urgent and it is inconvenient for patient to visit the clinic for specimen taking, the new specimen will be sent to us after a few days.
Hope this answer your questions. XD
Hui Juan
hi hui juan,
ReplyDeletefrom the way you mentioned, it seems that there will be alot of rejected specimens everyday. i'm sure the patient who is giving his specimen will not be happy when he/she hears they have to take his blood again (eg.). Do you guys determine whose fault is it and make changes to lower the frequency of mistakes made?
cheers,
JIA HUI (joey)
tg01 0703605f group 2
Hi Joey,
ReplyDeletetill now, I've seen at least one rejected specimen everyday. The rejections are made usually due to clotted or lysed blood, or blood in wrong dilution for sodium citrate tube. These are usually due to the collection methods used by the nurses in the respective clinics. For stool and urine leakage, these are due to the improper capping of the containers by the patients. Although there are two trained phlebotomist in our laboratory, it is impossible for them to travel to the different clinics and draw blood from the patients as there are clinics located all over Singapore that is under the hospital.
When we call the clinics regarding the rejection, we always tell them what is the correct thing to do, such as a full tube of blood (~3mL) should be collected for sodium citrate tube so that there will not be a wrong dilution of blood. Although we always correct the clinics' mistakes, the same mistake always happen again. XC So changes to lower frequency of mistakes are up to the respective clinics to decide...
Hui Juan