Abstract：Objective: To conduct quality control on the specimen collection process in the hospital's laboratory department，explore the causes of erroneous adverse events，take corresponding rectification measures and carry out quality evaluation. Method: Investigate and summarize the quality of specimens collected by the laboratory Department of our hospital throughout 2024 for monitoring，and conduct in-depth analysis of adverse events caused by specimen collection errors in the first half of the year. Analyze the causes of adverse events resulting from incorrect specimen collection and explore corresponding rectification measures. After the departmental cause analysis and summary scoring，it was found that the causes of adverse events due to incorrect specimen collection include four elements:（1）Nurses: ① Failure to implement the verification system；② The handover with the receiving and sending nurses was not implemented properly. ③ Not double-checked by two people；④ Lack of knowledge about the classification of blood collection tubes；⑤ Lack of responsibility；⑥ Be unaware of the container for the indwelling specimen.（2）Caregiver: Not knowing the type of specimen.（3）Environmental aspect: The handover of specimens received and sent was not properly implemented.（4）Management: ① No relevant operation procedures；② Supervision over the failure to implement the verification system；③ The management of consumables has not been implemented. In response to this，our hospital has made rectifications from multiple aspects such as personnel，environment，and management systems. Result: In the first half of 2024，a total of 13 cases of specimen collection errors occurred in our hospital，including 4 cases of incorrectbarcode pasting，4 cases of incorrect patient identity，3 cases of incorrect specimen collection，2 cases of information of two patients with the same specimen，and 1 case of no barcode pasting. After being included in the quality control system intervention in the second half of the year，the result was that no adverse events of specimen collection errors occurred in the test specimens collected by each department. Conclusion: There are many causes of adverse events resulting from incorrect specimen collection，involving improper personnel handling，poor environment，and improper management. Hospitals should make rectifications from multiple aspects such as personnel，environment，and management systems in order to reduce the incidence of adverse events caused by incorrect specimen collection.
耿亚菲 Yafei Geng (Thu,) studied this question.