Geisinger Medical Laboratories Cytopathology Specimen Collection Instructions

SPECIMEN REJECTION

PRINCIPLE:

The Cytology laboratory strives at all times to give the best possible service to our patients.
Occasionally specimens are submitted to the laboratory which are not acceptable as submitted for processing. In all such instances, lab personnel will document the problem and/or take appropriate action to resolve the problem or result in rejections and a recommendation for recollection. Following is an outline of specimen deficiencies that will cause such action.

PROCEDURE:

I. Improperly identified specimens:

1. All the following items are required on the Cytology requisition. Missing information may be requested from the submitting physician or clinic by Cytology personnel or Client Services:
• patient name
• medical record number
• date of birth/age
• ordering physician (must be provided or specimen will be rejected)
• specimen source (be specific)
• date of collection
• test requested (if other than routine Cytology)
• pertinent clinical information (for pap smears, this may include LMP, Risk vs Clinically Indicated and previous abnormal history)
  
  
2. The following is REQUIRED for identification of the specimen itself:

• Specimen containers must be labeled with 2 patient identifiers (ie. name and MRN).
• Glass slides must be labeled with 2 patient identifiers (ie. name and date of birth) written in pencil on the frosted end. In either case the patient name on the specimen must match that on the Cytology request.
• A patient name missing on the specimen container or slide, or that does not match the request will require corrective action by personnel involved and will most likely result in a rejection.

II. Inappropriately collected or preserved specimens:

• Cytology specimens require fixation, refrigeration, or on occasion special transport
  media. Please refer to the collection procedure for instructions for specific
  specimen types.
  

III. Inappropriately submitted SurePath Thinlayer Paps

• If the CytoRich vial is received without the Cervex-Brush tip, the specimen will be
  rejected according to FDA approval of methodology if deemed necessary by Cytology
  personnel

IV. Non-Gynecologic Cytology Specimens

• Many Non-Gynecologic or FNA specimens are irretrievable. Therefore, the acceptance and Rejection of these specimens will be made on a case by case basis by the Technical Specialist, Doctoral Director or qualified designee.

V. Procedure for Rejection of Cytology Specimens

1. Cytology personnel deem the specimen rejected following the above criteria


2. The specimen and original requisition remain together in the Cytoprep Lab


3. Log the rejected specimen on the Problem Log


4. A copy of the requisition is made with reason for rejection noted


5. Forward copy of requisition to Technical Specialist or designated staff to call clinic and notify of rejection


6. Specimen logged in Rejection Log and copy of requisition placed in folder by Technical Specialist or designated staff

VI. Acceptance of Unlabeled or Mislabeled Specimens

1. If a physician requests processing of a rejected or Unlabeled/Mislabeled specimen a Confirmation of Specimen Identity will be returned to the clinic with the specimen
   If the site is on campus, the collector must come to the lab to sign the Confirmation.
   
NOTE: This will be done with the director’s approval approval.


2. Confirmation of Specimen Identity must be signed upon return of the specimen for processing, if not, it will be returned to the clinic again for signature


3. Processing will not occur until the Confirmation has been obtained


4. Once Confirmation is obtained, process specimen.
   
   
5. At accessioning enter a comment in the Clinical History stating “Confirmation of Identity obtained for patient identification.”


6. Make a copy of the Confirmation of Identity and MONTHLY forward these to the QA Coordinator.

Reviewed/revised:  1/20/2011