Patient and specimen identification in a tertiary care pediatric hospital: Barcodes do not scan themselves

Despite the safety improvements linked to the use of barcodes for patient and specimen identification, patient misidentification remains a leading cause of transfusion-associated reactions including fatalities. A wealth of evidence supports the use of barcodes in general, but there is less published evidence of real-world barcode compliance. This project investigates barcode scanning compliance for patient and specimen identification at a tertiary care pediatric/maternity hospital.

Transfusion laboratory specimen collection noncompliance events between January 1, 2019, and December 31, 2019 were retrieved from the hospital laboratory information system. Data were analyzed including stratification of collections by collector role and collection event. A survey of blood collectors was conducted.

Collection compliance for 6285 blood typing specimens was evaluated. Full barcode scanning identification of both patient and specimen was utilized in only 33.6% of total collections. The remaining two thirds of collections were overridden by the blood collector: no barcode scanning occurred in 31.3%, while the specimen accession label was scanned but not the patient armband in 32.3% of total collections. There were significant differences between phlebotomists and nurses, with more phlebotomists performing the full scanning and specimen scanning only, while more nurses obtained specimens without patient or specimen scanning (p < .001). Blood collectors identified hardware challenges and training gaps as key contributors to barcode noncompliance.

Our study highlights an instance of poor barcode scanning compliance for patient and specimen identification. We formulated improvement strategies and launched a quality improvement project to address factors influencing noncompliance.