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Rejected Specimen Policy

Collection Procedure:

Policy Tech: Version 4

PURPOSE:
The purpose of this policy is to describe the process of how and when a
specimen will be rejected.

SCOPE/RESPONSIBILITY:
It is the requirement of Akron Children’s Hospital Enterprise as specified when
sending specimens to the laboratories operated by Akron Children’s Hospital to
follow the guidelines as dictated in this policy.

Applies to: Akron Children’s Hospital Enterprise

POLICY:
Universal criteria for specimen rejection are listed below.
There may be
specific criteria on an individual test which can be found in the Laboratory Test
Directory. Please note: Particular attention must be given to the specific
rejection reasons for Blood Bank (BB) specimens.
A mislabeled specimen (see Guidelines for definition) is the rejection reason
creating the greatest risk of potential misdiagnosis. For this reason mislabeled
specimens will routinely NOT be processed. Only two exceptions to this rejection
policy will be considered and then only when the appropriate procedure is
followed.

a. Specimens in which the clinical state cannot be recreated and the results
are critical to the diagnosis/treatment of the patient – e.g. specimens that
were collected for culture prior to antibiotic treatment.
b. Specimens which are difficult or traumatic to obtain e.g. CSF, bone
marrow, surgical specimen, stimulation tests, other irretrievable
specimens such as catheter tips.
Specimens resulting from the following two circumstances will not be
considered for processing regardless of the situation:
Mislabeled Blood Bank Specimens (including those with missing
information) will not be considered for processing regardless of the
situation. Mislabeled STAT Outpatient Specimens received after
hours.

Suboptimal specimens are defined in the Guidelines section will be:
a. processed at the discretion of the Department of Pathology with physician
input considered when provided.
b. retained in the laboratory until the physician or patient care unit ordering
the test is notified.
c. cancelled by the Laboratory unless they were already reported, in which
case the results will be made unavailable and the test no-charged.
d. re-ordered according to the Laboratory Specimen Recollect Policy.

GUIDELINES:
Reasons for rejection are broken into two general categories as follows:
Mislabeled Specimens


1. Definition
a. Any specimen with an incorrect patient label, which is described as
a label in which either or both of the two patient identifiers is
incorrect or a specimen with no label affixed to it.
b. Specimens for Blood Bank testing with any type of
mismatched, incorrect or missing information must be
redrawn.

Suboptimal Specimens

1. Definition
a. Specimen improperly collected and/or preserved (Clotted,
hemolyzed, contaminated, etc.)
b. Specimen sample volume not sufficient for requirement of test
protocol.
c. Specimen container contaminated by specimen (i.e., infectious
hazard).
d. Patient not properly prepared for test sample requirements.
e. Specimen submitted without a properly completed request form.
(This will include mismatches in which the specimen has the correct
label, but incorrect paperwork

f. Specimen labeling problems.

1. Specimens received without two patient identifiers.
Specimens received with only the patient name will be
accepted as one of the identifiers only if the individual
drawing the specimen is available to provide the second
patient identifier (excluding Blood Bank specimens).
2. Specimens received without collection time when required
and/or collector’s employee number.

Procedure for Handling Mislabeled or Suboptimal Specimens:
1. In all cases, the physician/nursing until will be notified when a specimen is
rejected. In any case where the test cannot be reported, it will be
cancelled. The test will need to be reordered and recollected at the
decision of the physician or patient care unit according to the Laboratory
Specimen Recollect Policy. When a mislabeled specimen is one defined
as “difficult/traumatic to obtain”, the physician must be notified and request
the specimen be processed for one of the reasons listed in the next step.
2. Mislabeled specimens will only be processed if they meet one of the two
criteria described in the policy section according to the following
procedures. In both cases the laboratory will, if needed, be responsible
for making any corrections to the report of the specimen to include a note
stating that the “specimen was originally rejected due to the specimen to include a note
stating that the "specimen was origianlly rejected due to mislabeling”.

a. Inpatient/Outpatient (On Campus) Setting
1. The manager/designee (clinical coordinator) of the individual
mislabeling the specimen must be contacted.
2. He/she must validate the circumstances and assure that the
specimen indeed belongs to the designated patient.
3. He/she must complete the appropriate mislabeled specimen
form including signature.
4. After receiving the completed form, the laboratory will return
the specimen to the area and person who collected the
specimen. The manager/designee must relabel the
specimen or supervise the relabeling of the specimen.
5. The laboratory will then process and report the requested
tests.
6. The pathologist will later review and sign the request form.
b. Outpatient Setting (Off Campus) – Mislabeled, off hours, STAT
specimens will not be considered for processing. (Routines will be
addressed the next business day.)
1. During off-hours, the physician/manager responsible for the
patient must be contacted in the case of a STAT so the
specimen can be recollected.
2. From 8 a.m. to 5 p.m., requests for a processing exception
of a specimen should follow steps 3 through 5.
3. This physician/manager must validate the circumstances
and assure that the specimen indeed belongs to the
designated patient. A Mislabeled specimen processing
exception form must be completed and the manager/
physician must sign this form. The form should be faxed to
the lab. (Fax: Inpatient – 330-543-3156 or 33156,
Outpatient 330-543-3732 or 33732.)
4. The laboratory staff will refer the request to the pathologist
who makes the final decision whether to proceed with
processing the specimen. If approved, he will sign the form
and return to the laboratory staff. If not approved, the
pathologist will contact the requesting physician/manager
and let them know of his decision.
5. Both signatures must be in place since it is the laboratory
staff who will be relabeling the specimen in accord with the
form signed by the physician and the pathologist.
3. Suboptimal specimens (e.g. wrong anticoagulant/tube, Blood Bank
specimen received on ice, contaminated with IV fluid, coagulation
specimens whose tubes are over or underfilled, dry swab, etc.)
a. Specimens improperly collected and/or preserved will be evaluated
by the technical staff and/or medical director as to the clinical
usefulness of analysis. It is preferable to obtain a totally new
appropriate specimen. If analysis of the unsatisfactory specimen is
to continue, a comment indicating potential interpretation problems
should be included in the report.
b. QNS specimens will be cancelled by the laboratory. If there are
multiple tests ordered but only enough specimen for a portion of the
tests, the patient care unit or physician will be contacted when
possible for instructions as to which tests to perform.
c. Specimens in which the outside of the container is minimally
contaminated will be transferred to a clean container and
processed. A recollected specimen may be requested when major
contamination has occurred. These specimens will be cancelled by
the laboratory.
d. Specimens submitted in which the patient was not properly
prepared will result in notification of the physician. A decision will
be made as to whether to continue with the analysis. Tests in
which the analysis will not be conducted will be cancelled according
to the Laboratory Test Cancellation Policy.
e. Specimens submitted without completed request forms will result in
the physician and/or patient care unit being contacted for the
required information. Once properly completed and received by the
laboratory, the specimen will be analyzed.