Health, general biochemistry laboratories medical errors. A presentation on preanalytical errors presented by. The pre and post analytical phases of the process account for 93% of errors. Preanalytical errors at the chemical pathology laboratory of. Types of preanalytical errors in the clinical laboratory. Even after so many advances in hematology laboratory practice, pre analytical errors remain a challenge for practicing. Ace, acetone, ammonia, catecholamines, free fatty acids, lactic acid, pyruvate and renin,pth. The same interest for the preanalytical errors will also decrease the errors though seems like a puzzle, but possible. Pre analytical errors can occur at the time of patient assessment, test order entry, request completion, patient identification, specimen collection, specimen transport, or specimen receipt in the laboratory. These include inappropriate tests that have been ordered, improper sample collection, transport delays, and illegible handwriting on requisition slips. These errors were overwhelmingly more common in inpatients than in outpatients. Pdf preanalytical errors in hematology laboratory an.
One study found that having dedicated laboratory technologists in emergency departments reduced blood culture contamination rates by 78% lowered from 5% to 1. Quality assurance system the activity of a laboratory to ensure the reliability of test results, to increase accuracy, reproducibility and laboratory to laboratory. Your staff is going to need continuous training to learn how to avoid the various causes of preanalytical errors. In a previous study by the association for clinical biochemistry and laboratory medicine pre analytical specialist interest group acbsigpa, we have shown that there is a wide variation in the definition, repertoire and collection methods for preanalytical qis. The rate of these errors was the highest in stat section 1. Pre analytical variableserrors are often unknown to testing personnel and the clinicians. A tool for reducing laboratory errors giorgio da rin. Pre analytical errors damage an institutions reputation, diminish confidence in healthcare services, and contribute to a significant increase in the total operating costs, both for the hospital and laboratory. Review of medical errors in laboratory diagnostics and where. In this lesson, sources of errors for the pre analytic and postanalytic phases of the total testing process are discussed, along with possible solutions. Avoid draws from vascular access devices vads such as arterial lines, picc lines and.
Wellwritten procedures and study protocols are tools that will help to decrease the number of analytical errors and reduce unnecessary variation in clinical pathology data. A large proportion, possibly a majority, of errors in laboratory medicine occur in the preanalytical phase of the testing process. Aug 01, 2017 the trend shows an increase in pre analytical errors over the study period. Jul 01, 2016 major advances in automation and instrumentation have helped reduce laboratory associated errors over the last decade, but with pre analytical errors currently accounting for up to 75% of all mistakes, laboratory medicine professionals must keep expanding their focus to what is happening outside of the lab. First of all, poct testing is usually performed by clinical staff i. Principles of pre analytic and postanalytic test management dr varsha shahane. Preanalytical errors in laboratory their consequences and. Clia compliance for preanalytic, analytic, and postanalytic.
Quality control provides quantitative estimates of analysis and measurement controls that can be used to determine compliance with project objectives. Since, clinical laboratory results play an important role in patients diagnosis, investigation and treatment. Recognizing and reducing analytical errors and sources of. Received 9 march 2009 accepted 10 march 2009 available online 18 march 2009 keywords. Pre analytical and post analytical qc often these papers play a zerosum game, emphasizing pre and post analytical quality while diminishing the importance of analytical quality. Preanalytical and post analytical qc often these papers play a zerosum game, emphasizing pre and post analytical quality while diminishing the importance of analytical quality. Feb 15, 2014 preanalytical errors contd order of draw. Preanalytical errors damage an institutions reputation, diminish confidence in healthcare services, and contribute to a significant increase in the total operating costs, both for the hospital and laboratory. Quality assurance in the hematology laboratory is a must to ensure laboratory users of reliable test results with high degree of precision and accuracy.
If so, share your ppt presentation slides online with. A professional with medical laboratory assistant training knows that the pre analytical phase when a specimen is collected, transported, and processed is a crucial part of the lab testing process. Quality assurance system the activity of a laboratory to ensure the reliability of test results, to increase accuracy, reproducibility and laboratory to laboratory comparability. Business health care industry best practices methods blood medical examination usage blood tests health care costs analysis medical care, cost of. The quality of the analytical phase increased due to the interest, tight control and following the quality procedures both internally and externally established by the medical laboratories and manufacturers.
Laboratory errors can be defined as any defect from ordering tests to reporting results and appropriately interpreting and reacting on these. Preanalytical errors in hematology laboratory an avoidable incompetence. At complianceonline you can access this type of training either online via a recorded class or by ordering the course on cd. Briggs this chapter outlines the various techniques that may be employed in analytical quality assurance aqa, and the reasons why they should be used. Pre analytical laboratory errors is the property of its rightful owner.
Identification of the types of preanalytical errors in the. Lipemic samples lipemic samples are often seen following collection after heavy meals or the due to pre existing metabolic. Errors in clinical laboratories or errors in laboratory. Performance of tests in the laboratory is rigorously controlled, with quality control procedures in place that markedly reduce errors. The pre analytical phase of the total laboratory testing process is where the majority of laboratory errors occur. The quantity of errors in the post analytical phase makes it the second most affected in the ttp as previously stated. According to bd and clsi clinical and laboratory standards institute, formerly nccls, following is the correct order of draw during venipuncture will help to ensure accurate test results. Pre analytical errors pre analytical procedures performed outside the control of the laboratory while the total testing process is typically divided into three main phases pre, intra and post analytical, exploration of the beginning and end of the loop reveals that currently, pre and post analytical steps. Evaluation of types of preanalytical errors in clinical.
Original research article, report by journal of evolution of medical and dental sciences. Over 40% of lab errors happen during the pre analytical stage, while a. Most failures or mistakes occur in the pre analytical or post analytical process. Why preanalytical procedures are important in laboratory. Pre analytical errors 1 free download as powerpoint presentation. Test precautions, introduction, pre analytical phase,clinical laboratory science duration. Currently, pre analytical errors account for up to 70% of all mistakes made in laboratory diagnostics, most of which arise from problems in patient preparation, sample collection, transportation, and preparation for analysis and storage. Reasons of pre analytical errors it is found that there are some major reasons that cause errors in pre analytical phase of laboratory testing like unawareness among healthcare professionals, do not follow the guidelines, carelessness during the sample collection, handling, storage and transportation. Important errors can occur during the pre analytic phase with specimen handling and identification. They have previously been shown to contribute a signi. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The significant contributions to errors in the postanalytic phase are a failure in reporting, erroneous validation of analytical data, and incorrect data entry. Preanalytical errors and their impact on tests in clinical laboratory practice pakistan journal of medical research, 2012 january march 29 phlebotomy practices should be adopted by all health care workers.
The current lack of attention to extra laboratory factors is in stark contrast to the body of evidence pointing to the multitude of errors that continue to occur, particularly in the pre analytical phase. Automated systems such as beckman coulters power processor sample handling system, and siemenss aptio automation solution can significantly reduce labor costs and eliminate the opportunity for. Preanalytical issues in the haemostasis laboratory. This phase may include specimen handling issues that occur even prior to the time the specimen is received in the laboratory. Diagnostic technology for minimizing preanalytical errors. A free powerpoint ppt presentation displayed as a flash slide show on id. Several studies have documented that most of the errors in the clinical laboratory occur in the pre analytical phase accounting up to 80% 2,4,6, 8, 9. Major advances in automation and instrumentation have helped reduce laboratory associated errors over the last decade, but with pre analytical errors currently accounting for up to 75% of all mistakes, laboratory medicine professionals must keep expanding their focus to what is happening outside of the lab. Target audience clinical laboratory and related healthcare professionals who can benefit from the academic content presented. Even after so many advances in hematology laboratory practice, pre analytical errors. Laboratory errors total testing process information technology preanalytical. For instance, the risk of errors in pre analytical processes outside the laboratory has been reduced by the introduction of systems designed to manage the distribution of tubes, to attach a proper identification label, to produce auxiliary labels for sample collection, to.
The identification of reliable quality indicators qis is a crucial step in enabling users to quantify the quality of laboratory services. Non lab personnel were responsible for 29% of the mistakes. The onus is on the laboratory to reduce this by the provision of standardised guidelines for the pre analytical phase of testing regardless of the fact that supervision of this process is not a direct responsibility of the laboratory. Preanalytical errors paes are errors which occur prior to the analytical stage in the total testing process ttp and can occur both before and after receipt of specimens in the laboratory. Automating your pre analytical processes is a very effective way of reducing human errors in the laboratory. Your laboratory cannot afford to continue to make these types of easily corrected errors. Postanalytical phase quality assurance for laboratory. Diligence is required on the part of the laboratory to prevent incorrect results must have quality indicators in place to monitor the steps of the pre analytical phase event management where errors are investigated and corrected so that repeat events are prevented. May 22, 2015 when a dedicated staff member takes care of pre analytical procedures, the amount of errors that happen during the pre analytical phase drops dramatically. Pre analytical variables in coagulation testing associated with diagnostic errors in hemostasis overall, a significant impact of patient care arising from diagnostic errors has been estimated to arise in around 9% to 15% of errors, while the likelihood of inappropriate care has been described in 2% to 7% of such cases.
Clinical laboratory should make efforts to reduce pre analytical errors in order to report accurate and expeditious results. Thus, errors with laboratory tests might lead to inappropriate medical decisionmaking. This chapter addresses the control of the analytical process in the laboratory, as distinct from meeting the typical analytical needs of a specific project. Timeliness and the incorrect interpretation of diagnostic or laboratory tests were responsible for a significant percentage of errors in ambulatory and emergency department settings. Clinical chemistry samples as a free haemoglobin concentration of 0. Preanalytical, analytical, and postanalytical phases of. Up to 70% of testing errors occur in the pre analytical phase1 it is not always clear when a sample is received in the lab that it may be unsuitable or compromised lab results lead to clinical action 7080% of all clinical decisions regarding patient care are based on lab. Preanalytical errors in medical laboratories ashishkumar soni qms manager west randox laboratories india pvt. Reducing preanalytical errors whitehat communications. The pre analytic testing phase occurs first in the laboratory process. Ppt preanalytical errors in medical laboratories powerpoint. Errors in clinical laboratories or errors in laboratory medicine. Preanalytical phase an overview sciencedirect topics.
It is well documented that most laboratory errors occur in the pre and postanalytic phases. The pre analytical phase thus showed the highest percentage of errors, the most frequent problems arising from mistakes in tubefilling with an incorrect blood to anticoagulant ratio for coagulation. The presentation will also analyze the effect of pre analytical errors on results and patient care. Preanalytical laboratory errors vein tissue biology. As with the pre analytic phase, the errors of the post analytical can occur either inside or outside of the laboratory. Mario plebani department of laboratory medicine, university hospital of padova and center of biomedical research, castelfranco veneto, italy abstract laboratory testing is a highly complex process and, although laboratory services are relatively safe, they. Preanalytical variables and factors that interfere with the. Analytical and post analytical errors in laboratory hanisha erica villaester. Prewarm infant heels or the fingers of older children and adults when performing a skin. There have been tremendous work and established quality control criteria for analytical phase of testing but there is paucity of standards for pre analytical phase.
Evaluation of types of pre analytical errors in clinical chemistry laboratory. Preanalytical errors and their impact on tests in clinical. Laboratory errors total testing process information technology pre analytical. Most errors affecting laboratory test results occur in the pre analytical phase 4668. Poc testing is not free from re analytical errors poc testing has unique challenges. Preanalytical laboratory errors free download as powerpoint presentation.
Pre analytical laboratory errors can arise throughout the pre analytical phase, because this phase comprises a lot of manual activities and accounts for most of the errors correspondence. Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. Biochemistry and laboratory medicine pre analytical specialist interest group acbsigpa, we have. As indicated above, the importance of extra analytical aspects in laboratory quality is encompassed in compliance with clia regulations. Analytical variables occur during actual testing of the specimen. It seems that people want to believe that analytical errors arent as frequent as the pre analytical and post analytical errors. Quality indicators to detect preanalytical errors in.
Reliability of data for a water quality monitoring programme depends on strict adherence to a wide range of operating. Their ultimate goal is to provide a timely and error free service to physicians and their patients. The use of modern laboratory instrumentation with high levels of test reliability and appropriate quality assurance measures will lead to very few analytical errors within hemostasis testing. Evaluation of types of preanalytical errors in clinical chemistry laboratory. Nov 02, 2019 these errors were overwhelmingly more common in inpatients than in outpatients. Preanalytical errors are quite frequent in the area of pointofcare testing poct. All three phases of the ttp can be dealt with separately, as the analytical errors account for errors in the clinical laboratory occur in the pre analytical phase accounting up to 80% 2,4,6, 8, 9. Chapter 9 analytical quality assurance this chapter was prepared by r. Appropriate validation of laboratory instruments and procedures is essential for smooth operation of the laboratory and the generation of accurate data.
441 571 464 758 231 788 1540 1614 118 1433 451 1207 633 924 357 1599 1184 391 614 958 126 873 514 352 1393 1005 701 1303 636 604 1164 184 1109 75 1246 142