patient safety lab 2015 blm
TRANSCRIPT
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Maimun Z Arthamin
The Laboratory andPatient Safety
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Introduction
• Laboratory data are used extensively inpatient care; consequently, laboratoryerrors have a tremendous impact on
patient safety.• Clinical laboratories ere early leaders
in e!orts to minimi"e medical errors and
improve patient safety.• #hese e!orts continue in many areas,includin$ patient and specimenidenti%cation, laboratory resultnoti%cation, and assistance in
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&re'analytic
• &re'analysis refers to all thesteps that must ta(e placebefore a sample can beanaly"ed.
• #he pre'analysis sta$e is ama)or source of residual *error+
andor variables that can a!ecttests results.
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• &re'analytic factors include patient'related variables -diet, a$e, sex, etc.,specimen collection techniques,specimen preservatives andanticoa$ulants, specimen transport,
processin$ and stora$e.• &otential sources of error, or failures in
this process, include sample
misidenti%cation, improper timin$,improper fastin$, improperanticoa$ulantblood ratio, improper
mixin$, incorrect order of dra, and
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Ten Common Errors in SpecimenCollection
1. Misidentification of patient2. Mislabeling of specimen
3. Short draws/wrong anticoagulant to blood ratio
4. Mixing problems/clots5. Wrong tubes/wrong anticoagulant
6. Hemolysis/lipemia
7. Hemoconcentration
8. Exposure to light/extreme temperatures
9. Improperly timed specimens/delayed delivery to laboratory
10.
rocessing errors! incomplete centrifugation" incorrect log#in"
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A /0 yo female came to centrallaboratory for $eneral medical
chec('up. #he result of completeblood count as in ithin thenormal limit. 1esult of the routineurinalysis as as follos2
Case 32 &reanalytical error
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Urinalysis
Macroscopic:
Color
Clarity
Reddish brown
cloudyChemistry:
pH
SG
Protein
Leuko
Nitrite
Blood
Glucose
eton
!"#
$"%$%
$&
'
'
(&
'
'
Sediment:
)rythrocytes
Leuko
Bacteria
* + , -HP.
$ + / -HP.
'
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• &atient refused this lab resultbecause she felt healthy, and not inmenstrual condition.
• Laboratory reevaluate this result andproblem, from patient preparationuntil recordin$ the result.
• Laboratory found the mista(e,simple but very important, ie,misidenti%cation and sitch over the
urine sample.
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rine Specimen ollection• It is important to instruct patients
hen they must follo specialcollection procedures
• 4loves should be orn at all times
• 5pecimens must be collected inclean, dry, lea('proof container
• &roperly applied scre'top lids
• Containers for routine urinalysisshould have a ide mouth
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• 5terile containers are also su$$estedif more than 6 hours elapse beteen
specimen collection and analysis• All specimens must be labeledproperly ith the patient+s name andidenti%cation number, the date andtime of collection,
• A requisition form -manual orcomputeri"ed must accompany
specimens
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5pecimen handlin$Table. Changes in Unpreserved Urine
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Case 62 Analytical error due topreanalytical error
#he laboratory %ndin$s of a /7 yoobess female ith heavy menstrualbleedin$ is as follos2
C8C day 32 9b 0 $dl, &C: /.6<, MC:=>.? @, MC9 6?.6 p$, 1B 3?.=<,leucocytes 0,Dl, platelet
?7,Dl.C8C day 62 9b >.> $dl, &C: /.<,
MC: =0.6 @, MC9 6?. p$, 1B
3?.7<, leucocytes >,/Dl, platelet
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• C8C day /2 9b 0.3 $dl, &C: /.><,
MC: =>. @, MC9 6/.> p$, 1B3?.=<, leucocytes 3,Dl, platelet7?,Dl.
In the day / laboratory examined theperipheral blood smear evaluation,ith the result2 erythrocytes sli$htly
hypochromic microcytic ithpolychromation; leucocytes ithinnormal limit; platelet ithin normal
value, manual countin$ of 63.Dl
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#he problem
• &roblem in veinpuncture in the obesspatients2 the subcutaneus fat isthic(, so that diEcult to palpate andlocate the vein. iEculty inpuncturin$ result in partial clottin$,platelet a$$re$ate, and %nally errorin hemanaly"er system.
• 5olvin$ this problem ith to ay of23. veinpuncture ith in$ needle, 6.crosschec( platelet number ith
manual countin$ on peripheral blood
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Postanalytical Errors:Misinterpretation
• Misinterpretation means that the careprovider has received the correct resultbut does not ta(e the correct action onthe result.
• Misinterpretation of lab test results isan important patient'safety problem2about //< of delayed or missed
dia$noses in the emer$ency room aredue to the incorrect interpretation oftests result.
• #he usual reason for the
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Case /2 Misinterpretation
A => yo female, ith chiefcomplaint of fatique, ea(nessand pale since ? mo a$o. 9er
doctor treat her ith Fe infusionbased only on complete bloodcount result, ith interpretation
of anemia hypochromicmicrocytic. 8ut her hemo$lobinstill lo until no. 5o that she
consulted to clinical patholo$ist.
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Laboratory Findin$s
CBC Hbelectrophore
sis
Bloodchemistry
9b >.? $dl, &C:6.3<, erythrocytes/.= x 3Dl, MC:
0.? @, MC9 66./ p$,1B 3=.7<,leucocytes ,63Dl,platelet 6?7,Dl,reticulocytes 3./<.
i! countin$2?>76.peripheral bloodevaluation2erythrocytes
hipochromicanisopoi(ilocytosis,
9bA6 6.?<-normal H /.79bF 3< -normal
H 69bA 0.<-normal 07
#otal 8ilirubin ./m$dl -JH3Con) bil .3? m$dl
-J H .67Kncon) bil .66m$dl -J H .=7L9 ? Kl -J6?'?>
Alpha thalassemia
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1easons hy clinician misinterpret labresults2
3. #echnical error
6. &hysiolo$ic variation
/. verinterpret of lab value
?. Knfamiliarity ith procedures or ith physfactors a!ectin$ them
7. Knaareness of extraneous factors thatin@uence tests
. Knaareness of the nature of the distributionof normal
=. Knnecessary use of tests
>. Knnecessary repetition of tests
0. Failure to interpret test in relation to clinical
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Communication lab
clinicians :erify verbal and phone orders by ritin$%rst and then readin$ bac(.
:erbal orders only in emer$encies
Avoid use of prohibited abbreviations ocument, Jotify and Communicate
clearly critical lab values
1eport up the chain of command ocument hand o!N communications O
complete transfer forms
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TERI!"!#I$