Specimen Collection Errors in Clinical Research Research Paper

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Introduction

Comprehensive and effective treatment is achieved through a number of factors, including not only medical and nursing interventions but also appropriate diagnostic procedures. The process of collecting specimens is an essential stage of work aimed at determining the specifics of a particular disease, its nature, and exposure methods. However, in a modern healthcare environment, there is a problem associated with specimen collection errors, which, in turn, leads to attendant issues, in particular, insufficiently accurate clinical research. Assessing potentially effective measures to promote a technique that may encourage a reduction in the number of such errors among medical personnel can be a valuable practice for improving the outcomes of interventions and the quality of diagnostic activities. As a primary research tool, a PICOT question will be developed to test a specific hypothesis through an experimental method. An evidence matrix compiled for obtaining credible results will provide an opportunity to review all the necessary resources. The purpose of this work is to determine how to avoid or reduce the number of specimen collection errors in the process of clinical medical research by finding evidence in academic literature and discussing a practice change.

Background

The problem under consideration has dangerous consequences for patients, which makes its solution an urgent task not only at the local level of individual clinics but also in general medical practice. According to Sandhu et al. (2017), the most serious risk of such errors may be expressed in the increase in the number of deaths. Therefore, both ethical issues and the legal norms of the observance of immediate duties are affected. As a result, the search for measures aimed at improving the situation in this area is a natural step towards the development of the healthcare sector. In addition, the minimization of patient deaths due to the negligence of medical personnel should also be pursued as a valuable objective.

The reason for choosing such a problem is that, according to the results of the collected data, the issue affects a large number of stakeholders. For instance, D’Angelo and Mejabi (2016) give an example of a large-scale study on the assessment of specimen collection quality in medical laboratories. Based on the results of the calculations, out of 1 million procedures performed, 6% were carried out with violations (D’Angelo & Mejabi, 2016, p. 8). These statistics are alarming since, in terms of more realistic numbers, the results are 60 errors per 1,000 cases. As Saathoff, MacDonald, and Krenzischek (2018) note, specimen collection errors are a serious problem for the modern healthcare system due to “incorrect diagnoses, delayed care, lack of essential treatments, and patient injury or death” (p. 133). In addition, such complications as increased treatment time and ever-growing costs explain the significance of this problem from the perspective of various stakeholders.

A change in the mode of the operation of specialists collecting patients’ specimens may improve the quality of treatment procedures and reduce readmissions caused by improper interventions. It is expected that the modern practice of collection and storage based on manual work will give way to more modern methods. This, in turn, will improve the algorithm of actions and help medical professionals to avoid errors. West et al. (2017) argue that the employees of laboratories where relevant activities are carried out need modern systems for monitoring workflow and evaluating results. The study of this topic is necessary since attention to this problem may provide an opportunity to change the outdated practices of collecting and storing specimens and move on to more advanced mechanisms. As Zhu et al. (2017) note, different categories of the population may experience the undesirable consequences of such mistakes, including newborns. Today, the requirements made by clinical centers to healthcare institutions cannot guarantee the absence of errors, despite guidelines with specific work standards developed for employees. Therefore, the need to reorganize work in this direction is a natural step towards innovations and improving the quality of care.

The background of the problem involves an immediate intervention aimed at promoting the updated principles of working with laboratory specimens. According to D’Angelo and Mejabi (2016), “17% of specimen misidentification defects result in incorrect therapies” (p. 8). This figure is significant, given that death is the potential outcome of errors. Therefore, it is crucial to pay attention to this issue and take appropriate measures to help not only medical staff but also patients since they experience the negative consequences of mistakes. Introducing more modern and effective principles of collecting and storing specimens will contribute to improving the current rates of recovery and become valuable tools for staff involved in this area.

Nursing Theorist

In order to substantiate the problem under consideration from the standpoint of the nursing theory as a concept involving different approaches to care, it is necessary to draw additional substantiations. In particular, among the variety of models, it is essential to choose the one that will correspond to the issue and touch its aspects. For this purpose, the Roper-Logan-Tierney theory will be used. Williams (2015) argues that this model developed by the prominent figures of nursing may provide an opportunity to predict the outcomes of care based on certain actions of medical personnel. This interpretation is relevant in the context of the specimen collection errors problem and can be applied as an additional theoretical concept.

This model is chosen because it implies assessing the success of nursing activities on visible and measurable results. In relation to the specimen collection errors problem, medical personnel is responsible for the quality and safety of laboratory materials. In case of compliance with all the immediate requirements for the work performed, the chances of intervention success increase. According to Williams (2015), based on the provisions of the Roper-Logan-Tierney theory, the goal of care is planning that starts with the evaluation of a patient’s condition. Further, necessary interventions are carried out, and the interaction of a medical provider with those who need help depends on specific needs. One of the nursing roles is to help doctors perform certain procedures, as well as follow an attending physician’s appointments. Williams (2015) states that those theorists who created this concept planned that it would be used to assess not only patient outcomes but also the results of nurses’ professional activities. Thus, this model is relevant to the analyzed problem with specimen collection since the responsibility that lies with the junior medical staff implies strict adherence to job instructions, and their violation entails additional difficulties.

The Evidence-Based Practice Question

As a research tool, a PICOT question may be posted in order to identify stakeholders and the key aspects that need to be analyzed. Since the main focus is on preventive measures, the question needs to be built on the basis of this specificity. The introduction of modern technologies that simplify control over the collection and storage of specimens is an alternative to the outdated principles of working with laboratory materials. The scheme of the question, including all the necessary components, may be as follows:

  • P: Nursing personnel
  • I: Innovative automatic systems
  • C: Traditional principles of materials processing
  • O: Specimen collection errors reduction
  • T: 6 months

In a question format, this scheme may look as follows:

For nursing personnel (P), does the use of innovative systems (I) compared with traditional principles of processing (C) may reduce the future risk of specimen collection errors (O) in a period of 6 months (T)?

The Search

The process of finding sources to substantiate specific hypotheses and assumptions is an important research stage. In the course of this study, relevant resources were selected based on the criteria for compliance with the stated topic and the principles of using both experimental and non-experimental academic articles. Sourcing was performed in such databases as PubMed, Cochrane Review, and CINAHL. The search time frame was extended to 15 years because, despite the fact that experimental studies are relevant (up to 5 years), non-experimental research papers are less frequent and have a longer publication period. This fact may be explained by the development of innovations in medicine and the emergence of new technologies for collecting and storing specimens, which, in turn, stimulates the evaluation of their functionality.

As keywords, such units were utilized as “specimen,” “collection,” “error,” “laboratory,” “innovation,” “labeling,” and “reduction.” Through the analysis of the collected sources, it was confirmed that all of them contained these entries, which prove their relevance in the framework of this study. The inclusion criteria were the documented cases of specimen collection errors, outdated practices in processing laboratory materials, and the mentioning of the importance of modern data processing methods. The exclusion criteria were nursing errors in the performance of other duties, non-health research, and non-academic studies. Initially, 15 appropriate articles were found, and subsequently, 5 of them were selected for further analysis and reference information. Subsequently, these sources were used to form an evidence matrix and provide the necessary rationale for supporting the proposed research goal and the answer to the set PICOT question. The results of the review were summarized in tables, and on the basis of the detailed analysis of the findings, essential data were obtained for subsequent discussion.

Table of Evidence Matrix

In order to present the results of the studies used, 5 selected academic sources will be analyzed in Table 1 in the form of an evidence matrix. The basic components of the review will be utilized, and the data obtained will make it possible to determine whether the articles applied to correspond to the proposed research topic and the PICOT question. As the objects of the evaluation, 3 experimental and 2 non-experimental scholarly works will be used.

Table 1. Evidence Matrix.

Author, Date, Title, JournalEvidence TypePurpose/HypothesisDesignSample/SettingData Collection InstrumentsStatistical Results/FindingsImplications/Conclusion
Kahn, S. E. (2005). Specimen mislabeling: A significant and costly cause of potentially serious medical errors. Radiometer Medical ApS.Level 3To estimate the prevalence of the problem of specimen labeling errors and give examples of cases in quantitative terms.Non-experimental quantitative research.The documentary reports of various healthcare boards, statistical calculations, as well as the analysis of financial, patient, and hospital outcomes.Statistical correlations, tables.60%-75% of errors occur at the pre-analytical phase; high costs of correcting errors committed; a human factor is a weakness.More modern ways of specimen labeling are needed to reduce errors and minimize additional costs.
Kurec, A. (2017). Proper patient preparation, specimen collection, and sample handling are critical to quality care. MLO: Medical Laboratory Observer.Level 3To analyze the pre-analytical phase and determine the factors affecting specimen collection errors.Qualitative research.Examples from medical practice and concepts analyzed on the basis of the goal.The review of the previous findings and compiling tables.Proper specimen labeling is crucial; the pre-analytical phase requires following specific preparations.The accuracy of laboratory testing depends on the quality of specimen collection and preliminary work with patients.
Layfield, L. J., & Anderson, G. M. (2010). Specimen labeling errors in surgical pathology: An 18-month experience. American Journal of Clinical Pathology.Level 1Implementing innovative technologies contributes to reducing specimen collection errors.Experimental research based on a meta-analysis.The analysis of the quality control and quality assurance methods of specimen labeling in the framework of the chosen medical unit during 18 months.We are evaluating the documented cases of errors and compiling statistical correlations.0.25% of all cases reviewed are associated with labeling errors; the absence of relevant equipment worsens performance results.The use of modern methods of collecting and storing specimens helps reduce the number of errors.
Ning, H. C., Lin, C. N., Chiu, D. T. Y., Chang, Y. T., Wen, C. N., Peng, S. Y.,… Wu, T. L. (2016). Reduction in hospital-wide clinical laboratory specimen identification errors following process interventions: A 10-year retrospective observational study. PloS One.Level 1Introducing the modern methods of specimen labeling is helps to reduce errors.Experimental research based on a meta-analysis.Documented specimen labeling errors in a Taiwan medical center during the period from 2005 to 2009.I am taking the results provided by the Department of Laboratory Medicine and compiling statistical tables and graphs.The number of errors for the period under review decreased by 98% due to the introduction of automatic control systems.The use of suitable systems for specimen labeling contributes to reducing the number of errors and improving patient outcomes.
Sandhu, P. K., Bandyopadhyay, K., Hunt, W., Taylor, T. H., Birch, R. J., Krolak, J., & Ernst, D. J. (2017). Effectiveness of laboratory practices to reduce specimen labeling errors at the time of specimen collection in healthcare settings: A laboratory medicine best practices (LMBP) systematic review. The Journal of Applied Laboratory Medicine.Level 1The analysis of possible labeling errors and the description of the advantages of introducing modern technologies.The systematic review of randomized control trials.The evaluation of evidence from 12 sources; the analysis of the findings; general patients in different healthcare facilities.The analysis of the cases of errors from different studies and the compilation of statistical correlations and tables.The evaluation of the findings reveals that 5.6%-6.7% of errors were made. The use of modern methods of collecting and storing specimens improves the quality of laboratory and clinical work.The use of modern equipment reduces the risk of making mistakes and increases the professionalism of healthcare employees.

Five Evidence Appraisal Tools

Table 2. Evidence Appraisal Tool (a).

Appraisal Tool: ResearchEvidence Rating

Strength

Quality

Article Title: Specimen mislabeling: A significant and costly cause of potentially serious medical errors
Author(s) in APA formatKahn, S. E.Publication Year: 2005
Journal:Radiometer Medical ApS
Setting:Documentary reportsSample Size: Results from 1999 to 2005
Population:Nursing personnel
Intervention:Non-experimental qualitative research
☐ Experimental☐ Meta-analysis☐ Quasi-experimental☐ Non-experimental☐ Qualitative☐ Meta-synthesis
Does this study provide evidence to answer the PICO question?☐ Yes☐ No
If the answer is No, STOP here (unless there are similar characteristics)
Strength of Study Design
  • Was the sample size adequate and appropriate?
☐ Yes☐ No
  • Were study participants randomized?
☐ Yes☐ No
  • Was there an intervention?
☐ Yes☐ No
  • Was there a control group?
☐ Yes☐ No
  • If there was more than one group, were groups equally treated, except for the intervention?
☐ Yes☐ No
  • Was there an adequate description of the data collection methods?
☐ Yes☐ No
Literature Review
  • Does the literature review identify what is known and not known about the research problem?
☐Yes☐ No
  • Does the literature review address gaps in knowledge? ☐Yes ☐ No
  • Was research reviewed current (within the last 5 years or ☐Yes ☐ No

classic)?

Study Results
  • Were results clearly presented?
☐ Yes☐ No
  • Was an interpretation/analysis provided?
☐ Yes☐ No
Study Conclusions
  • Were conclusions based on clearly presented results?
☐ Yes☐ No
  • Were study limitations identified and discussed?
☐ Yes☐ No
Summarize Pertinent Study Findings and Recommendations:

More modern ways of specimen labeling are needed to reduce errors and minimize additional costs.

Will the results answer the PICO question?☐ Yes☐ No
Evidence Rating
Strength of Evidence☐ Level I (Strong)☐ Level II☐ Level III☐ Level IV☐ Level V
Quality of Evidence (check one)☐ High (A)☐ Good (B)☐ Low/Major flaw (C)

Table 3. Evidence Appraisal Tool (b).

Appraisal Tool: ResearchEvidence Rating

Strength

Quality

Article Title: Proper patient preparation, specimen collection, and sample handling are critical to quality care
Author(s) in APA formatKure, A.Publication Year: 2017
Journal:MLO: Medical Laboratory Observer
Setting:Documented examples from medical practiceSample Size: Not identified
Population:Nursing personnel and patients
Intervention:Non-experimental quantitative research.
☐ Experimental☐ Meta-analysis☐ Quasi-experimental☐ Non-experimental☐ Qualitative☐ Meta-synthesis
Does this study provide evidence to answer the PICO question?☐ Yes☐ No
If the answer is No, STOP here (unless there are similar characteristics)
Strength of Study Design
  • Was the sample size adequate and appropriate?
☐ Yes☐ No
  • Were study participants randomized?
☐ Yes☐ No
  • Was there an intervention?
☐ Yes☐ No
  • Was there a control group?
☐ Yes☐ No
  • If there was more than one group, were groups equally treated, except for the intervention?
☐ Yes☐ No
  • Was there an adequate description of the data collection methods?
☐ Yes☐ No
Literature Review
  • Does the literature review identify what is known and not known about the research problem?
☐Yes☐ No
  • Does the literature review address gaps in knowledge? ☐Yes ☐ No
  • Was research reviewed current (within the last 5 years or ☐Yes ☐ No

classic)?

Study Results
  • Were results clearly presented?
☐ Yes☐ No
  • Was an interpretation/analysis provided?
☐ Yes☐ No
Study Conclusions
  • Were conclusions based on clearly presented results?
☐ Yes☐ No
  • Were study limitations identified and discussed?
☐ Yes☐ No
Summarize Pertinent Study Findings and Recommendations:

The accuracy of laboratory testing depends on the quality of specimen collection and preliminary work with patients.

Will the results answer the PICO question?☐ Yes☐ No
Evidence Rating
Strength of Evidence☐ Level I (Strong)☐ Level II☐ Level III☐ Level IV☐ Level V
Quality of Evidence (check one)☐ High (A)☐ Good (B)☐ Low/Major flaw (C)

Table 4. Evidence Appraisal Tool (c).

Appraisal Tool: ResearchEvidence Rating

Strength

Quality

Article Title: Specimen labeling errors in surgical pathology: An 18-month experience
Author(s) in APA formatLayfield, L. J., & Anderson, G. M.Publication Year: 2010
Journal:American Journal of Clinical Pathology
Setting:A chosen medical unit (University of Pathology)Sample Size: 29,479 cases
Population:Nursing personnel
Intervention:Experimental research based on a meta-analysis
☐ Experimental☐ Meta-analysis☐ Quasi-experimental☐ Non-experimental☐ Qualitative☐ Meta-synthesis
Does this study provide evidence to answer the PICO question?☐ Yes☐ No
If the answer is No, STOP here (unless there are similar characteristics)
Strength of Study Design
  • Was the sample size adequate and appropriate?
☐ Yes☐ No
  • Were study participants randomized?
☐ Yes☐ No
  • Was there an intervention?
☐ Yes☐ No
  • Was there a control group?
☐ Yes☐ No
  • If there was more than one group, were groups equally treated, except for the intervention?
☐ Yes☐ No
  • Was there an adequate description of the data collection methods?
☐ Yes☐ No
Literature Review
  • Does the literature review identify what is known and not known about the research problem?
☐Yes☐ No
  • Does the literature review address gaps in knowledge? ☐Yes ☐ No
  • Was research reviewed current (within the last 5 years or ☐Yes ☐ No

classic)?

Study Results
  • Were results clearly presented?
☐ Yes☐ No
  • Was an interpretation/analysis provided?
☐ Yes☐ No
Study Conclusions
  • Were conclusions based on clearly presented results?
☐ Yes☐ No
  • Were study limitations identified and discussed?
☐ Yes☐ No
Summarize Pertinent Study Findings and Recommendations:

The use of modern methods of collecting and storing specimens helps reduce the number of errors.

Will the results answer the PICO question?☐ Yes☐ No
Evidence Rating
Strength of Evidence☐ Level I (Strong)☐ Level II☐ Level III☐ Level IV☐ Level V
Quality of Evidence (check one)☐ High (A)☐ Good (B)☐ Low/Major flaw (C)

Table 5. Evidence Appraisal Tool (d).

Appraisal Tool: ResearchEvidence Rating

Strength

Quality

Article Title: Reduction in hospital-wide clinical laboratory specimen identification errors following process interventions: A 10-year retrospective observational study
Author(s) in APA formatNing, H. C., Lin, C. N., Chiu, D. T. Y., Chang, Y. T., Wen, C. N., Peng, S. Y.,… Wu, T. L.Publication Year: 2016
Journal:PloS One
Setting:Taiwan medical centerSample Size: The analysis of errors from 2005 to 2009
Population:Nursing personnel
Intervention:Experimental research based on a meta-analysis
☐ Experimental☐ Meta-analysis☐ Quasi-experimental☐ Non-experimental☐ Qualitative☐ Meta-synthesis
Does this study provide evidence to answer the PICO question?☐ Yes☐ No
If the answer is No, STOP here (unless there are similar characteristics)
Strength of Study Design
  • Was the sample size adequate and appropriate?
☐ Yes☐ No
  • Were study participants randomized?
☐ Yes☐ No
  • Was there an intervention?
☐ Yes☐ No
  • Was there a control group?
☐ Yes☐ No
  • If there was more than one group, were groups equally treated, except for the intervention?
☐ Yes☐ No
  • Was there an adequate description of the data collection methods?
☐ Yes☐ No
Literature Review
  • Does the literature review identify what is known and not known about the research problem?
☐Yes☐ No
  • Does the literature review address gaps in knowledge? ☐Yes ☐ No
  • Was research reviewed current (within the last 5 years or ☐Yes ☐ No

classic)?

Study Results
  • Were results clearly presented?
☐ Yes☐ No
  • Was an interpretation/analysis provided?
☐ Yes☐ No
Study Conclusions
  • Were conclusions based on clearly presented results?
☐ Yes☐ No
  • Were study limitations identified and discussed?
☐ Yes☐ No
Summarize Pertinent Study Findings and Recommendations:

The use of suitable systems for specimen labeling contributes to reducing the number of errors and improving patient outcomes.

Will the results answer the PICO question?☐ Yes☐ No
Evidence Rating
Strength of Evidence☐ Level I (Strong)☐ Level II☐ Level III☐ Level IV☐ Level V
Quality of Evidence (check one)☐ High (A)☐ Good (B)☐ Low/Major flaw (C)

Table 6. Evidence Appraisal Tool (e).

Appraisal Tool: ResearchEvidence Rating

Strength

Quality

Article Title: Effectiveness of laboratory practices to reduce specimen labeling errors at the time of specimen collection in healthcare settings: A laboratory medicine best practices (LMBP) systematic review
Author(s) in APA formatN Sandhu, P. K., Bandyopadhyay, K., Hunt, W., Taylor, T. H., Birch, R. J., Krolak, J., & Ernst, D. J.Publication Year: 2017
Journal:PloS One
Setting:Different healthcare facilitiesSample Size: The analysis of 12 academic sources
Population:Nursing personnel
Intervention:The systematic review of randomized control trials.
☐ Experimental☐ Meta-analysis☐ Quasi-experimental☐ Non-experimental☐ Qualitative☐ Meta-synthesis
Does this study provide evidence to answer the PICO question?☐ Yes☐ No
If the answer is No, STOP here (unless there are similar characteristics)
Strength of Study Design
  • Was the sample size adequate and appropriate?
☐ Yes☐ No
  • Were study participants randomized?
☐ Yes☐ No
  • Was there an intervention?
☐ Yes☐ No
  • Was there a control group?
☐ Yes☐ No
  • If there was more than one group, were groups equally treated, except for the intervention?
☐ Yes☐ No
  • Was there an adequate description of the data collection methods?
☐ Yes☐ No
Literature Review
  • Does the literature review identify what is known and not known about the research problem?
☐Yes☐ No
  • Does the literature review address gaps in knowledge? ☐Yes ☐ No
  • Was research reviewed current (within the last 5 years or ☐Yes ☐ No

classic)?

Study Results
  • Were results clearly presented?
☐ Yes☐ No
  • Was an interpretation/analysis provided?
☐ Yes☐ No
Study Conclusions
  • Were conclusions based on clearly presented results?
☐ Yes☐ No
  • Were study limitations identified and discussed?
☐ Yes☐ No
Summarize Pertinent Study Findings and Recommendations:

The use of modern equipment reduces the risk of making mistakes and increases the professionalism of healthcare employees.

Will the results answer the PICO question?☐ Yes☐ No
Evidence Rating
Strength of Evidence☐ Level I (Strong)☐ Level II☐ Level III☐ Level IV☐ Level V
Quality of Evidence (check one)☐ High (A)☐ Good (B)☐ Low/Major flaw (C)

Discussion on Implementation of a Practice Change

Based on the analysis of the sources used, it will be an objective decision to implement a practice-changing in the surgical department. Patients in this medical unit need thorough care, and the proper process of collecting specimens is a valuable element of the workflow. Junior staff, in turn, is to follow physicians’ prescriptions strictly and perform their duties responsibly while having the necessary skills to work with special equipment. The key stakeholders are preoperative surgical patients and nursing caregivers. As a team of specialists, two on-call nurses will be involved, one surgeon and a specialist maintaining and evaluating the use of modern equipment for collecting and storing specimens. Each of the participants will make an individual contribution due to special training. For instance, nurses will work with innovative equipment directly, and the surgeon will monitor the treatment process and make the necessary adjustments to subordinates’ activities in case of violation detection. Potential barriers may relate to the improper maintenance of innovative equipment. However, these challenges can be solved by conducting the appropriate training of the staff.

Evaluating Organizational Change Readiness

When evaluating the potential results of the proposed change plan, one can assume that this practice will enhance the quality of specimen collection and storage and, consequently, patient outcomes due to improved care. One of the main barriers that may arise is the unpreparedness of the staff to updated activities on the new equipment. Therefore, before introducing the implementation of the practice, it is essential to carry out preparatory work among interested persons, in particular, nurses, and explain to them the principles of a specific technology’s operation and its advantages. This measure will provide an opportunity to eliminate errors and staff dissatisfaction with new responsibilities. Also, it is crucial to test the operation of the equipment to ensure its reliability and effectiveness. Since the staff in the department may be unfamiliar with the nuances of specific devices’ work, it is essential for an employee responsible for the safety of certain devices to explain to colleagues the peculiarities of servicing modern systems. These procedures will allow avoiding the incorrect maintenance of the equipment.

Conclusion

The conducted study allows understanding how the problem of specimen collection errors may be prevented, and relevant findings from academic literature help in solving this issue. The topic under consideration is relevant to nursing practice due to the fact that it affects patient outcomes directly. The Roper-Logan-Tierney theory provides an opportunity to substantiate the significance of the intervention and prove the arguments in support of oriented work. Through a careful search for sources, 3 experimental and 2 non-experimental scholarly resources are selected. Such special analysis mechanisms as an evidence matrix and appraisal tools help identify the key features of the chosen studies and their significance. The proposed plan will be carried out in the surgical department, and, despite potential barriers, the anticipated results of the intervention imply improving patient outcomes and increasing the professionalism of caregivers.

References

D’Angelo, R., & Mejabi, O. (2016). Getting it right for patient safety: Specimen collection process improvement from operating room to pathology. American Journal of Clinical Pathology, 146(1), 8-17. Web.

Kahn, S. E. (2005). Radiometer Medical ApS. Web.

Kurec, A. (2017). Proper patient preparation, specimen collection, and sample handling are critical to quality care. MLO: Medical Laboratory Observer, 49(1), 22-24.

Layfield, L. J., & Anderson, G. M. (2010). Specimen labeling errors in surgical pathology: An 18-month experience. American Journal of Clinical Pathology, 134(3), 466-470. Web.

Ning, H. C., Lin, C. N., Chiu, D. T. Y., Chang, Y. T., Wen, C. N., Peng, S. Y.,… Wu, T. L. (2016). Reduction in hospital-wide clinical laboratory specimen identification errors following process interventions: A 10-year retrospective observational study. PloS One, 11(8), e0160821. Web.

Saathoff, A. M., MacDonald, R., & Krenzischek, E. (2018). Effectiveness of specimen collection technology in the reduction of collection turnaround time and mislabeled specimens in emergency, medical-surgical, critical care, and maternal child health departments. CIN: Computers, Informatics, Nursing, 36(3), 133-139. Web.

Sandhu, P. K., Bandyopadhyay, K., Hunt, W., Taylor, T. H., Birch, R. J., Krolak, J., & Ernst, D. J. (2017). Effectiveness of laboratory practices to reduce specimen labeling errors at the time of specimen collection in healthcare settings: A laboratory medicine best practices (LMBP) systematic review. The Journal of Applied Laboratory Medicine, 244-258.

West, J., Atherton, J., Costelloe, S. J., Pourmahram, G., Stretton, A., & Cornes, M. (2017). Preanalytical errors in medical laboratories: A review of the available methodologies of data collection and analysis. Annals of Clinical Biochemistry, 54(1), 14-19. Web.

Williams, B. C. (2015). The Roper-Logan-Tierney model of nursing: A framework to complement the nursing process. Nursing2019, 45(3), 24-26. Web.

Zhu, X. L., Wang, S. H., Cui, Y. X., Yao, R. F., Chen, J., & Jin, H. Z. (2017). Effect of specimen storage time on neonatal blood glucose level. Biomedical Research (India), 28(14), 6464-6466.

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