I finished the counting basics series in September but I missed one. This past week, I was at the hospital for a call case when I, as a routine part of the evening shift charge nurse duties, checked the cart where specimens stay until they are picked up by the lab.
I know that this was on the list that I left behind for the next evening shift charge nurse. Oh, wait, they have lost four of the five that have been hired to replace me in the last two years. To other hospitals mostly. Because being the evening shift charge nurse is hard!
The list I left behind got lost somewhere. I have to reprint it. But on the list was to check the specimen cart to make sure that all the specimens had been transported to the lab for processing.
There were 9 cases worth of specimens in the cart when I checked it before taking the case specimen that I had to the lab. NINE!
My sister the pathologist was crying and didn’t know why. There were specimens that didn’t even have formalin on them for over 12 hours. Thankfully there were no cultures. Makes my blood boil; you bet I wrote an email to the manager explaining how checking the cart is an expectation of the evening shift charge nurse.
But, Kate, if they didn’t know… Bah! The specimen cart is not magic, drop off the specimen and never think of it again. Specimens have to be treated carefully. Which is why it is the 14th counting basic.
Care and handling of the specimen was also the subject of my master’s thesis and project, the standardization of specimen hand-off.
Imagine if you are that patient whose specimen goes missing but there isn’t any more tissue left in your body to test. Imagine if you are that patient whose specimen is not handled correctly, with formalin, or put in the specimen refrigerator promptly if there is no formalin and the specimen is unusable for testing. Heck, imagine the nurse who failed to collect the specimen correctly and caused all this furor.
Think of how badly you would or should feel.
This is why the correct specimen hand-off is the counting basic # 14. The surgeon has to name what the specimen is, the nurse prints the label, puts the label on the container, shows the label to the scrub tech and they both agree that this is the specimen that is going into the labeled container for this patient that is currently on the OR table.
In fact, the corporation changed its policy to reflect what I had done in my master’s project. Don’t think I didn’t notice!
Specimen hand-off is of utmost importance to the patient. Second is the handling of the specimen after the case. Whether or not it needs formalin, or is a frozen section, or needs to go fresh.
Know the rules of your particular OR for how the specimen gets to the lab, and who takes it, and the hours that the lab collects the specimen. Because they don’t have the manpower to be collecting at all hours of the day and night.
Dispatches from the Evening Shift 