21.Westgard J, Klee GG. Pre-analytical fallacies damage an institutions reputation, decreased assurance in healthcare customer, and contribute until a significant increase in the total I started out my carrier change studying to be a RN. doi:10.1111/jth.12012. For example, there are 18 different titles of Vitamin D related tests, so clarity in test names is essential as is a complete interpretative handbook to serve as a guide in test ordering.. Those individuals ordering the tests must pay close attention to detail to avoid clerical errors such as placing an order on the incorrect patient or for the incorrect test. The study further sought to describe error rates and laboratory performance, provide recommendations, and identify the role of health professionals' continuous education to minimize laboratory errors, thereby contributing to laboratory performance improvement. Wayne, PA: Clinical Laboratory Standards Institute. Specimen transport to reference laboratory. A practice of keeping a record of the errors at all stages of analysis and then devising corrective strategies for their prevention can gradually free a laboratory from such errors. Our phlebotomists (99 % work for departments other than Pathology) are advised monthly of the rate of preanalytical errors (along with what those specific errors were, e.g., mislabeling or IV contamination) via a newsletter written and distributed by the supervisor of our laboratory's Specimen Processing section. Preanalytical errors remain a challenge to hematology laboratories. Carraro Preventing pre-analytical errors to reduce costs and ensure positive Once the specimen is collected and labeled, it must be properly transported, accessioned and stored. A total of 51,244 samples were received for processing from our OPD. The pre-analytical phase is a major source of laboratory errors that have a significant impact on the outcome of other phases. Physicians rely on exact The .gov means its official. doi:10.1093/ajcp/aqw164. Alshaghdali, Khalid PhD; Alcantara, Tessie Y. MSc; Rezgui, Raja PhD; Cruz, Charlie P. PhD; Alshammary, Munif H. BSc; Almotairi, Yasser A. BSc; Alcantara, Jerold C. PhD. Another useful quality assessment tool for the preanalytical phase is the sigma metrics or the Six Sigma method. 29.Gaskin D, Yahaya O. Clots in EDTA lavender top blood samples. . Also, barcode entry of patient demographics has been a huge improvement, allowing results to be captured electronically by the laboratory computer system, and then re-broadcast and stored within the electronic patient record system. We will first discuss the findings of the routine samples obtained from the inpatients in our hospital. The collection is carried out during fixed hours. Although there was no formal process of looking into this data or increased focus at the hospital, potential reasons for the declining rate include regular training among the hospital and clinical staff, increased experience of staff, and proper communication with the clinical laboratory department. Preanalytic variables of thrombin generation: towards a standard procedure and validation of the method. We label all specimens at the bedside with pre-printed labels, including accession numbers, test name, and container type, with the appropriate number of labels for all testing and routing of specimens. She continues to visit Kenya where she trains CLS students at the University of KMU, Meru and is a consultant to hospitals in Meru for better laboratory testing. Primary reasons for test cancellation: a single hospital experience. The data generated here magnify the areas where hospital staff and laboratory personnel could benefit from focused learning and educational updates related to specimen quality in hematology. Based on objective measures, QIs can be utilized to assess critical health care dimensions; thus, QIs are useful evaluation tools that enable the determination of laboratory performance levels.2 Quality in the laboratory has a significant impact on diagnosis and patient management, as about 80% of all diagnosis is made based on laboratory tests.3 Patients' treatments are directly affected by the information reported by clinical laboratories; thus, reducing errors and adopting a quality control system are a priority in laboratories.4 Quality assurance of laboratory testing in the preanalytical and postanalytical phases has continuously gained attention among health professionals.5,6 Recognized and standardized QIs are employed to monitor laboratory errors to manage the risk in diagnostic testing.7 Quality indicators are useful performance monitoring tools for the preanalytical phase of the testing process.2. Clin Chem Lab Med. A higher sigma value indicates fewer inaccurate results reported by the laboratory.21 The quality performance of average processes has a sigma value of approximately 4 irrespective of their complexity.22. Berlin, Germany: De Gruyter; 2015. doi:10.1515/9783110334043. Notably, clotted samples and samples not received were the most frequent errors determined. Bookshelf Of all the samples received in the lab, the overall percentage of rejection is 1.52%. 18.Dikmen ZG, Pinar A, Akbiyik F. Specimen rejection in laboratory medicine: necessary for patient safety? Does the process affect the outcome? Further, the researchers obtained permission to utilize the QIs, QSs, and performance criteria.17. Pre-analytical. J Thromb Haemost. 2015;25(3):377385. RR Lack of homogeneity of a blood sample can lead to incorrect results. 33.Kitchen S, Olson JD, Preston FE. Our blood specimens are tubed to the laboratory and processed immediately. However, the laboratory cannot function in isolation. Our going live date is scheduled for this fall., Rick Brant: The printing of barcode labels has eliminated errors due to poor hand writing. is a medical writer and editor with 14 years of experience covering the health-care field. 2012;10(12):25442554. WebPre-analytical errors were categorized into four main categories: rejected sample, error related to test ordering, misidentification, and others. ", "For the first step, the syringe is placed into the analyzer. 2016;146:S39S46. 2022 Jul-Sep 01;31(3):176-183. doi: 10.1097/QMH.0000000000000343. doi:10.7860/JCDR/2017/30159.10378. ", "We then refer to a decision tree before reporting the results; b) sources of error are explained, including: air bubbles in blood gas samples, clotted samples, samples too old/not preserved on ice, or venous vs. arterial; c) employees are educated about where to find in the SLH ABG Manual significant reasons that pulse oximetry O2 saturation and blood sample O2 saturation may differ. The highest percentage of errors from the total samples received per year was 11.6% in 2017, followed by 9.6% in 2018, and 6.5% in 2019. Munoz Pre-analytical errors: working with manufacturers to help improve quality. The sigma performance evaluation scale below was adopted from the study of Grecu and colleagues2 to assess the performance level: The University of Hail Research Ethics Committee approved the study protocol (Nr.13675/5/42). Lab Testing Matters: Lab Testing Takes Center Stage for HAI Surveillance, NIPT The Pros, the Cons, and How It Affects Patient Safety, Non-Invasive Monitoring of Transplant Recipients Using Next-Generation Sequencing, At the time of patient assessment and decision to perform an analysis, Specimen receipt and storage in the laboratory. 2011 Jun;43(4):346-9. doi: 10.1097/PAT.0b013e32834634f4. We also store all specimens for a week after receipt in a refrigerator or freezer as appropriate., Carol Poehler: Our approach to avoiding preanalytical errors at Saint Lukes Hospital (SLH) is very tried-and-true. Hoboken, NJ: Wiley-Blackwell; 2013:2244. The goal of the present paper is to enumerate and analyze the prevalence of different preanalytical errors that surfaced during sample processing in the clinical biochemistry department during a 1-year period. Determining the performance over the key processes in the preanalytical phase was done by employing the sigma-scale method, which detects risks that may lead to errors that harm patients. 6.Atay A, Demir L, Cuhadar S, et al. The pre-and post-analytical phases of the process account for 93% of errors.1. These include inappropriate tests that have been ordered, improper sample collection, transport delays, and illegible handwriting on requisition slips. I remember one case where a patient had complaints that were confusing to the doctor and he (the patient) was https://www.labtestingmatters.org/testimonials/complaints-that-were-confusing/, 2015 CRI Symposium for Clinical Laboratories, http://www.mlo-online.com/articles/201405/pre-analytical-errors-their-impact-and-how-to-minimize-them.php, http://www.pathologyinformatics.com/sites/default/files/2012Powerpoints/23AllerWed.pdf, Quality Improvement: The Process to Improve Patient Safety. Ranjna Chawla and others, Identification of the Types of Preanalytical Errors in the Clinical Chemistry Laboratory: 1-Year Study at G.B. Rick Brant, Director of Lab Information Systems, Mount Carmel Health, Columbus, Ohio, USA. EDTA tubes are occasionally overfilled, resulting in inadequate mixing due to limited or no air space to enable proper inversions.18 A common factor that also contributes to these errors is incidents of prolonged venipuncture.29 The use of the syringe system continues to be practiced in various departments of this institution. Qual Manag Health Care. In contrast, the sigma-based performance level indicates acceptable performance on all the key processes. The health care system must be more diligent in applying scientific knowledge to reduce the errors in this phase. Quality indicators (QIs) have been employed to detect errors in laboratory testing, which serve as bases in developing strategies to improve the performance of the clinical laboratory. Pre-analytical errors: their impact and how to minimize them 10.LLopis M, Alvarez V, Martnez-Bru C, et al. 2004 Dec 1;88(3):161-81. doi: 10.1002/jso.20125. J Clin Diagn Res. Data from this study revealed that the preanalytical errors were issues predominantly related to specimen collection procedures, which compromised the specimen quality. Lipemia accounted for rejection of 0.03% and 0.11% of the samples in the inpatient and outpatient departments respectively. FOIA The data collection procedure involved review of blood samples received from the inpatient as well as outpatient departments. Factors such as using different QIs in the evaluation, the reporting and recording system, and the existing policies in sample acceptance and rejection criteria may contribute to the variation in the rate of errors. ", "Furthermore, samples are kept anaerobic to prevent contamination from the environment. Percentage of: number of samples with inappropriate sample-anticoagulant volume ratio/total number of samples with anticoagulant. Unauthorized use of these marks is strictly prohibited. WebOverall, 60.3% of all errors were pre-analytical phase errors, while 39.7% were post-analytical phase errors (Tables 3 and Kaushik N, Green S. Pre-analytical errors: their impact and how to minimize them. Clin Chem. hematology; laboratory errors; quality indicators; sigma metrics. Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors. Wolters Kluwer Health VACUTAINER It is clear from the above discussion that incorrect phlebotomy practices are the main reason behind preanalytical errors. The lab provides routine and reference testing in biochemistry. Gross lipemia led to rejection of 16 samples (0.03%). 26. Pre-analytical errors: their impact and how to minimize them 810 Studies have Pathol Lab Med Open J. IntJ Bioassays, 2014; 3(9): 3270-3275. A study of pre-analytical errors in a hospital-based clinical biochemistry laboratory. ", "Also, our medical director has a dramatic and pervasively positive impact on preventing preanalytical errors. modify the keyword list to augment your search. D The distribution of the various preanalytical variables is depicted in Table 2. You may be trying to access this site from a secured browser on the server. We are strict with our policy of asking the patient for their name unless the patient is non-communicative. Reducing preanalytical laboratory sample errors through - PubMed to maintaining your privacy and will not share your personal information without Nitin Kaushik, Sol Green. Difficult sampling and patient non-compliance further aggravates this problem. Without quality systems in the clinical laboratory, diagnosis can be a crap shoot. Errors in the perioperative period can often have grave consequences, and hence, perioperative clinicians need to be aware of the impact of human errors and how to minimize them. Hemolyzed specimens: A reason for rejection or a clinical challenge? Automation system customers used identification bracelets with patient data and prebarcoded syringes with the specimen ID. G The hospital's clinical laboratory performs routine and special tests and has several departments, such as the hematology laboratory. Unfortunately, 46-68 percent of all laboratory errors occur during the pre-analytics phase of testing due to the complexity and manual processes involved. Pre-analytic errors occur in a number of different circumstances: An estimated 25 percent of pre-analytical errors result in unnecessary investigation or improper diagnosis, resulting in added costs and negative patient outcomes. Labs must be aware of the data that involves a few of the crucial information like When collecting the specimen, the individual should confirm collection pre-requisites. May contain information that is not supported by performance and intended use claims of Radiometer's products. Jay Further analysis of the study showed a decreasing rate of preanalytical errors from 11.6% to 6.5%. Hemolysis was responsible for rejection of 607 samples, which accounts for 1.1% of the total number of samples received during this period. Focusing quality in the analytical phase alone and the absence of interest in preanalytical errors can potentially harm patients.16 This study aimed to define and review QIs for the preanalytical phase of hematology testing in a clinical laboratory. Blanckaert Modern day diagnosis is heavily dependent upon reliable laboratory data. THE PREANALYTICAL ERRORS: A CONTINUOUS Would you like email updates of new search results? Detecting Preanalytical Errors Using Quality Indicators in a Hematology Laboratory. Preanalytical Errors Pre-analytical errors: their impact and how to minimize them Attaining clinically reliable results in coagulation testing requires total quality. In addition, specimen collection, processing and storage (duration, temperature) are critical steps as improper handling may lead to specimen rejection if beyond the manufacturer's recommended storage timeframes, or delay testing, and reporting due to erroneous results (pre-analytical errors) (Kaushik and Green, 2014). Laboratory personnel were asked to register rejections, and causes for rejection of ward as well as out-patient samples collected in the laboratory. N N. Green. Rejections arose as a result of the following reasons: 0.74% were rejected due to hemolysis; 0.47% were specimens without proper requisition slips; and 0.23% had insufficient sample quantity.
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