Lampiran 1

HANDLING AND SUBMISSION OF SPECIMEN TO KK KOTA SAMARAHAN

LABORATORY, KOTA SAMARAHAN SARAWAK
1. Request Form
1.1. A standard laboratory request form PER-PAT 301 is used for all categories of
tests except stated otherwise.
1.2. All request forms must be filled legibly or labelled with a patient information.
The completed forms shall be stamped and signed by a doctor or authorized
personnel and accompanied by the properly collected specimens.
1.3. The following information must be provided for every request in the request
form:
1.3.1. Patient’s details:
a) Name (in capital letters), e.g., AHMAD B. ABU.
i. Newborn patient use B/O followed by mother's name
ii. Twin patients should state 1st twin or 2nd twin after the name, e.g.,
B/O MAIMUNAH BT HASAN-1ST TWIN
b) Identity card (IC) number: -
i. Use new IC number for Malaysian patients (12 digits)
ii. Children who are using mother's / guardian’s IC Number, to write 12
digits followed by the letter E
(e.g., 730422055116E)
iii. Twin patients should state E/1 (1st twin) and E/2 (2nd twin) at the
end of guardian’s IC Number
(e.g., 730422055116E/1)
iv. Passport number should be used for non-Malaysian patient
v. Police / army IC number can be used when necessary
vi. Refugees should be used UNHCR following series number.
c) Sex
d) Age / Date of birth - compulsory in newborn /children who use mother's
IC number (for age adjusted reference range)
1.4. Location: clinics/Health Clinic
1.5. Patient’s clinical summary
1.5.1. Relevant clinical summary
1.5.2. Relevant medications of patients
 1.5.3. Diagnosis / Provisional Diagnosis (Abbreviations are discouraged)
1.6.
Test details: Mark () at the appropriate box for the tests required. Tests which are not listed in box, sh

1.7. Specimen:
1.7.1. Date and time of specimen collection
1.7.2. Type of specimen and anatomic site (if relevant)
1.8. Requester detail:
1.8.1. Name clearly written
1.8.2. Signature with official stamp
1.9. Phlebotomist’s detail (if different person involved)
1.9.1. Name clearly written
1.9.2. Signature with official stamp

Note:

1. Use different request forms for requesting tests from different laboratories.
2. Blood taking and labelling a patient's blood specimen shall be carried out
by one person at the patient’s bedside.
3. All information is compulsory to fill.

2. Specimens / Type of Containers

2.1. Ensure the specimen container used is suitable and not expired.
2.2. The specimens should be collected, properly labelled and despatched
according to the transport requirement for the tests requested.
2.3. Specimen containers must be placed in appropriate packaging.

3. Guide For Specimens Collection

3.1. Perform blood taking according to local guidelines or standard operating
procedure.
3.2. Identify the patient and type of laboratory tests requested.
3.3. Before any specimen is collected, the patient identity must be verified by
asking them for 2 identifiers (e.g., full name and identification number) and
 checking the answer given against information stated on patient identification
wristband or case note.
3.4. Proper procedure, adequate volume and mixing with correct specimen
containers are of paramount importance in ensuring the quality of specimen
and accurate laboratory test results.
3.5. Transfer the blood immediately into the appropriate specimen container as
per procedure.
3.6. Specimens must be labelled with patient's name and IC number immediately
to avoid mislabelling.
3.7. Stated date and time specimen taken on the specimen container for certain
Biochemistry testing whenever time is crucial for interpretation of results.
3.8. Ensure the label name / IC number/ barcode (minimum 2 identification) tally
with the request form.
3.9. Each completely filled laboratory request form must be accompanied with
appropriate packaging specimen submitted for testing. Each packaging must
contains specimens belong to one patient.

Acceptable

filling level
4. Specimen Transportation
4.1. Documentation
All requests must be recorded in Borang Penghantaran Dan Penerimaan
Spesimen Klinik Kota Samarahan makmal or despatched record with
adequate information.
4.2. Transportation of Specimen
The specimens should be transported to the laboratory as specified
according to the type of test immediately or in an appropriate time frame and
according to transport requirements. The specimens are sent to the KK Kota
Samarahan laboratory twice a week (Monday and Wednesday).

5. Rejection Criteria
5.1. Specimen rejection rates are aimed to be <1.0% and specimen rejection
rates for inpatients should be less than 1% (MS 2702:2020).

▪ General rejection criteria.

i. Incomplete request form

ii. Wrong patient identification
iii. Information on request form and specimen do not tally
iv. Specimen/ form and container not suitable
v. Expired container
vi. Test not offered
vii. No specimen/ form received

▪ Specific rejection criteria (Vetted in specific laboratories).

i. Haemolysed
ii. Clotted
iii. Inappropriate specimen volume (inadequate or overfill)
iv. Leaking
v. Unsuitable/unsatisfactory specimen (lipemic, icteric, diluted)
vi. Specimen contaminated with foreign additive or other specimen
vii. Repeating test within inappropriate time
viii. Sharing form/specimen
 Note:
1. The laboratory staff at the main counter will fill the rejection form and a copy
will be dispatched to the requesting clinic / health clinics pigeon hole.
2. Unit with a LIS system will register the request in the system and produce a
rejection report.
3. Laboratory staff will inform the rejection to the clinic/ health clinics depend on
unit procedure.
Precious specimens e.g., paediatric specimen etc will be processed if
possible. It will be indicated in the report about the quality of the primary
specimen which was unsuitable for testing or could have compromised the
results.

6. Test Result/ reports

6.1. Critical Results Notification

▪ Tests with the critical value/results will be notified to the requestor or

authorized personnels from the clinic immediately after result validation.

However critical value/results from outpatient will be informed to
authorized personnel within office hours or on next working day (if
weekend or public holiday). Please refer to Quick Guide for Improving
Notification of Critical Laboratory Results in MOH Hospitals
(https://patientsafety.moh.gov.my/v2/)

▪ Note: Critical values/results are defined when the test results fall outside

the low or high limits or the presence of any unexpected abnormal

findings, cell or organism that may potentially cause life threatening and/or
requires immediate medical attention. These values may be identified from
the routine or urgent test request.
6.2. Result / Report Release

▪ Results /reports in Klinik Kesihatan Kota Samarahan will be viewed from

the LIS system.

7. Despatch Of Laboratory Results
Printed reports or results will be placed in the pigeonhole of the respective clinics
and health clinics located at the reception counter in the department. The
attendants / porter from the clinics and health clinics are required to collect them
as soon as possible.

8. Referred Test
8.1. Tests which are not provided in Klinik Kesihatan Kota Samarahan will be
referred or outsourced to other laboratories for analysis.
The specimens from Klinik Kesihatan Kota Samarahan are sent to the
referred laboratory twice a week (Tuesday and Thursday).
8.2. All requests for referred tests must be accompanied with relevant form. Call
the respective laboratory for further clarification.
8.3. Results from the referral laboratory will be email to the respective requesting
laboratory or collected by Klinik Kesihatan Kota Samarahan porter.
8.4. Tests which are not provided in MOH, will be sent to the private /university
laboratory. Before sending the sample the clinical staff have to ensure the
payment is done according to the local guidelines or standard operating
procedure.
Lampiran 2
Quick Guide Order of Blood Draw Tubes and Additives

Blood samples must be drawn by phlebotomists in a specific order to avoid cross-

contamination of the sample by additives found in different collection tubes.
Phlebotomy order of draw is the same for specimens collected by syringe, tube
holder, or into tubes preevacuated at the time of collection. The correct order of draw
follows:
1. Blood culture tube or bottle
2. Sodium citrate tube (eg, blue closure)
3. Serum tubes, including those with clot activator and gels (eg, red, red-
speckled, gold closures)
4. Heparin tube with or without gel (eg, dark green, light green, speckled
green closures)
5. EDTA tube with or without gel separator (eg, lavender, pearl, pink
closures)
6. Sodium fluoride/potassium oxalate glycolytic inhibitor (eg, gray closure)

The placement of tubes not listed here should take into consideration the potential
for their additive to alter results obtained from the next tube if carryover were to
occur. Plastic serum tubes containing a clot activator may cause interference in
coagulation testing. Only blood culture tubes, glass nonadditive serum tubes, or
plastic serum tubes without a clot activator may be collected before the coagulation
tube.

Numerous errors can occur during the collection and handling of blood specimens,
which pose significant and avoidable risks to the patient and the phlebotomist. When
global standards are not fully implemented, it is more likely that patients will be
injured during the procedure, biologically representative specimens will not be
obtained from patients, and test results will not be comparable from one facility to
another.