Specimen Rejection Criteria
The purpose of this policy is to define general guidelines for specimen rejection. Refer to individual written procedures for specific guidelines for specimen acceptability for individual analytes.
The following render specimens unacceptable for testing:
1. Unlabeled specimens
2. Specimens containing missing, incomplete, incorrect, or illegible label information (minimum information on a label should include the patient’s name, identifying number(s), date and time of collection, and initials of person collecting the specimen)
3. Samples containing less than the minimum required specimen amounts necessary for the testing requested
4. Specimens collected above intravenous infusion sites and thus contaminated with infusion fluids
5. Broken tubes
6. Specimens collected in incorrect anticoagulants or preservatives
7. Unprocessed blood specimens arriving to the laboratory beyond 90 minutes post collection (Refer to individual written procedures. Specimens for some tests require faster arrival.)
8. Specimens that are improperly stored, handled, or contaminated
9. Specimens in containers that are grossly contaminated on the outside with blood, urine, stool or other body fluids.
10. Unpreserved specimens for culture if arriving in the laboratory greater than two hours after collection
11. Urine specimens for urinalysis held unrefrigerated for more than two hours or that are older than eight-hours post collection (refrigerated or not)
Specimens that are lipemic, icteric or hemolyzed are not considered unacceptable per se by the laboratory. The degree of interference in given assays due to these conditions varies and specific information is available in the individual written procedures. The fact that a specimen is visibly lipemic, icteric, or hemolyzed should be noted on the report, however. If possible and applicable, recollection of the specimen may be indicated.
In the event unacceptable specimens are received, it is the responsibility of the laboratory to immediately notify the nursing staff and/or physician to explain why the specimen is being rejected and to determine whether recollection is desirable or feasible. If recollection will occur, it must be scheduled in Meditech according to the guidelines provided in the “Recollection of Specimens” protocol in the Specimen Center Procedure Manual. A Senior Phlebotomist should be notified to facilitate the recollection process. Nursing staff and/or the ordering physician should be notified of any problems with recollecting the specimen.
The nurse or physician should be notified of rejected specimens. The reason for specimen rejection must be documented on the patient’s report. When scheduling a recollection in Meditech, a comment giving the reason for recollection should be included.
NOTE: Irreplaceable specimens that are received unlabeled or containing missing or incomplete label information will be shown leniency in regards to this policy. An irreplaceable specimen is defined as any specimen that would be impossible or extremely difficult to re-obtain.
If the specimen is from an inpatient, call the floor and ask the collector, or staff member familiar with the collection, to come to the lab to label the specimen. If the specimen is from a reference account, call the account to notify them of the issue. If the accompanying requisition is completed with proper identifying information, register the patient and order the testing. Try to obtain verbal confirmation from the account that the specimen is indeed from the patient listed on the requisition.
In both scenarios, an internal comment should be entered stating the specimen was received unlabeled, or with missing or incomplete label information, and therefore accuracy of results cannot be guaranteed. Include the name of the person notified.