Aatika Maryam Learning Objectives 1. Describe Test Variable Knowledge. 2. Describe different types of Test variables Knowledge. 3. Discuss the steps taken to prevent pre-analytical and post-analytical errors. 4. Discuss the steps taken in the lab to prevent analytical errors. Stages:
The diagnostic testing process can be separated into three phases:
(a) The Pre-analytical stage It consists of patient preparation and sample collection. E.g - Blood or Urine & sending it to Lab (b) The Analytical stage The analytical phase consists of processes involved in the testing of the specimen (c) The Post-analytical stage It refers to the interpretation of test to formulate a diagnosis. Types of Variables Pre-Analytical Variables Pre-analytical errors
By clinicians: By nursing staff
Hand writing not legible Form lost or delayed
Request written on wrong form Improper preparation of patient Patient identification incorrect Wrong position of patient at time of sample collection Errors before, during and after collection of sample
Before collection During collection After collection
Patient Extended tourniquet • Specimen lost or misidentification delayed Haemolysis • Unsuitable storage Improper time of Under filling tubes and conditions collection • Failure to separate Blood diluted with IV Exercise serum from sample fluid • Improper light Improper posture exposure Fasting • Wrong tube / contamination from stopper Analytical phase variables Analytical protocols
Skill of the technician.
Fresh reagent must be used and not the expired one. Instrument maintenance must be done as it must be checked periodically by the staff. Equipment used must be properly calibrated. Test procedure must be appropriate with proper mixing of the components. Dilution and pipetting errors must be reduced. Post analytical variables Post analytical protocols
1. Proper entry of lab results
Entry on the form Entry on record register
2. Pathologist signature & interpretation
Results should be shown to pathologist for interpretation & rectification
3. Immediate delivery of results for cases requiring urgent consideration
4. Attachment of reports on case sheet Immediately With the case sheet of actual patient
5. Clinician knowledge/correlation of results
Post analytical errors
Incorrectly transcribed data.
Not reported in timely manner. Reported in a confusing or uninterpretable format. Copying mistake from a raw data sheets onto patient record chart. Acronyms are often used to shorten the test names listed on reports or computer monitor screens. EXAMPLE: The acronym "LAP" can stand for "leucine amino peptidase" and also for "leukocyte alkaline phosphatase." The computer code "ALDO" could be applied to both aldolase and aldosterone. EXAMPLE: If the reference range for albumin is 3.5 to 5.0 g/dL and an unrealistic patient value of 0.35 g/dL is identified, this may alert the analyst to an instrumental, mathematical, or decimal positioning error, which may have caused a 10-fold error from an expected value of 3.5 g/dL Steps to prevent pre and post analytical errors Phlebotomy education: All employees should be required to take continuing education classes to stay current with recent developments in pre-analytical error reduction. Using appropriate technology: Barcodes for correct patient identification. Automated detection of serum indices. Choosing appropriate products/instruments: Plastic tubes offer significant advantages over glass tubes, such as minimizing exposure to blood by reducing the chance of shatter, increasing shock resistance, increasing centrifugation speed tolerance, and decreasing weight. Developing clear, written procedures: Specific protocols and operating procedures (SOPs) in the lab help to reduce the heterogeneity in process and streamline the lab workflow. Validating any new instrument or procedure. Monitoring quality indicators in the lab: Laboratory General Checklist of the College of American Pathologists (CAP) specifically lists a few such pre-analytical quality indicators which should be monitored: a. Patient identification (% of patient wristbands with errors, % of ordered tests with patient identification errors, % of results with identification errors) b. Test order accuracy (% of test orders correctly entered into a laboratory computer) c. Specimen acceptability (% of general Hematology and/or Chemistry specimens accepted for testing).