Meeting Requirements for Lab Specimen Collection, Handling
By: O.J. Bradshaw, MLS (ASCP), Laboratory Specialist
OJ Bradshaw, MLS (ASCP), brings 36 years of experience to his role as a laboratory specialist in ACHC’s Clinical Laboratory Accreditation Program. Prior to joining ACHC in 2024, he served as a lead medical technologist at his local medical center and later focused on blood bank and microbiology.
Posted: January 2, 2025
Ensuring a specimen is adequate and appropriate for laboratory testing is a team effort that involves the patient, the individual collecting the specimen, and the laboratory technician.
ACHC Standard 05.05.03 details the written requirements for five critical aspects of the process:
1. Patient preparation. The laboratory must provide instructions directly to patients or clients regarding proper preparation for optimal specimen collection. For example: Maintaining appropriate temperature and transportation time for semen specimens, fasting instructions for lipid profile testing, 24-hour urine collection and fasting for specific tests, and 2-hour post-prandial glucose collection. For patients with special communication needs (hearing impaired, not fluent in English, etc.), resources must be available to ensure instructions for collection, preservation, and transportation to the laboratory are understood.
2. Specimen collection. Procedures must be available to the staff responsible for collecting the specimen, specifying confirmation of the patient’s identity prior to collection and continuing with the appropriate collection technique (including the order and site of draw), the proper materials to use (e.g., acceptable anticoagulants, sterile containers for culture specimens), and the use of Dacron swabs versus cotton swabs.
3. Specimen labeling. Staff must label the specimen in the presence of the patient. The patient’s identity is confirmed by checking at least two identifiers, such as name and unique wristband number, if applicable, or birth date. When possible, the patient should be asked for verbal identification.
If the laboratory receives two specimens simultaneously with the same first and last name or birth date, the laboratory must have a system to process these specimens using distinct identifying indicators to distinguish between the specimens. This is also true for personnel collecting and labeling specimens. This may include a system that involves labeling the specimen container and request slip (or the patient’s medical record or chart) with a unique patient identification number, but does not preclude the use of other mechanisms to assist in patient identification and tracking of specimens throughout the collection, accessioning, testing, and reporting processes. Barcode formats may be used.
In situations where patient identification is unknown, such as trauma, a single identifier, such as a code, may be used, provided that the code is traceable to the trauma patient. If the laboratory provides transfusion services, additional identification and labeling procedures may be required. For specimens from a specific site (e.g., surgical specimens, cultures, cytology specimens), the specimen container must clearly be labeled with the site of origin, including descriptors such as left, right, etc. All multiple containers for the same ordering requisition must be clearly labeled with identification and site, and numbered (e.g., “1 of 5,” “2 of 5”).
4. Specimen preservation and conditions for specimen transportation. Instructions must be provided for specimen preservation and transportation, when applicable. For example:
- Sputum for cytology.
- Specimens for parathyroid hormone.
- Specimens for blood gas analysis.
Specimens for culture should be transported to the laboratory as soon as possible after collection or placed in preservatives or special transport containers. Refer to individual test requirements for special handling instructions if transport must be delayed.
5. Specimen storage before testing. Review the manufacturer’s instructions for performance of each test method to ensure that specimens are properly stored (e.g., maintained at room temperature, separated and frozen, kept refrigerated after separation, requiring preservatives).
Compliance questions
1. Has the laboratory provided its staff and/or individuals external to the laboratory who collect specimens with written procedures to ensure that patient preparation requirements have been followed?
2. How does the laboratory ensure that all staff, including phlebotomists, give appropriate instructions for patient preparation when needed?
3. If there are remote drawing/collection sites, are specimens handled appropriately for preservation and transportation to the laboratory?
4. When should a specimen be rejected?
As always, reach out to ACHC’s laboratory team with your questions.
—
Read more articles about Clinical Laboratory Accreditation here.