[Histonet] slide labeling

Thu Jan 9 18:22:59 CST 2014

Yes,  I also contributed comments to the public review/survey and read through the comments of others as they were compiled,  and found them interesting. Agree Tim, that is why I like two identifiers of some kind even when it is not required. I don't see the logic of doing this at some steps, but not others. I like it all the way through, beginning to end.
There are problems with numbers, fatigue and people, agree. I still resist the name on the slide for space reasons mostly, and prefer one barcode or QR code and one "human readable". I add to that physical matching of the blocks with the slides. I also like to make cross checking steps formally part of the process for every slide, not just "suspicious" ones. Part being paranoid I suppose and partly because I have not been given any bar coding or other technology solution where I work now, and I got kind of used to having something. There is probably no perfection, but whatever you can think of  and do in your particular system and situation for ID verification,  has to be positive if it reduces errors and increase patient safety. It will be interesting to see the final version and how much impact it has on standardizing labeling practices....stay tuned I guess.  

Joelle Weaver MAOM, HTL (ASCP) QIHC

> From: Timothy.Morken <@t> ucsfmedctr.org
> To: joelleweaver <@t> hotmail.com; c.tague <@t> pathologyarts.com; histonet <@t> lists.utsouthwestern.edu
> Subject: RE: [Histonet] slide labeling
> Date: Thu, 9 Jan 2014 23:42:49 +0000
> 
> 'BTW - CAP & NSH are working on a standard labeling guidelines for AP. I"
> 
> I read this over (search "Uniform Labeling of slides and blocks" and the pdf from the NSH site will appear).
> 
> What is notable is the number of comments from labs that are still hand-writing all their blocks and slides. The primary comment is that there is no room to write all that CAP suggests. Even some with older slide labelers commented that they could not fit the information on the cassette face. Modern labelers eliminate that problem with much better resolution and formatting of the information. We print a 2D code, Accession number and patient name on all blocks. There is plenty of room due to variable font sizes for various elements. Of course, it takes money to get newer equipment so it will continue to be a problem for some labs. 
> 
> Another discussion throughout is what constitutes a "unique" identifier. Many comment that a name is not unique and can be truncated. (however, a combination of number and name will  be unique, though having several numbers with the same last name, but different patients,  can be confusing. Hopefully at least part of the first name can be included). Having a first name or initial as well will greatly add to the probability of a name and number being unique.
> 
> Some contended that a number alone was ok because I can be traced back to two identifiers. Unless the number is wrong....
> 
> Others thought that a barcode should be accepted as a second identifier. I don't' think it would work - the code usually has the identical information as the accession number so is only redundant and does not add to the uniqueness of the information. A second identifier must have different information that adds to the uniqueness. Also, you need a scanner to make use of it. Human-readable information is still going to be useful for troubleshooting. 
> 
> One interesting thought is that if blocks and slide labels are being printed directly from an LIS (no barcode), are two identifiers necessary to positively ID the item? Probably not. However, being human, a person could mis-read a number, and then a second identifier can confirm the ID or not.
> 
> But what if you are printing barcodes on blocks and slides and then scanning barcodes (or 2D codes) to bring up a case in the LIS? Then technically a second identifier is not necessary. There could still be exceptions - if the barcode cannot be read, then the user would need to type in the info, and then a mistake could be made, and therefore a second ID is useful to confirm it. 
> 
> Overall it seems a second identifier greatly  both increases the probability of uniqueness and increases the probability of catching typo mistakes when info is hand-written or hand-entered via keyboard. 
> 
> Personally I like the number/name combination because it is too easy to confuse things with two different numbers .
> 
> 
> 
> Tim Morken
> Supervisor, Electron Microscopy and Neuromuscular Special Studies
> UC San Francisco Medical Center
> San Francisco, CA
> 
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of joelle weaver
> Sent: Thursday, January 09, 2014 6:27 AM
> To: Curt; histonet <@t> lists.utsouthwestern.edu
> Subject: RE: [Histonet] slide labeling
> 
> CAP has requirement for 2 identifiers on slides for intra-operative, such as frozen sections only as far I know. That's for slides since the case may not yet have an accession #. The blocks, 2 identifiers.
>  
> For specimen integrity though, ( CAP required all over the place) you really want two different, unique identifiers on everything that you track through the whole process.  I like your idea with the labeling, but the intent is to have two identifiers and to cross check them. I know how harsh the response can be sometimes when a "human" error ( such as failing to catch the discrepancy ) is made with an entirely flawed, and "human dependant" system. There is a tendancy to cast blame.   
> I don't like using patient names on work product much personally, but with at least a partial manual system ( I have that too) it becomes necessary. I just flip the slide over and read what is under the label, match the name & number with the log, or LIS, and match the block with the section on the slide. Still not perfect.  For ease of follow up- I just define what constitutes an "error", and how many you are "permitted" ( yes I know, its really none), # before  there are consequences. 
> 
> BTW - CAP & NSH are working on a standard labeling guidelines for AP. It is in the "works" and defines a lot of these issues and more,  I found it helpful. Not sure when it will be published. A draft is probably on CAP and NSH sites. 
>  
>  Joelle Weaver MAOM, HTL (ASCP) QIHC
>  
> > From: c.tague <@t> Pathologyarts.com
> > To: histonet <@t> lists.utsouthwestern.edu
> > Date: Tue, 7 Jan 2014 18:33:26 +0000
> > Subject: [Histonet] slide labeling
> > 
> > So we have a facility we do some work for that requires both the hand written number and the slide label be viewable, so we place the slide label a little lower and write the number on the top of the frosted end. Does CAP recognize both numbers as a legal record? The reason I ask is because there was a case that the hand written number was wrong but the slide label was correct. That being said, there's still a QA issue with the slide not being accurately labeled. Slides are labeled at microtomy too, the hand written number and the slide label. I contend internally that the slide WAS accurately labeled because the sticker number and block number correspond accurately, the discrepancy was in the hand written number.
> > 
> > Thoughts? Does CAP have any guidance on this?
> > 
> > Thanks,
> > 
> > Curt
> > 
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