Introduction
Laboratories provide many intricate services, including sample collection, consultation services, and diagnostics testing. The primary objective of the diagnostic service is to obtain the correct results from the right patient and to deliver them to the concerned doctor without errors or delays. The mechanisms within laboratories should ensure the quality and integrity of samples and test results in order to protect patients from wrong results. Such mechanisms include policies and procedures. However, performing the right tests and procedures on the wrong samples still results in incorrect results (LLopis, Alvarez, and Martínez-Brú 184). This paper looks at pre-analytical errors and the implementation of the principle of zero tolerance of error identification in the laboratory.
Pre-Analytical Errors
The two primary pre-analytical errors are identification problems and sample problems. Identification problems arise when wrong results are linked to the patients. These errors occur when the sample collector fails to ensure that the patient identification corresponds to the identification band, or when the samples collected are not labeled with the sample identification at the patient’s bedside. The main identification problems, according to RCPA KIMMS (Key Incident Management and Monitoring System) Quality Assurance Program, include unlabelled samples, mislabeled samples, and samples lacking at least two identifiers. The issuing of incorrect patients leads to redundant treatments, lack of treatment, and in some cases, death (Bayley 4).
Sample problems occur when the samples collected cannot be used to perform the required tests. The analysis of such samples causes an inaccurate representation of the patient’s condition. These problems are identified during the analytical phase. They misinform the doctor when interpreting the results for treatment. Some of the reasons why samples may be unsuitable for testing include wrong samples, contaminated samples, and wrong storage or transportation of the sample. These samples are inappropriate for examination and must be discarded, and a repeat sample requested (Bayley 7).
Implementation of Zero Tolerance
Implementation of the zero-tolerance policy is aimed at preventing the occurrence of patients obtaining wrong test results. Zero tolerance refers to the rejection of all samples whose identity has been compromised in order to make certain that the right results are reported on the appropriate patient. Zero tolerance also emphasizes the significance of patient sample and identification to the sample collector. This principle helps to eliminate the occurrence of errors such as “Wrong Blood in Tube’. However, there are some samples that cannot be readily repeated. These samples that must be processed are known as irreplaceable samples. They include surgical samples, biopsies, lumbar puncture samples, and blood gas samples. In the event that the identity of irreplaceable samples is compromised, the laboratory should inform the appropriate doctor in order to consider the error when interpreting the test result.
Organizational Impact
The implementation of zero tolerance to pre-analytical errors ensures that sample collectors get the correct sample the first time. The policy can be enforced by ensuring that laboratory personnel has relevant education, training, and apparatus to conduct the necessary duties. The implementation of a zero-tolerance policy will enhance the communication between the collectors and laboratory technicians in order to enhance accountability. In addition, the policy requires the presentation of information using an aggregated form that shows the involved parties in sample transfer.
Sample rejection is also likely to result in rework, which makes the Request-Test-report Cycle inefficient, and wasteful of both resources and time. While some problems are detected at the point of receipt, some are detected during the analysis stage, after a lot of time has passed. The rejection of such samples leads to a repeat request that is communicated by the laboratory technician to the collector or doctor. The patient is affected in terms of having to travel to the sample collection center, which is both time and energy wasting. The collectors, doctors and laboratory technicians are also impacted in terms of time-wasting, due to the time spent in the communication process, as well as the collection, processing, and interpretation of the new samples.
The Potential Threat of Implementing the Change
While sample rejection protects the patients from wrong treatment procedures, it also results in sub-optimal patient safety and care. Sample recollection increases the risk of venipuncture and psychological instability. Acquisition of a new sample may have a traumatic effect on the patient due to the fear of severe illness, leading to stress. In treatments requiring regular blood tests, the patients may be prone to iatrogenic anemia. This condition refers to a state of anemia that arises from treatment, which may be worsened by sample recollection. Sample rejection and relocation also delay the treatment process due to delayed diagnosis. There are instances when treatment commences before the results are released. The sample tests are administered to confirm the treatment; however, sample rejection causes the test process to become redundant, and nullifies the need for sample recollection and retesting.
Monitoring and Evaluation
Implementation of the policy requires an evaluation of feedback acquired during monitoring and evaluation processes during the administration of the interventions in a five-stage cycle. The first stage involves the recording of pre-analytical errors that have occurred using a Laboratory Information System (LIS). The system allows the creation of an error test panel that comprises a collection date, location of the patient, type of error, nature of the collector (lab staff / hospital / external depending on your client mix), action taken (sample rejected or still processed) and the tests that have been affected by the error (LLopis, Alvarez and Martínez-Brú 187).
The second stage involves data analysis using applications such as excel or access to manipulate the data using tables and charts to illustrate problems. Once the results are in a presentable format that is easy to understand, they are provided as feedback to the internal management. The information can also be presented in external meetings such as Hospital Medical Advisory Committees and Emergency Department meetings. The fourth stage involves the formulation of corrective action in order to reduce the rate of pre-analytical errors. The stage requires the involved parties, namely doctors, laboratory personnel, and collectors, to brainstorm on possible solutions, such as the possibility of training and target education. The final stage involves the implementation of corrective action, and evaluation of the success of the intervention in reducing pre-analytical errors.
Conclusion
The elimination or reduction of errors in sample analysis increases patient safety and reduces redundant treatment operations. The success of interventions to eliminate pre-analytical errors also reduces time wastage and enhances the efficiency of the laboratory service. A vital element in the process involves progressive education of sample collectors in order to reduce the rate of pre-analytical errors.
Works Cited
Bayley, Kathy. Pre-analytical Errors – Make a difference. Western Australia: PathWest Laboratory Medicine WA, 2008. Print.
LLopis, M. Antonia, et al. “Quality Assurance in the Preanalytical Phase.” Applications and Experiences of Quality Control (2011): 185-201. Print.