Thousands of Lab samples ‘mislabelled’

  • 21 August 2009

Tens of thousands of clinical samples are being wrongly labelled when they arrived at NHS pathology laboratories, an investigation has found.

The survey of every NHS trusts, to which 120 replied, found 365,608 specimens were mislabelled before they arrived at laboratories.

In addition, a further 11,712 specimens were incorrectly labelled by lab staff, according to data obtained under the Freedom of Information Act by More4News. In 46 cases incorrect labelling was reported to have contributed to delays in patients’ treatment and even deaths.

The Department of Health says that it takes the issues seriously and is “promoting the use of electronic requests for laboratory tests in primary care, and similar systems are also being deployed in hospitals, reducing the risk to patients by producing a 2D barcode unique to the patient".

Professor Jonathan Kay, a consultant at John Radcliffe Hospital, Oxford, and spokesman for Royal College of Pathologists, told More4News the errors related to handwritten request cards which then had to be copied.

"Most of those errors actually occurred because we are using handwritten request cards, they then come into the laboratory, we have to copy type them and that’s where these errors are coming into the system."

He said the most serious problems came with blood transfusions, “if the specimen that comes into the laboratory is wrong then the blood product that goes out is going to be wrong and some of them will be important things like the diagnosis of cancer."

The DH stressed that only a "tiny fraction" of samples were affected, with mislabelling only occurring with 0.05% of the 700 million pathology samples the NHS carries out each year.

"The NHS makes every effort to reduce mislabelling errors and only a very tiny fraction of the total number of pathology tests carried out in English NHS laboratories in a year contribute to a serious adverse impact on patients.”

"Many of these labelling errors happen outside the laboratory, with very few the result of error inside labs, where bar codes are almost universally used for patient/sample identification.

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