This document summarizes the experience of the laboratory at Hospital Sibu in managing blood film for malaria parasite (BFMP) testing in 2012. It discusses the monthly BFMP workload and positivity trends, prevalence of different malaria species, turnaround times and compliance with the 1-hour laboratory target. It also describes two cases where BFMP results were incorrectly reported initially and the root cause analyses and corrective actions taken. External quality assurance participation and training for on-call staff and hospital staff on BFMP smear preparation are also summarized.
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BFMP Management Experience in Hospital Sibu Lab
1. Experience in BFMP
Management in Serology
Laboratory, Hospital Sibu
By Makmal Serologi
Jabatan Patologi Hospital Sibu
2. Introduction
Blood Film for Malaria Parasite (BFMP) as both routine and
critical test in Sarawak.
In Hospital Sibu, BFMP results adhere to 1-hour Lab Turn-
Around Time, for both office hours and after office hours
Use Geimsa staining
8. Internal QC
Internal QC for Giemsa staining
3% GIEMSA QUALITY CONTROL FOR BFMP STAINING
Date
Reagent Batch
Operator
QC Slide
Verification
Stock Buffer Working Buffer Background RBC
WBC
Nucleus Cytoplasm
9. Kes salah lapor
1 case in 2012
Root-cause Analysis done
New microscope supplied by JKNS post-RCA
2 cases in 2013
10. RCA of Incident : BFMP Epid
Week 36 Wrong Reporting
Team Members
1. Alexander Beemer Mijen
2. Siti Syartinah Shawkawi
3. Noel Ting Yong Yin
4. Saiful Ungo
5. Siti Syazwana Taip
6. Faiz Osen
11. Brief Summary of Incident A (Iban)
31st August 2012 (Friday, PH) sample Alexander Amit received by
oncall staff at 3pm. Oncall staff reported as negative.
1st September 2012 (Saturday, WE) Sero staff A counterchecked (AM
clearing) positive for P.Falciparum.
3rd September 2012 (Monday) Sero staff B countercheck (AM routine)
positive for P.Knowlesi, send slide to Vector Control Sibu.
12. Define the problem
(Using process diagram / sequence of
events)
Ref Date Time Location Event Description Key person(s)
involved
Comment/ Queries
31st August
2012 (PH)
1500hrs Lab sample Alexander Amit received by oncall staff at
3pm. Oncall staff reported as negative
Oncall MLT Was the sample
properly prepared
smear? (YES)
Was the smear
properly stained?
(YES)
1st September
2012
(Saturday)
AM
Clearing
Lab Sero staff A counterchecked (AM clearing) positive
for P.Falciparum.
MLT Organism clearly seen
on microscope? Can
make out for sure the
physical properties of
the said organism?
3rd
September
2012
AM
routine
Lab Sero Staff B countercheck (AM routine) positive for
P.Knowlesi, send slide to Vector Control Sibu
MLT Organism clearly seen
on microscope? Can
make out for sure the
physical properties of
the said organism?
13. Specimen
collection
Receive by
MLT, stained
View thru
microscope, res
ult released as
negative
Countercheck,
release as
positive for
P.falciparum
Routine
countercheck,
reported as
P.knowlesi
Send to
vector, vector
report as
P.falciparum
Smear
okay
Stain okay
Parasite
cannot be seen
Microscope not
clear, yellow light
not suitable for
viewing parasite
1st Sept 201231st August 2012
Identify contributory factors
(cause effect diagram/fishbone /5why)
3rd September 2012
Parasite can
be seen, can
confirm
positive, physio
logy not clear.
Parasite can
be seen, can
confirm
positive, physio
logy not clear.
14. Brief Summary of Incident B (Cina)
30th August 2012 (Thursday) – sample for Tan Kai Yung received by lab
staff, reported as P.Falciparum. Sent to Vector Control Sibu.
Vector Control reported as P.knowlesi, followed by State Vector as
P.knowlesi.
15. Define the problem
(Using process diagram / sequence of
events)
Ref Date Time Location Event Description Key person(s)
involved
Comment/ Queries
30th August
2012
(Thursday)
Routine Lab sample for Tan Kai Yung received by lab staff,
reported as P.Falciparum. Sent to Vector Control
Sibu
MLT Was the sample
properly prepared
smear? (YES)
Was the smear
properly stained?
(YES)
Organism clearly seen
on microscope? Can
make out for sure the
physical properties of
the said organism?
Vector Control reported as P.knowlesi, followed by
State Vector as P.knowlesi.
Vector
control staff,
State vector
liaison officer
N/A
16. Specimen
collection
Receive by
MLT, stained
View thru
microscope,
reported as
positive for
P.falciparum
Send to vector Vector Control
report as
P.knowlesi, State
vector as
P.Knowlesi
Smear
okay
Stain okay
Microscope not
clear, yellow light
not suitable for
viewing parasite
3rd Sept
2012
30th August 2012
Identify contributory factors
(cause effect diagram/fishbone /5why)
Parasite can be
seen, can confirm
positive, physiology
not clear.
4th Sept
2012
17. Plan of action
No Root cause Action Responsibility Date due
1
2
Microscope condition not
good, yellow light not
suitable for viewing
parasite morphology,
microscope lens not clear
Current microscope is
old, >10 years
To ask Faber to change the yellow
bulb into white bulb
To ask Faber to change lens
To replace current microscope with
new unit
Laboratory and
Faber
Laboratory
Management
Immediate
As soon as
possible
18. External QA Programme
MKA Kota Kinabalu BFMP EQA Programme
Series 1 / 2013 participated
Vektor Negeri EQA Programme
Sending of all positive BFMP slides to Vektor Sibu and Vektor
Negeri.
19. Staff Training
Oncall staff BFMP training in 2012, 2013
July 2013 – estimate to send mnimum 15 oncall staff to
Vektor Sibu for refresher course
20. Hospital Staff BFMP Smear
Training
Done in 2012 and 2013
Targets doctors and nurses responsible to prepare BFMP
slide smears
Multiples sessions weekly, 10-15 participants per session
Facilitated by Serology/Parasitology MLTs under supervision
by MLT Siti Syartinah Sharkawi