causes of laboratory errors

causes of laboratory errors

• 2.
   Error isthe difference between the true result (or accepted true result) and the measured result.  failure of a planned action to be completed can occurring at any part of the laboratory cycle from ordering examinations to reporting results and appropriately interpreting and reacting to them  The handling of the specimens is critical to decreasing the error in the lab results ERROR The frequency of laboratory errors varies greatly depending on:-  The study design  The specific steps of the total testing process (TTP) investigated
• 3.
  Why do laboratoryerrors occur? Inadequate Attention To Detail Poor Sample Control Poor Results Verification Quality Control & Assessment Non- validated Tests Time Pressures Poor Workload Management Understaffed
• 4.
  Possible source oflab Errors Specimen collection Specimen handling Chemical analysis Patient preparation Reporting results Various factors leading to lab errors of the patients tests are:
• 5.
  1) Latent errors Theseare the errors occurring due to: 1- Organizational failures. • Chronic understaffing • Multi-tasking and improper job distribution amongst staff • Lack of instrument interface • Poor formatting of results • Overloading of analyzer and no back up 2- Infrastructure and design • Poor laboratory layout leading to misplacement of specimen • Poor sample labelling policy • Policy, design and process pertaining to Test requisition form. 3- Faulty policies from management. • Poor communication between shifts and departments • Excessive focus of management on costs • Management’s approach towards incident reporting Classification of Lab errors
• 6.
  2) Active errors Therest are active errors, which are of three types  Pre-analytical—specimen collection, transport and processing  Analytical—testing  Post-analytical—testing results transmission, interpretation, follow-up, retesting.
• 7.
  Pre-analytical errors  Pre-and post-analytical errors are estimated to constitute 90% of errors  Errors at any stage of the collection, testing and reporting process can potentially lead to a serious patient misdiagnosis  Errors during the collection process are not inevitable but can be prevented with a diligent application of quality control, continuing education and effective collection systems.
• 8.
  The steps ofthe preanalytical phase Sampling/handling Preparation prior to sampling Storage/transport Preparation prior to analysis
• 9.
  Implications of errors andcompromise the diagnosis and treatment of the patient • Errors made in the period prior to the analysis of the sample ... • may influence the quality of the final measured results ...
• 11.
  Preventive actions Phlebotomy Education Academiccourse and training under the supervision of a senior phlebotomist. Continuous Medical Education Competency assessments (written and observational). Professional Licensure. Phlebotomy Staffing Adequate staffing to maintain collection standards. Technology Use of barcode scanners for patient identification
• 12.
  Analytical Errors 1) Systematicerrors– indicates poor accuracy • Poor calibration • Wrong standard • Incorrect procedure 2) Random errors – indicates poor precision • Pipetting error • Transcription error • Incorrect sample numbering • Reader fluctuation. Classifying Analytical Errors
• 13.
  - Standard protocolto prevent analytical errors • Regular equipment maintenance and calibration • Test method validation • Development and adherence to Standard operating procedures • Regular staff training and competency assessment • Adherence to IQC, EQC, PT and ILQC appropriately. Preventive actions
• 14.
  Practical approach andexperience sharing To prevent Analytical errors 1. Sample 8. Reference intervals 7. Personnel 6. Quality system 5. Validations 4. Equipment and automation 3. Method of analysis 2. Reagent
• 15.
   the post-analyticalphase of the total laboratory testing process.  inappropriate use of laboratory test results, critical result reporting, and transmission of correct results are areas of potential error We can avoid via: 1. Standardized procedures 2. Training / education 3. Computerized critical result reporting Post-analytical Error
• 16.
  Monitoring Errors  Thesuccess of any efforts made to reduce errors must be monitored in order to assess the efficacy of the measures taken.  Quality indicators must be used for assessment  The entire health care system must be involved in improving the total testing process.  There must be adequate and effective training of personnel throughout the institution to be competent in following processes
• 17.
  • The laboratorieshave long focused their attention on quality control methods and quality assessment programs which lead to :- • More accurate result • Less hazards and errors • Patient safety • More qualified diagnostic technique Importance of lab errors
• 18.
  REFERENCES  Institute ofMedicine (US) Committee on Quality of Health Care in America Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000.  Plebani M. The CCLM contribution to improvements in quality and patient safety. Clin Chem Lab Med 2013;51:39-46  Belk WP, Sunderman FW. A survey of the accuracy of chemical analyses in clinical laboratories. Am J Clin Pathol 1947;17:853-861.]  Diagnostic errors and laboratory medicine – causes and strategies Mario Plebani anuary 2015  Bland, J. Martin, and Douglas G. Altman (1996). “Statistics Notes: Measurement Error.” BMJ 313.7059: 744.  Cochran, W. G. (1968). “Errors of Measurement in Statistics”. Technometrics. Taylor & Francis, Ltd. on behalf of American Statistical Association and American Society for Quality. 10: 637–666. doi:10.2307/1267450  Dodge, Y. (2003). The Oxford Dictionary of Statistical Terms. OUP. ISBN 0-19- 920613-9.  Taylor, J. R. (1999). An Introduction to Error Analysis: The Study of Uncertainties in Physical Measurements. University Science Books. ISBN 0-935702-75-X.
• 19.
  Thank you foryour attention