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Doesn’t happen often. But, when it does, expect a potential s*%#storm.

Patient is anxious about the mole on his back. A dermatologist removes the mole and sends the specimen to the lab. Rule in or rule out melanoma. The lab says it never received the specimen. The dermatologist then does full excision. Then the doctor and patient discuss the pros and cons of doing a metastatic melanoma workup. Not a fun day at the OK Corral.

A urologist performs a cystoscopy on a patient with hematuria. He identifies a fungating mass, removes what he sees, then takes tissue to learn whether the mass is more invasive than expected. It’s nursing shift change and the circulator drops the ball. The specimen never makes it to the lab.

Fortunately, for many cases, the ramifications of losing a specimen are not horrific. It’s embarrassing. And it causes the patient to lose faith. But, frequently, care can still be rendered. And often, the inconvenience of obtaining another specimen is not life-altering.

Problem related to surgical specimens are not limited to getting lost. They are sometimes mislabeled. The laundry list of mislabels include:

a.    No label

b.    No specimen

c.    Incorrect laterality

d.    Incorrect tissue site

e.    Incorrect patient

f.    No patient name

g.    No tissue site

h.    No clinical history

How do you sidestep this?

Include a verification step to check-out the specimen the same way blood products are checked-in before transfusion.

The nurse reads back the patient name, specimen name, and laterality (if relevant). Surgeon confirms and documents at the end of the case. The names of all parties who participated in the “chain of custody” should be known and recorded.

What about chain of custody for specimens sent to outside labs?

Document the specifics of the specimen and to whom it was handed off and when. So, if Fed Ex or UPS pick it up, keep a record of that. Once the delivery service has picked it up, liability should transfer to them if lost.

Remember the Tom Hanks movie Castaway? If so, you’ll remember a Fed Ex plane crashes.  Hanks’ character, who was overseeing the air transport, survives on an island. Eventually he makes it back to land. The movie closes with him delivering one of the packages that never made it to the intended recipient.

I’m trying to imagine a different ending. Hanks’ takes surviving lab specimens and delivers them to pathology lab. I doubt that would have been a happy ending.