Patient Safety Lab 2015 Blm

8/20/2019 Patient Safety Lab 2015 Blm

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Maimun Z Arthamin

The Laboratory andPatient Safety



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



&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.



• &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



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"



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



Urinalysis

Macroscopic:

Color

Clarity

Reddish brown

cloudyChemistry:

pH

SG

Protein

Leuko

Nitrite

Blood

Glucose

eton

!"#

$"%$%

$&

'

'

(&

'

'

Sediment:

)rythrocytes

Leuko

Bacteria

* + , -HP.

$ + / -HP.

'



• &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.



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



• 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



5pecimen handlin$Table. Changes in Unpreserved Urine



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



• 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



#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



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



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.



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



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



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



TERI!"!#I$

Patient Safety Lab 2015 Blm

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