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Pre and Post Analytical Errors
- 1. P- ERRORS Pre andPost Analytical Errors in Laboratory SPEAKER : MARRIAPPA MANI MICROBIOLOGICAL LABORATORY
- 2. Diagnosis is largely DEPENDENT upon integrityof LABORATORYdata. FACT
- 3. But more than60-80% of the most IMPORTANT DECISIONS on ADMISSION, DISCHARGE and MEDICATION are based on LABORATORY TEST RESULTS
- 4. but the AWFULFACTis There is a OOPS in Laboratory Results.
- 5. can cause SERIOUS INJURY topatients or even RESULTin their DEATHS
- 6. A defect occurringat 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, whichcommonly called the Total Testing Process-TTP, is a highly Multifarious process.
- 8. Pre-Analytical Phase 3 Phases Testing PatientRequisition.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 ofERRORS occur in the PRE-ANALYTICAL phase 90% of errors are in P-Phase PRE-ANALYTICAL phase Pre-Analytical Phase
- 10. P-Phaseis the mostCRUCIAL 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 forOrdering 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 laboratorytests PREVALENCE EFFICIENCY ACCURACY PREDICTIVE VALUE Pre-Analytical Phase
- 13. most 7USUAL typesof 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 MISLABELLINGof 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 VARIABLESof Pre-analytical ERRORS PATIENT variables DISEASE variables 1 2
- 16. most 4common VARIABLESof Pre-analytical ERRORS SPECIMEN COLLECTION variables SPECIMEN HANDLING variables 3 4
- 17.
- 18. 2. DISEASEVariables INSULIN –DEPENDENT DIABETUSMELLITUS NEPHROTIC SYNDROME/ CHRONIC RENEL FAILURE BILIARY TRACT OBSTRUCTION HYPOTHYROIDISM ACUTE MYOCARDIAL INFARCTION
- 19. Order of draw TOURNIQUET TIMEof collection POSTURE Presence of IVs FASTING status DIURNAL variation Anticoagulants 3. SPECIMEN COLLECTIONVariables
- 20. CENTRIFUGATION LABELING ALIQUOTING TEMPERATURE TRANSPORT conditions PROCESSING time SUNLIGHTLIPEMIAHEMOLYSIS 4. SPECIMEN HANDLING Variables
- 21. 9reasons for SPECIMENREJECTION 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 TESTNAME 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 2050 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 centrifugemust be PARTof the QUALITY ASSURANCE PROCESS Pre-Analytical Phase
- 25. to avoiding IDENTIFICATIONERRORS 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 theCLINICIANS 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 ofCONFIDENTIALITY 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 commonPOST 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 4common POST ANALYTICAL ERRORS TRANSCRIPTION errors Wrong VALIDATION Excessive DELAY in reporting values Post-Analytical Phase
- 30. Junior Staff Headof the Department Doctor Report VALIDATION Process To MINIMIZE ERRORS Post-Analytical Phase
- 31. All the ERRORS (Pre-analyticalor 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 canPREVENTERRORS 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 & LABORATORIANSshould recognize that the Laboratory data, although poten-tially extremely USEFUL AID in DIAGNOSTIC DECISION MAKING FINAL ANALYSIS
- 35.
- 36.