Effect of Pre-Analytical Errors in Laboratory Testing Facilities: the Way Forward

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DOI: 10.21522/TIJPH.2013.11.02.Art002

Authors : Ofaka, Cordelia Enyanwu, Nafarnda Wesley Daniel, Sonika, Raj Goel

Abstract:

Pre-analytical errors contribute a significant proportion of errors of all major sources of mistakes made in laboratory testing processes and are responsible for several patient safety risks. It contributes to wrong therapeutic interventions, irrelevant follow up laboratory investigations and diagnostic delays, which impact negatively on the economy and laboratory effectiveness of health services. Pre-analytical phase is directly related to the procedure of specimen collection and is mostly out of the direct control of the laboratory; further, most pre-analytical errors are related to human factors. The aim of the study is to determine the nature and the occurrence of pre-analytical errors and recommendations on possible measures to reduce these errors. A total of 300 specimens were randomly sampled from a study population of 600 patients and analyzed for pre-analytical errors. One hundred and eighty-four (184) samples were found unsuitable for further processing accounting for 1.9% of all samples analyzed for pre-analytical errors and sample rejection. Rejections were due to following reasons: hemolysis 21.7 % (40) wrong tubes 19 % (35); clotted blood 17% (32); inappropriate timing of collection 15.7% (29); mislabeled specimens 15.2% (28); insufficient specimen quantity 6.5 % (12) and lipemic specimens 4.3% (8). The overall percentage of rejection was 1.9% and the substantial numbers of the rejected specimens were re-tested. Efforts aimed to reduce the rates of rejected samples can improve the quality of laboratory-based health care response.

Keywords: Error, Laboratory, Pre-analytical, Rejection, Specimen.

References:

[1] Bowen RA, Hortin GL, Csako G, Otañez OH, Remaley AT. (2010) Impact of blood collection devices on clinical chemistry assays. Clin Biochem.; 43(1-2):4-25.

[2] McCall R, Tankersley C. Phlebotomy Essentials. 5th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins, 2008:245.

[3] Favaloro EJ, Adcock DM, Lippi G. (2012) Preanalytical variables in coagulation testing associated with diagnostic errors in hemostasis. Lab Med.; 43(2):1-10.

[4] Validation and verification of tubes for venous and capillary blood specimen collection; approved guideline. CLSI document GP34-A. Wayne, PA: Clinical and Laboratory Standards Institute, 2012.

[5] Lippi G, Fostini R, Guidi GC. (2008). Quality improvement in laboratory medicine: extra-analytical issues. Clin Chem Lab Med.; 28(2):285-294.

[6] Arneson W, Brickell J. (2008). Clinical Chemistry: A Laboratory Perspective. Philadelphia, PA: FA Davis Company, :418.

[7] Wallin O, Söderberg J, Van Guelpen B, Stenlund H, Grankvist K & Brulin C. (2008) pre-analytical venous blood sampling practices demand improvement — A survey of test-request management, test-tube labelling, and information search procedures. Clin Chim Acta 391; 91-7

[8] Hawkins R. (2012). Managing the pre- and post-analytical phases of the total testing process. Ann Lab Med.; 32(1):5-16.

[9] Green SF. (2013). The cost of poor blood specimen quality and errors in pre-analytical processes. Clin Biochem.; 46(13):1175-1179.

[10] Plebani M. (2007). Laboratory errors: How to improve pre- and post-analytical phases Biochemia Medica. 2; 17(1):5-9

[11] Jiu T, The importance of pre-analytical phase in laboratory testing and diagnosis.

[12] Datta P. (2005). Resolving discordant specimens. ADVANCE for Administrators of the Laboratory.: 60.

[13] Plebani M. (2006). Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med.; 44(6):750-759.

[14] Lippi G, Becan-McBride K, Behúlová D, Bowen RA, Church S, Delanghe J, et al. Preanalytical quality improvement: in quality we trust. Clin Chem Lab Med. 2013;51(1):229-241.

[15] Bonini P, Plebani M, Ceriotti F, Rubboli F, Errors in Laboratory Medicine. Clinical Chemistry, 48: 5691–698 (2002).

[16] Plebani M, Carraro P. (1997) Mistakes in a stat laboratory: Types and frequency. Clin Chem.; 43(8):1348-1351.

[17] Söderberg J, Brulin C, Grankvist K, Wallin O. (2009) Pre-analytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling. Clin Chem Lab Med.; 47(2):195–201.

[18] Söderberg J, Wallin O, Grankvist K, Brulin C. (2010) Is the test result correct? A questionnaire study of blood collection practices in primary health care. J Eval Clin Pract.; 16(4):707–711.

[19] Plebani M. (2005) Exploring the iceberg of errors in laboratory medicine. Clin Chim Acta.; 404(1):16-23.

[20] Barak M, Jaschek R. (2013). A new and effective way for preventing preanalytical laboratory errors. Clin Chem Lab Med.; 50(4):1-4.

[21] Favaloro EJ, Adcock DM, Lippi G. (2012) Preanalytical variables in coagulation testing associated with diagnostic errors in hemostasis. Lab Med.; 43(2):1-10.

[22] Hollensead SC, Lockwood WB, Elin RJ, Errors in Pathology and Laboratory Medicine: Consequences and Prevention. Journal of Surgical Oncology 2004; 88:161–181.

[23] Jiu T, The importance of pre-analytical phase in laboratory testing and diagnosis.

[24] Hammerling J. (2012) A review of medical errors in laboratory diagnostics and where we are today. Lab Med.; 43(2):41-44.