PRACTICE RATIONALE
2.10.1 Surgical specimens shall be saved unless designated for discard by provincial
legislation, and/or health care facility policy. Surgeons/Registered Nurses may not override this legislation and policy.
The accurate and efficient care of specimens is essential in assisting the surgeon, pathologist, and laboratories to establish an accurate diagnosis and for future treatment of the patient.
2.10.2 The circulating perioperative Registered Nurse shall be prepared to respond to a request for specimen analysis throughout the procedure.
2.10.3 The scrub perioperative Registered Nurse shall preserve all specimens in the state received and assure that sterility of the specimen is preserved, when required. 2.10.4 The perioperative Registered Nurse shall
verbally confirm with the surgeon the identity of the specimen and the testing required.
2.10.5 The perioperative Registered nurse shall accurately document information on the specimen label, including:
- two unique patient identifiers(i.e. patient name and hospital number), - specimen type;
- specimen site; and
- current date and time. (AORN, 2010)
2.10.6 The circulating perioperative Registered Nurse shall add appropriate
fixative/preservatives in consultation with the surgeon and/or pathologist. Specimens requiring formalin should be placed in containers as soon as possible.
Compliance with lab protocol is essential for proper care and handling of specimens. Staff should be aware that formaldehyde is a potent allergen, mutagen, and carcinogen. (Gruendemann & Mangum, 2001, p. 294)
2.10.7 Action should be taken to prevent drying-out of specimens. Specimens and cultures should be handed off the sterile field as soon as they are taken, and the surgeon has given consent.
This prevents inadvertent discard of specimen during or at the end of the procedure. (Gruendemann & Mangum, 2001, p. 293)
2.10.8 During special testing or research projects, the appropriate health care facility protocol should be followed (i.e., special consent). 2.10.9 Tissue and calculi should not be given to
patients.
Specimens may require analysis and present a contamination risk.
PRACTICE RATIONALE 2.10.10 When laboratory personnel are in the
theatre, the circulating perioperative Registered Nurse should:
- assure the dress code is followed; - prevent unnecessary materials from
entering the theatre;
- provide supplies and forms; and - prevent counted instruments or sponges
from leaving the theatre.
Removed items may interfere with the count.
2.10.11 The circulating perioperative Registered Nurse in preparing specimen(s) for the laboratory shall:
- verify specimen identity with the scrub nurse;
- provide a separate container for each specimen, if required;
- prevent contamination of the outside of the container;
- use a hospital grade disinfectant to remove contaminants from the outside of the container; (Gruendemann & Mangum, 2001, p. 294)
- sequentially number the specimens; - confirm that the label contains the
required information, including: -patient name;
-identification (ID) number; -identity of specimen; -side if appropriate; -date;
-any times as required; and -initials of person completing label.
- after putting specimen in container confirm that the patient's name and identification (ID) number on the specimen label(s) match those on the requisition and operative nursing record;
- protect the requisition form from contamination;
- wear gloves when handling specimens; and
- arrange transport of the specimen(s) to the appropriate location.
Care in handling of specimens will: - prevent specimen contamination; - avoid cross-contamination; - protection of individual (self); and - avoid mislabeling or loss of specimen(s).
Incorrectly, labeled specimens could result in an incorrect diagnosis, with possible critical
implications for two patients. The loss of a specimen could prevent a definitive diagnosis and subsequent initiation of therapy.
2.10.12 The circulating perioperative Registered Nurse shall document:
- required information on the appropriate requisition; and
Recording specimen(s) sent to the lab assists in control and may prevent loss. This process may assist in error analysis when a specimen is lost. (Slavin, Best, & Aron, 2002, p. 55)
PRACTICE RATIONALE - type and number of specimens sent to
the lab on the operative record according to the health care facility's policy.
2.10.13 A log should be kept to track the specimen from the theatre/surgical suite to the laboratory or pathology department. The log may include:
- patient identification;
- source of culture or type of tissue; - date & time of specimen log in; - name & signature of person sending
specimen;
- name of person in lab to receive specimen; and
- time of transfer of specimen to laboratory.
Proper documentation allows tracking of a specimen from its source to its disposition. (Gruendemann & Mangum, 2001, p. 297)
2.10.14 Reference material with samples of incomplete and completed requisitions should be available in the theatre. 2.10.15 Incident reports shall be completed for all
errors related to specimen management. 2.10.16 There shall be a written policy and
procedure regarding:
- the handling of legal specimens (bullets, knives, other foreign bodies);
- presence of police officers in the theatre; and
- cooperation with police officers in the course of an investigation.
(See ORNAC Standards for Gathering Medicolegal evidence). The perioperative Registered Nurse is accountable for forwarding the specimens(s) to the pathology department and may be called upon to attest to that continuity of care (or chain of custody) in a court of law.
REFERENCES
Association of PeriOperative Registered Nurses. (2010). Recommended practices for the care and handling of specimens in the perioperative environment. Perioperative Standards and Recommended Practices. Denver: Author.
Phillips, N.M. (2007). Berry & Kohn’s operating room technique. (11th ed.). St. Louis: Mosby.
Slavin, L., Best, M., & Aron, D. (2002). Gone but not forgotten: The search for the lost surgical specimens: Applications of quality improvement techniques in reducing medical error. Journal of Nursing Care Quality, 16 (3), 50-59.
BIBLIOGRAPHY
Gruendemann, B., & Mangum, S. (2001). Infection prevention in surgical settings. Toronto: W.B. Saunders. Rothrock, J. (2007). Alexander's care of the patient in surgery. (13th ed.). Toronto: Mosby.
Watson, D. & Crum, B. (2005). Improving specimen practices to reduce errors. AORN Journal, 82(6), 1051-1054.