Pre and Post Analytical Errors

1. P- ERRORS
Pre and Post Analytical Errors in Laboratory
SPEAKER : MARRIAPPA MANI
MICROBIOLOGICAL LABORATORY

2. Diagnosis
is largely
DEPENDENT
upon integrity of
LABORATORYdata.
FACT

3. But more than 60-80%
of the most IMPORTANT DECISIONS
on ADMISSION, DISCHARGE and MEDICATION are
based on LABORATORY TEST RESULTS

4. but the AWFUL FACTis
There is a OOPS
in Laboratory Results.

5. can cause
SERIOUS INJURY
to patients or even
RESULTin their
DEATHS

6. A defect occurring at any part of
the laboratory cycle, from
ordering tests to reporting
results and appropriately
interpreting and reacting on these
Laboratory ERROR is define as
OOPS

7. Laboratory Testing, which commonly
called the Total Testing Process-TTP,
is a highly Multifarious process.

8. Pre-Analytical Phase
3 Phases
Testing
Patient Requisition.1
Order the Test.2
Specimen Collection.3
Transportation.4
Processing.5
1.Testing result
Transmission
2. Interpretation
3.Follow-up
4.Retesting
Analytical Phase Post-Analytical Phase

9. HUGE NUMBER of ERRORS occur
in the PRE-ANALYTICAL phase
90% of errors are in P-Phase
PRE-ANALYTICAL phase
Pre-Analytical Phase

10. P-Phaseis the most CRUCIAL and HARDEST to
REGULATE and MONITOR because of the
INVOLVEMENT of TOO many PROFESSIONALS such as
Physicians, Specialists of laboratory medicine, Nurses, Laboratory technicians
and Phlebotomists
Pre-Analytical Phase

11. major REASONS for Ordering a
LABORATORY TEST
DIAGNOSIS MONITORING SCREENING
to rule in or rule out a diagnosis the effect of drug therapy
eg, for congenital hypothyroidism
via neonatal thyroxine testing

12. CLINICALperformance CHARACTERISTICS
of laboratory tests
PREVALENCE
EFFICIENCY
ACCURACY
PREDICTIVE VALUE
Pre-Analytical Phase

13. most 7USUAL types of Pre-analytical ERRORS
MISSING sample/
TEST REQUEST WRONG/missing identification CONTAMINATION
from infusion route
HAEMOLYSED/
CLOTTED and
insufficient samples
INAPPROPRIATE
containers
Inappropriate BLOOD to
anticoagulant ratio
Inappropriate TRANSPORT and STORAGE conditions
Pre-Analytical Phase

14. MISIDENTIFICATION of Patient
MISLABELLING of specimen
SHORT Draws/ Wrong anticoagulant/ blood
RATIO
MIXING problems/CLOT
Wrong Tubes/ Wrong Anticogulate
HEMOLYSIS/LIPEMIA
HEMOCONCENTRATION from prolonged
TOURNIQUET time
EXPOSURE to light/ EXTREME temperatures
IMPROPERLY TIMED specimens/ DELAYED
delivery to laboratory
PROCESSING errors
Incomplete CENTRIFUGATIONS /
IMPROPER storage
10common ERRORS
in SPECIMEN COLLECTION
Pre-Analytical Phase

15. most 4common VARIABLES of Pre-analytical ERRORS
PATIENT variables
DISEASE variables
1
2

16. most 4common VARIABLES of Pre-analytical ERRORS
SPECIMEN
COLLECTION variables
SPECIMEN HANDLING variables
3
4

17. 1. PATIENTVariables
DIET
AGE
EXERCISE
PREGNANCY
SMOKING
MEDICATIONS
BODY MASS
DEHYDRATION

18. 2. DISEASEVariables
INSULIN –DEPENDENT
DIABETUS MELLITUS
NEPHROTIC SYNDROME/
CHRONIC RENEL FAILURE
BILIARY TRACT
OBSTRUCTION
HYPOTHYROIDISM
ACUTE MYOCARDIAL
INFARCTION

19. Order of draw
TOURNIQUET
TIME of collection
POSTURE
Presence of IVs
FASTING status
DIURNAL variation
Anticoagulants
3. SPECIMEN
COLLECTIONVariables

20. CENTRIFUGATION
LABELING
ALIQUOTING
TEMPERATURE
TRANSPORT conditions
PROCESSING time
SUNLIGHTLIPEMIA HEMOLYSIS
4. SPECIMEN
HANDLING Variables

21. 9reasons for SPECIMEN REJECTION
Pre-Analytical Phase
1. HEMOLYSIS/LIPEMIA
2. CLOT present in the
ANTICOAGULATED specimen
3. NONFASTING specimen when test
REQUIRES FASTING
4. IMPROPER blood collection tube
5. SHORT draws/ Wrong Volume
6. Improper TRANSPORT conditions
(Ice for blood gases)
7. DISCREPANICES between
SPECIMEN LABEL and
REQUISITION
8. UNLABELED or
MISLABELLED specimen
9. CONTAMINATED specimen/
LEAKING container

22. TESTS
AFFECTED
by DIURNAL
VARIATION,
POSTURE
and STRESS
TEST NAME MORNING AFTERNOON EVENING NIGHT STRESS SUPINE
CORTISOL
ADRENOCORTIC
OPIC HORMONE
PLASMA RENIN
ACTIVITY
ALDOSTERONE
INSULIN
GROWTH
HORMONE
ACID
PHOSPHATASE
THYROXINE
PROLACTIN
IRON
CALCIUM
Pre-Analytical Phase

23. Minimal Hgb 20 50 100 250 500 1000
Approximate Hemoglobin Concentration (mg/dL)
General guidance for acceptance/rejection:
<50 mg/dL – not hemolyzed
>100 mg/dL – hemolyzed
HEMOLYSIS chart of SERUM/PLASMA
Pre-Analytical Phase

24. CALIBRATION of the
centrifuge must be PARTof the
QUALITY
ASSURANCE
PROCESS
Pre-Analytical Phase

25. to avoiding IDENTIFICATION ERRORS
CORRELATE Orders with
Patient NAME
Use BARCODE readers
Identification on SAMPLE DEVICE at site of Collection Patient ID label attached
Pre-Analytical Phase

26. In which the CLINICIANS receive, interpret and
REACT to LABORATORY results.
Similar to the PRE-ANALYTICAL STEP,
the POST ANALYTICAL phase can be subdivided into 2
1 PHASE
performed WITHIN the LABORATORY
(post-post-analytical phase)
Post-Analytical Phase

27. Common Post-Analyticalactivities
Assurance of CONFIDENTIALITY
of patient information
PROCEDURES for notification
of test results with statistics
Corrected REPORTS
REFERRAL specimens and
their reports
TAT
ACCURACY and completeness of
results and reports
Disposition of
UNACCEPTABLE specimens
Procedures and POLICIES
to Prevent recurrences
Post-Analytical Phase

28. 3 most common POST ANALYTICAL procedures within laboratory
VERIFYING laboratory RESULTS
Feeding them into the laboratory information system (LIS)
COMMUNICATING them to the clinicians in a number of ways (in particular,
by producing a report and making any necessary ORAL communications regarding
‘‘ALERT’’ or PANIC results).
Post-Analytical Phase

29. Incorrect REFERENCE values
4 common POST ANALYTICAL ERRORS
TRANSCRIPTION errors Wrong VALIDATION
Excessive DELAY in
reporting values
Post-Analytical Phase

30. Junior Staff Head of the Department Doctor
Report VALIDATION Process
To MINIMIZE ERRORS
Post-Analytical Phase

31. All the ERRORS
(Pre-analytical or Post-analytical) occurring at
the different stages of TTP RESULTS in
Increase
TURNAROUND TIME
Patient
INCONVENIENCE
Extra
WORK LOAD on staff
Extra cost to
REPEAT TESTING
as a whole significantly
AFFECT THE PATIENT WELL BEING
ERROR SUMMARY

32. Information Technology (IT) Establishment of (LIS)
LEAD to
improved quality of HEALTH care and
PATIENT SAFETY
Moreover Increasing use of

33. STEPS that can PREVENTERRORS
Improve the health
professional continuous
EDUCATION and
TRAINING
Implement
Standard Operating Procedures
Improve COMMUNICATION
and TEAMWORK between
health care professionals
as well as promote
COOPERATION between
DEPARTMENTS
to improve PATIENT CARE

34. CLINICIANS & LABORATORIANS should recognize that the Laboratory data, although
poten-tially extremely USEFUL AID in DIAGNOSTIC DECISION MAKING
FINAL ANALYSIS

35. QUERIES PLEASE

36. MICROBIOLOGICAL LABORATORY