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Barcode Technology in the Specimen Collection Process

Matteline Fagan

Delaware Technical Community College

Nursing Informatics

Ms. Brown

February 11th, 2023

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Barcode Technology in the Specimen Collection Process

Many patients receive surgery for diagnostic purposes such as obtaining a cancer

diagnosis or discovering the extent of metastasis. During these surgeries many specimens such as

lymph nodes can be collected and sent to the laboratory for immediate testing. The specimen

collection process has to be effective and efficient for the operating nurse to ensure patient safety

and avoid delaying patient treatments. Nursing informatics has played a major role in this

collection process since charting is now performed on the electronic health record (EHR).

Nursing informatics introduced a barcode scanning system to better identify correct patients and

avoid charting errors.

Once a specific specimen order has been placed the specimen collection system starts

with a barcode scanner that has the ability to read the account number on the patient’s wristband

that was specifically designed for them during their current hospital stay (Saathoff et al., 2017).

This scanner is connected to the nurse’s workstation on wheels (WOW) or mobile EHR

computer. Along with the scanner should be a portable and wireless specimen label printer. This

means that after the patients identity has been verified specific specimen labels can be created for

collection. These labels include a barcode that is linked to the order entry number, patient’s

account number, patient’s name, date of birth, unit where the patient is located, name of

specimen collected, collection date/time, and nurse’s initials (Saathoff et al., 2017).

This process would not happen if the initial barcode scan did not properly identify the

correct patient. Also, this process should be performed as close to bedside as possible to prevent

errors. Once labels are created they should be immediately applied to the specimen and sent to

the laboratory. This process is designed to reduce the intraoperative nurse’s time and effort in

collecting specimens (Saathoff et al., 2017). The ability to print barcode specimen labels on
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demand during surgery means less time is spent on patient chart labels, paper order requisitions

and if necessary laboratory personnel labeling specimens (Saathoff et al., 2017). Improved

efficiency of the specimen collection process is important because faster access to laboratory

results reduces healthcare costs and improves quality of patient care (Saathoff et al., 2017).

It is crucial for the intraoperative nurses to apply information technology such as barcode

scanning to prevent human errors and enhance the quality of patient care (Yu et al., 2019). A

study proved that before the introduction of barcode specimen collection out of 17,092

specimens 28 samples were rejected whereas after the implementation only 3 were rejected out

of 14,343 (Yu et al., 2019). Those that were rejected can be due to mislabeling or improper

identification of specimens. These errors negatively affect patient care, delay treatment, increase

length of stays, and decrease patient satisfaction (Yu et al., 2019).

During the process of collecting a patient’s tissue, blood, or fluid it’s important to follow

ethical and legal processes. A potential ethical issue is when these specimens are used for other

testing purposes that were not consented with the patient. These specimens belong to the patient

and only the patient, so they have to autonomy to do what they please with these specimens. If

the patient is unaware of possible federal testing done to their specimen this is breaking the code

of ethics and confidentiality. Another possible ethical issue is if these specimens are not handled

properly from nurse to lab. The specimen’s collection labels contain personal information such

as name/date of birth and could possibly have a breach in personal information if the specimen is

collected by the wrong person.

There are three core ethical principles when discussing specimen collection which are

respect for persons, beneficence, and justice (Aggarwal et al., 2020). All competent patients have

the right to autonomy and the freedom of decision making concerning their specimens and
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research studies. Consent must be understood by the patient and if patients are not able to give

consent then the patients power of attorney should be contacted. If patients refuse testing that

should be appreciated and respected by all participants of the specimen collection process.

Beneficence refers to our duties as the nurse and laboratory personnel to act in the best interests

of the patient (Aggarwal et al., 2020). This includes all tests that are being performed on the

specimen are beneficial to the patient and their diagnosis. Lastly is justice which is an obligation

to provide all patients with what they deserve such as confidentiality (Aggarwal et al., 2020). To

maintain strict confidentiality within the specimen collection process the International Federation

of Biomedical Laboratory Science enforces strict privacy of patient information and test results

while also safeguarding the dignity and privacy of patients (Aggarwal et al., 2020).

The issue of confidentiality relates to my nursing practice because it’s part of my duty to

advocate for my patient’s if their personal information has been shared. If I feel as though their

information has been shared with those who are not part of their healthcare team I am

responsible for reporting this. The actions I can take to better ensure confidentiality is by being

the one to collect the specimen and deliver it to the correct laboratory personnel. Also, it is my

duty to protect my patient’s personal information on the computer by locking my computer when

the specimen has been successfully collected. Informed consent is also part of my nursing

practice and ensuring that all my patients are aware of what specimens are being collected and

what testing is being done is essential. All my patients are entitled to be treated equally and

receive the necessary testing for their specimens.

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Workflow Map Part 1

Surgery begins. Specimen is Specimen is drop off at designated

created. area.

Nurse creates
Nurse will place specimen
order for
in biohazard bag with
specimen in
patient ID stickers and
EHR.
copy of written specimen
form.

Nurse will
scan patient
Nurse will scan patients ID wristband
band barcode, label barcode and
printer barcode and print specimen
specimen labels. barcode to
document
collected.

Nurse will collect

specimen from scrub
Nurse will fill out paper tech confirming
documentation of date, name, date of birth
operating room number, and specimen name.
phone extension, name of
procedure, clinical history,
name of specimen, what
type of specimen is
collected, doctor name,
your name, date and time Nurse will write
of collection specimen name on
printed specimen
label.
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The current workflow for specimen collection at my place of employment includes both

computer and paper charting. During surgery especially oncology surgery there is a likelihood

there will be specimens collected to be sent to the laboratory. The current process of this starts

with creating an order for the proper specimen to be collected such as pathology for tissue and/or

cytology for fluids. Once a order is placed the nurse is able to use the scanner connected to the

computer to print specimen labels. We do this by scanning the patient specific barcode on their

armband then scanning the bedside label printer. Once labels are printed the nurse will then fill

out a paper documentation of the specimen. This paper includes date, operating room number,

phone extension, name of procedure, clinical history, name of specimen, what type of specimen

is collected, doctor name, your name, date and time of collection. Once specimen is passed off

the sterile field and collected in proper container the specimen is now considered collected. The

nurse will then have to repeat the steps of scanning the patients barcode and scanning the

specimen barcode to document its collection in the computer.

After all documentation is completed both computer and paper the specimen is then

placed in a biohazard bag with two patient sticker labels and the copy of the paper charting.

Certain specimens are then dropped off at a designated specimen drop off location where

laboratory personnel will then pick up and check all paperwork.

There are multiple issues with this process of specimen collection starting with double

charting of the specimens by both computer and paper. This creates room for error and extra

steps the nurse must take to collect these specimens. Laboratory personnel has contacted

operating room nurses on several occasions discussing issues with the paper charting due to

insufficient information or unable to read description of specimen due to copying of paper. These

extra steps are not efficient for the operating room nurse and operating room turnover times.
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Workflow Map Part 2

Surgery begins. Specimen is

created.

Specimen is dropped off at

designated area.
Nurse created
order for
specimen in
EHR.

Specimen collected in
appropriate container and
placed in biohazard bag.
Nurse completes
intraoperative specimen form
in EHR including name of the
specimen, what type of
specimen it is (tissue or fluid),
and when it was out of the
Nurse will scan
body and collected.
patient wristband
barcode and
specimen barcode to
document collected.

Nurse scans patient ID band Nurse will collect specimen from

barcode, label printer barcode scrub tech confirming name,
and prints specimen labels. date of birth and specimen
name.
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Computerized charting with the electronic health record has shown over the past years

how efficient and effective it can be. By charting all specimens on the computer, it decreases the

risk of errors by double charting and helps classify patient information to just those who are

allowed in their electronic health record.

This new process will start the same way it has been by creating an order in the computer

specific to the specimen to be collected. Following the creation of the order a nursing form

should be created and completed under the patient’s intraoperative record. This information

would already include the date, procedure being performed, physician name, nurse signature and

patient name/date of birth. Specific sections of this form will need to be completed by the nurse

such as the name of the specimen, what type of specimen it is (tissue or fluid), and when it was

out of the body and collected. By naming the specimen on the computer form decrease the

chance of spelling errors.

After the specimen is documented in the intraoperative specimen collection form steps

will be followed the same. The nurse will scan the patients barcode and print specimen labels

using the label printer. These specimen stickers will include the patients name and date of birth,

specimen barcode, and most importantly the name of the specimen. This eliminates the

continuous writing of specimen names from the computer, paper form and stickers. These

stickers will then be applied to specimen cup and confirmed by both nurse and surgical scrub

technicians. The specimen will be scanned as collected.

This new process is benefits financially by not continuously paying for more copies of

specimen collection forms. This also benefits financially by using all features of our electronic

health record that we pay for. If specimens are sent wrong and are incorrectly tested this means
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the provider will have to order the correct testing. This additional testing means the patients are

charged with additional costs. This benefits the hospital and patients financially.

When specimens are documented on the computer this takes away additional paper

charting which will make the operating nurse more effective and efficient. This will increase

nursing satisfaction and will ensure proper documentation of specimens. This will also include

laboratory personnel satisfaction because specimen data will be more accessible in a timely

manner rather than whenever they are able to pick it up from the specimen drop off. This way of

specimen collection will also help nursing staff specifically the travel nurses that have been in

high demand the past few years. If all hospitals were able to perform the same task it helps all

nurses understand the process without having to learn new ways.

The use of a workflow map will assist the hospital and its nurses in completing the

specimen collection process steps correctly. This helps the nurses work in a timelier manner

which means surgeries are able to flow faster. If surgeries flow faster this means more can be

performed in a day and makes the hospitals more money. Making this process completely

computerized also helps develop better nursing informatics. This decreases the chance of

spelling errors due to computerized spell check. This type of technology also helps decrease the

chance of documentation under the wrong patient since we use patient specific labels,

documents, and barcode scanning. This workflow map can be printed and placed in every

operating room for anyone to access.

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Barcode Technology Use in Specimen Collection Policy

I. PURPOSE: The purpose of this policy is to improve proper care, handling,

documentation and labeling of all specimens by using barcode technology.

II. POLICY: Specimen collection is used for diagnostic purposes and demonstration will be

provided to all surgical staff on proper collection using the barcode technology in EHR.

III. PROCEDURE:

A. Surgery begins. Specimen is created.

B. Nurse creates order for specific specimen (tissue or fluid) in EHR.

C. Nurse completes intraoperative specimen form in EHR including name of the

specimen, type of specimen, time out of body, time collected.

D. Nurse scans patient ID band barcode, label printer barcode and prints specimen

labels.

E. Nurse will collect specimen from scrub tech confirming name, date of birth,

specimen name.

F. Nurse will scan patient wristband barcode and specimen barcode to document

collected in EHR.

G. Specimen collected in appropriate container and placed in biohazard bag.

H. Specimen is dropped off at designated area.

IV. RESPONSIBILITIES:

A. Only surgical team involved in case should be collecting and documenting

specimen collection.

B. RN and necessary laboratory personnel transports specimens while protecting

patient personal information.

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References
Aggarwal, N., Kare, P. K., & Datta, S. K. (2020). Ethics in Laboratory Medicine: An Overview

of Considerations for Ethical Issues. Bioethics in Medicine and Society.

https://doi.org/10.5772/intechopen.96122

Saathoff, A. M., MacDonald, R. & Krenzischek, E. (2017). Effectiveness of Specimen

Collection Technology in the Reduction of Collection Turnaround Time and Mislabeled

Specimens in Emergency, Medical-Surgical, Critical Care, and Maternal Child Health

Departments. Computers, Informatics, Nursing. 36(3), 133-139.

https://doi.org/10.1097/CIN.0000000000000402

Yu, M., Lee, T., & Mills, M. E. (2019). The Effect of Barcode Technology Use on Pathology

Specimen Labeling Errors. AORN Journal. 109(2), 183-191.

https://doi.org/10.1002/aorn.12585