Pre-Analytic Specimen Error Reduction Through Standardized Nursing Practice for Specimen Management in an Interventional Radiology Setting

Purpose: This project aimed to standardize nursing specimen management in peri-procedural processes within an interventional radiology setting and to determine the effects of implementing a guideline utilizing best practice recommendations from the Association of perioperative Registered Nurses (AORN), World Health Organization (WHO), Agency for Healthcare Research and Quality (AHRQ), and The Joint Commission (TJC).

Materials and Methods: A departmental protocol was designed based on best practices from the AORN, WHO, AHRQ, and TJC to standardize nursing specimen management. The pre-procedure assessment tasked RNs with determining relevant specimen requests and discussing anticipated specimens with the intra-procedure RN during handoff. During the procedure, a specimen verification was implemented to occur either at the time of collection or prior to access removal. This verification ensures the right specimens are transferred into the correct fixatives and that all requested specimens were obtained. Post-procedurally, a final inspection of the specimen was instituted to assess for common pre-analytic error types. Capture of these practices was assessed through unit documentation. Using the Model for Healthcare Improvement, the Plan-Do-Study-Act (PDSA) method was employed to execute the bespoke specimen management process.  A pre-post study design was used to evaluate the impact of the new protocol on reported pre-analytic specimen errors. Pre-test data was obtained via a 1-year retrospective study of the department’s error reports. Post-test data collection occurred over a period of 10 weeks.

Results: A total of 2828 applicable cases were included in the study (pre-test 2200 and post-test 628). The new practice guideline significantly reduced the incidence of reported pre-analytic specimen errors (P = 0.04). Prior to implementation, 15 events were reported. Error types included form/request mismatch, missing requisitions, lost specimens, mislabeled or unlabeled specimens, and unfulfilled requests. No such errors were reported during the testing phase. Nursing practice compliance data revealed no uptake in the prescribed pre-procedure handoff (0%), but increased compliance with the intra-procedure specimen verification (81.2%) and the post-procedure confirmation with the recovery RN (100%) prior to specimen transport.

Conclusion: Specimen management is a complex and error-prone activity. The use of a standardized nursing protocol for this critical activity may assist in reducing or preventing the occurrence of pre-analytic specimen errors.