Re: Histology slide labeling errors

From:=?iso-8859-1?q?Steve=20Machin=20UK?=

Well. I this will open a huge can of worms and a very interesting
debate. 

There are a few points I would like to make. 

1. Errors are in the domain of quality control / assurance. I don't
think many would disagree with that statement.

2. Errors in slide labelling are just one member of a large set of
errors, all of which should receive the same level of scrutiny and be
controlled by similar systems. 

3. There should be a quality management system in place which
describes all the activities of the department and the step taken to
assure quality.

4. Since it is the pathologists who is issuing the report, they too
have a role to play in checking that the details on the paper label
match those on the slide.
 
There is a fanastic site which has downlaodable documents describing
quality management. http://www.cpa-uk.co.uk/

These can be found in the section "download documents" but others
parts of this site are well worth reading.


--- "Norman, Barbara"  wrote: > Would
greatly appreciate your comments and any suggestion that you
> may have
> on the issue concerning labeling errors.
> Our department does realize that the acceptable level of labeling
> errors is
> zero. We are all aware of the serious problems that can arise if
> labeling
> errors are not addressed. We are very conscientious about providing
> the
> patient with the best service while preserving the patients
> identity. 
> Our procedure dictates that slides are labeled at the time of
> sectioning and
> before they are signed out they are rechecked and checked again
> when the
> permanent paper label is applied.
> There have been times when the pathologist did receive slides that
> were
> mislabeled. It was brought back into the department and checked and
> re-labeled. This error is unacceptable by a few of our
> pathologists, and my
> concern is that they are also responsible to read each label, thus
> maintaining another QC review.
> Last month the department produced close to 6000 slides and 4
> slides were
> mislabeled, ( a positive control was labeled negative and the
> negative was
> labeled positive (for IHC).
> Please help fellow Histologist, How are you handling these errors
> at your
> institution?
> 
> Many thanks,
> B.L. Norman
> Naples, FL
> 
>  

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