Chemistry Question

An entry level competency for medical laboratory scientists is to demonstrate communications sufficient to serve the needs of patients, the public and members of the health care team.

Preanalytical errors are tricky for laboratories to manage.  It’s useful for you to have exposure to the literature for improvement in this area.  For this discussion:

Review one scholarly source related to the improvement of pre-analytical error related to diagnostic laboratory testing.  A bibliography of suitable articles is attached or you are welcome to seek a source of your own choosing (must be scholarly)  Review one of this list or review a source of your choice.Alcantara, J. C., Alharbi, B., Almotairi, Y., Alam, M. J., Mahmoud Muddathir, A. R., & Alshaghdali, K. (2022). Analysis of preanalytical errors in a clinical chemistry laboratory: A 2-year study. Medicine, 101(27).

https://doi.org/10.1097/MD.0000000000029853

Cornes, M. (2019). The preanalytical phase – Past, present and future. Annals of Clinical Biochemistry.

https://doi.org/10.1177/0004563219867989

Galior, K. D., & Baumann, N. A. (2020). Challenges with At-home and Mail-in Direct-to-Consumer Testing: Preanalytical Error, Reporting Results, and Result Interpretation. Clinics in Laboratory Medicine, 40(1), 25–36.

https://doi.org/10.1016/j.cll.2019.11.006

Arslan, F. D., Karakoyun, I., Basok, B. I., Aksit, M. Z., Celik, E., Dogan, K., & Duman, C. (2018). The Effects of Education and Training Given to Phlebotomists for Reducing Preanalytical Errors. Journal of Medical Biochemistry, 37(2), 172–180.

https://doi.org/10.1515/jomb-2017-0045

 Lineberry, C. (2020). Effectiveness of an Educational Intervention to Reduce Preanalytical Specimen Errors. ProQuest Dissertations Publishing. https://wisconsin-uwm.primo.exlibrisgroup.com/permalink/01UWI_ML/1c042gi/cdi_proquest_journals_2436884373

For your discussion post, summarize the key findings or messages for the resource you have reviewed.

Review the posts of your peers and provide a summary of their findings.

1) Jenna

The article that I read was about a 2 year study of preanalytical errors in a clinical chemistry laboratory in Saudi Arabia. They tested over 55,000 samples for errors and found that the preanalytical phase was the biggest cause for errors, at 12%. They found that most of the errors were from unreceived samples or samples that had been hemolyzed or clotted. If samples are not received or have clotted when they weren’t supposed to, then the patient will need to get their blood redrawn, which can cause them to feel more anxious and stressed.

2) Oscar

The article The Preanalytic Phase- Past, Present, and Future provides a summary of what the preanalytical process is, along with a definition for the term and some background information. The article defines the Preanalytical phase as “all parts of the total testing process that occur from the conception of the requirement for the test through obtaining of the sample, transport to the laboratory and sample preparation, to the point where the sample is ready for analysis.” During this phase it is stated that 60-70% of errors occur in Lab medicine, with most errors occurring outside of the lab by staff that is not monitored by the lab. This high error percentage raises interest in the phase as it is one of the most important stages of the testing process. According to the article, it is presumed that the high percentage of error is due to steps that involve more human tasks, making the steps more prone to human error.

In an attempt to counter this, there have been guidelines that have been set in place to try and standardize the methodology and treatment of samples during the preanalytical phase. Although these guidelines are helpful, standardization is difficult to achieve due to cost. Due to this, the article suggests that staff responsible for handling samples receive proper and continuous training on correct sample collection and handling.

Despite the relatively high percentage of error, the article states that it is important to realize how much modern laboratory has advanced over time. With the incorporation of equipment (such as blood tubes, centrifugation, anticoagulants, etc.) and advances in medical technology, the quality and stability of samples has significantly improved since the 1800s.

At the lab that I work at I hear about some of these errors all the time. When we receive specimens, for example, tissue samples, we need to log it in to the computer and then send them to the histology department. The histology department in my lab is one floor below the main lab so we would usually send the tissue samples to histology through the pneumatic tube system. In our last staff meeting, we were told that the histology department was not receiving samples after they had been logged in. This was a huge problem because most of the time tissue samples cannot just be “redrawn” like a blood or urine sample could be. And if the specimen goes missing in the tube system, testing can’t be done and the patient won’t get results that could possibly save their life. Because of this, we now walk down to the histology department to hand deliver tissue samples so that the specimens do not get lost and the patients can get the results they need.

3) Colleen

It is evident that the preanalytical phase is the biggest source of errors when it comes to laboratory testing. My group has found that this is due to a lack of communication and knowledge of the tests being performed. It has been discussed how a hospital has changed the way specimens are delivered due to specimens being lost. My group has also discussed the importance of continuing education on correct specimen collection and handling due to the implementation of standardization.

It is important to address the preanalytical phase to reduce the risk of an error occurring and negatively impacting a patient’s treatment. There have been numerous advances in equipment that have improved sample quality and stability, but it is only until the last 30 years that documentation of errors in the lab has been reported. When I read this, I was shocked that for decades no one was reporting when a mistake was being made. Once this monitoring was put in place, error frequency in the preanalytical phase reduced from 0.47% to 0.309%. With monitoring errors, standardization of the preanalytical phase was implemented which contributed to lowering the rate of preanalytical errors. This includes recommendations for an order of draw, patient identification, standardized fasting requirements, and quality indicators for the pre-analytical phase. In order for these guidelines and standardizations to work, it is important for laboratories to promote implementation and education in order to achieve a high level of performance. Laboratories can achieve this by monitoring the preanalytical phase by using a collaborative approach and intervening when necessary. Working in a laboratory setting is a team effort where everyone must play their role and work together in order to receive the best outcome for their patients.