Surgical Pathology

1. If order is entered by the prescriber, indicate phase of care.

1. Required patient identifiers:
   1. Patient's name
   2. Unique identifier i.e. medical record number
   3. Date of birth
2. Source/type of Specimen
3. Comments/description (e.g., additional information such as location of suture tags)
4. Request for special handling or special studies
5. Authorized prescriber identification and contact information

1. Frozen section
2. Onsite evaluation related to Specimen adequacy
3. Rapid gross evaluation

1. frozen, fresh, or permanent exam
   1. Frozen section diagnoses require verbal communication from the pathologist to the surgeon/proceduralist and the need for additional Specimens to be procured
2. research

Collect and handle Specimens in a manner that preserves the integrity (i.e., does not crush, twist, or compact) of the Specimen during transfer from the sterile field.

1. Specimens kept on the sterile field before transfer should be sequestered, identified, and monitored.
2. A designated person (e.g., scrub person, technologist, nurse) obtains the Specimen from the sterile field as close to the time of removal as possible after confirmation with surgeon/proceduralist that Specimen can be passed off.

1. Specimens requiring flowcytometry
2. Specimens where lymphoma is suspected or lymphoma work-up is requested
3. Specimens that are too big to place in a closed container (e.g., above or below the knee amputation, pannus)
4. Shared Specimens with microbiology
5. Specimens that require chromosome analysis/cytogenetics studies
6. Specimens that need intraoperative gross evaluation
7. Specimens that require frozen section
8. Specimens for tissue harvesting under a research or clinical trial protocol
9. Specimens that require additional specialized testing (e.g., urinary tract stones, disaccharide, crystal analysis)
10. Specimens for neuromuscular (muscle or nerve) biopsies

1. Obtain appropriately sized Specimen containers prior to the procedure that should be large enough to fully secure the Specimen and preservative fluids.
   1. Place the Specimen in an appropriate-sized container.
   2. A Specimen too large for any container should be double bagged (using a biohazard bag) and clearly labeled as Specimen.
2. All Specimen containers must:
   1. Be leak proof and puncture resistant;
   2. Be the correct size and type (large enough to fully secure the Specimen and preservative fluids);
   3. Accommodate labeling requirements.

1. Confirm the use of preservation or chemical additive for tissue preservation with the physician and, if necessary, consult Pathology Department.
   1. When 10% neutral buffered formalin (NBF) is used, fully immerse the Specimen.
   2. Use prefilled NBF containers whenever possible.
2. All tissue should be placed in fixative as soon as possible after removal from the body, unless special studies are ordered that might be affected by the available fixative.
   1. NBF time placed in fixative shall be documented in the EMR, when applicable.
   2. If fixative cannot be added in a timely manner, the Specimen should be placed in a sterile basin and kept moist with sterile saline or wrapped in saline-dampened sponges until the Specimen can be properly placed in fixative.
   3. All unfixed Specimens should be transported to the pathology laboratory as soon as possible, or refrigerated until placed into appropriate fixative.

1. Confirm patient identification and Specimen name on the label at the time the Specimen is removed from the patient and/or surgical field and placed in a container.
   1. Submitted slides may be labeled with a single patient-specific identifier but two are preferred.
2. Prior to affixing the label, verify Specimen is in container.
3. Securely affix Specimen identification label to the container. Do not overlap label resulting in patient data/ barcode being covered.
   1. Participating organizations may have additional procedures for labeling
4.  Label one Specimen at a time
   1. Print the Specimen label (i.e., pathology order label) from the electronic medical record (EMR) once the Specimen has been obtained. Only use a chart label in the event of downtime.
   2. Use dark, indelible ink on the Specimen container label and requisition form.
   3. Specimen containers that contain biohazardous materials (e.g., blood, tissue) must be labeled with a biohazard label or placed in a biohazard bag.
   4. Specimen containers with a chemical preservative (e.g., NBF) must be labeled to communicate chemical hazard.
   5. Specimen containers with radioactive material must be labeled with the appropriate radioactive hazard label.
5. Specimen labeling must be congruent with the operative note.
6. If scanning is utilized, patient Specimen is scanned at each checkpoint(e.g., out of OR, into holding bin, into pathology).

1. Patient name, medical record number, date of birth, collection date and time.
2. Specimen source (i.e., type of tissue) including site and laterality, if applicable.
3. Description of Specimen including relevant orientation such as location of suture tags or specific requests.

1. This may done by Specimen barcode scanning (where available) or paper log book.
2. For barcode scanning
   1. If the person who scans is also transporting the Specimen, their name is automatically recorded in the EMR.
   2. If the person scanning is not the Specimen transporter, the name of the transporter shall be documented in the EMR when scanning the Specimen.
3. For log book
   1. The person transporting the Specimen is documented in the log book with the date/time delivered.

1. Specimens that will not be transported immediately to the pathology laboratory must be temporarily stored in a manner that maintains Specimen integrity for examination.
2. Unfixed Specimens that cannot be immediately transferred must be refrigerated until transferred to the laboratory.

1. Transport to Pathology per participating organization procedure.
2. Prior to a Specimen leaving the operating room/procedure room, verbally verify patient identification with the surgical Specimen label and requisition and Specimen destination.
3. Upon arrival of Specimen to laboratory, verbally verify Specimen is frozen or rapid gross section for examination with laboratory personnel.

1. Transport to laboratory
2. Store and transport Specimen(s) to maintain integrity for examination

1. Critical and time-sensitive Specimen(s) collected but not received by Pathology shall be immediately investigated by the clinical staff.

1. Pathology reviews the expected Specimen report on a daily basis.
2. Pathology follows-up with the OR/procedure area regarding expected Specimen(s) not received