Pre analytical variableserrors are often unknown to testing personnel and the clinicians. Prepreanalytical md doesnt know best test test was already done orders miscommunicated patient doesnt have test done. An effective diagnostic strategy for urinalysis should be based on standard procedures for collection, transport, sample preparation and analysis. Preanalytical errors in a microbiology laboratory aim. Your computer must have audio capabilities to hear the audio portion of the presentation. It seems that people want to believe that analytical errors arent as frequent as the pre analytical and post analytical errors. For total elapsed time of 120 min, the percentage of preanalytic collection to laboratory receipt times handling and transport page 6 of 6. This descriptive, crosssectional study was conducted throughout 2012 januarydecember 2012. Nonlab personnel were responsible for 29% of the mistakes. The majority of errors come from the preanalytical phase, which is considered the basis for all laboratory works. Tube treatments, automation tube requirements, etc wians cites carraro p, plebani m.
Laboratory errors total testing process information technology preanalytical. Pre warm infant heels or the fingers of older children and adults when performing a skin. Pre analytical errors pre analytical procedures performed outside the control of the laboratory while the total testing process is typically divided into three main phases pre, intra and post analytical, exploration of the beginning and end of the loop reveals that currently, pre and post analytical steps. Quality controlquality assurance qcqa can be defined as the set of planned and systematic activities focused on providing confidence that quality requirements will be fulfilled. The term preanalytical phase describes all actions and aspects of the medical laboratory diagnostic procedure that occurs prior to the analytical phase. The pre and post analytical phases of the process account for 93% of errors. Reducing preanalytical errors whitehat communications. In larger laboratories, it is common to see a disconnection between different areas of. Jul 01, 2016 major advances in automation and instrumentation have helped reduce laboratory associated errors over the last decade, but with pre analytical errors currently accounting for up to 75% of all mistakes, laboratory medicine professionals must keep expanding their focus to what is happening outside of the lab.
Preanalytical variables account for 3275% of laboratory errors, and encompass the time from when. According to bd and clsi clinical and laboratory standards institute, formerly nccls, following is the correct order of draw during venipuncture will help to ensure accurate test results. Pre analytical errors damage an institutions reputation, diminish confidence in healthcare services, and contribute to a significant increase in the total operating costs, both for the hospital and laboratory. Preanalytical laboratory errors free download as powerpoint presentation. The overall rate of critical preanalytical errors was 0. Components of qa in hematology lab pre analytical stage analytical stage post analytical 8. The effects of education and training given to phlebotomists. The identification of reliable quality indicators qis is a crucial step in enabling users to quantify the quality of laboratory services. Pre analytical stage mainly concerned with specimens integrity. A study of preanalytical variables in clinical biochemistry. Preanalytical errors and their impact on tests in clinical.
Our many years of experience specializing in pre and postanalytics mean that we are able to respond to individual, complex laboratory requirements and offer customerspecific automation solutions for the laboratory processes in question. Questions 5 and 6 examined whether laboratories recorded preanalytical errors, and if recorded, were electronic platforms or manual recording. Numerous factors associated with this phase of the testing process, if not. Mario plebani department of laboratory medicine, university hospital of padova and center of biomedical research, castelfranco veneto, italy abstract laboratory testing is a highly complex process and, although laboratory services are relatively safe, they.
Received 9 march 2009 accepted 10 march 2009 available online 18 march 2009 keywords. The ifcc working group on laboratory errors and patient safety. Quality laboratory practice in the preanalytic phase. Do the glps apply to validation trials conducted to. Preanalytical phase is most important in testing process and involves variables that are not under the control of the laboratory. Prevalence of preanalytical errors in clinical chemistry. Until there is consensus on the identification and recording of pre analytical errors, any. The cost of preanalytical errors in inr testing at a tertiarycare hospital laboratory. Useful tips to avoid preanalytical errors in blood gas testing. Most pre analytical errors, which account for up to 70% of all mistakes made in laboratory diagnostics, arise during patient preparation, and sample collection. Useful tips to avoid preanalytical errors in blood gas. Several studies have documented that most of the errors in the clinical laboratory occur in the pre analytical phase accounting up to 80%2,4,6, 8, 9.
It covers a wide range of matters that influence the quality of a product or service. To formulate corrective measures to be taken to avoid such errors all types of preanalytical errors were documented by technical assistants and later veri. Sample preparation is a preanalytical process that can be controlled by the laboratory 10. Preanalytic phase errors 4668% constitute the majority of the total errors in the laboratory. Review of medical errors in laboratory diagnostics and where. Laboratory personnel need to be aware of the errors that can occur when collecting specimens preanalytical stage, reporting and interpreting test results postanalytical. Preanalytical errors related to venous blood sample. Various sample methods can cause significant preanalytical errors. In view of a better reproducibility of the analyses, the preanalytical requirements become stricter. Identification of the types and frequencies of preanalytical errors. Chapter 9 analytical quality assurance this chapter was prepared by r. These include inappropriate tests that have been ordered, improper sample collection, transport delays, and illegible handwriting on requisition slips. Quality assurance system the activity of a laboratory to ensure the reliability of test results, to increase accuracy, reproducibility and laboratory to laboratory comparability.
Postanalytical phase an overview sciencedirect topics. A tool for reducing laboratory errors giorgio da rin. In the last decades, a dramatic decrease of analytical errors has been experienced, while a relatively high frequency of errors has been documented in the preanalytical phase. Most preanalytical errors, which account for up to 70% of all mistakes made in laboratory diagnostics, arise during patient preparation, and sample collection. The preanalytical phase thus showed the highest percentage of errors, the most frequent problems arising from mistakes in tubefilling with an incorrect blood to anticoagulant ratio for coagulation. Patient safety is the ultimate goal above all other considerations. The quality of the laboratory diagnostic approach in farm animals can be severely affected by preanalytical factors of variation. Phlebotomy preanalytical errors flashcards quizlet. By establishing a procedure for the correct collection of blood by venipuncture many preanalytical errors and patient management complications can be avoided.
Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Postanalytical phase quality assurance for laboratory. The detection and prevention of errors in laboratory. Apr 29, 2015 preanalytical errors related to venous blood sample collection and handling preanalytical errors related to venous blood sample collection and handling. The runs test for randomness was calculated to assess changes in the trend of the series, and the degree of control over the process was estimated by the six sigma scale. Preanalytical errors and their impact on tests in clinical laboratory practice pakistan journal of medical research, 2012 january march 29 phlebotomy practices should be adopted by all health care workers. Prevention of such errors requires a coordinated interdepartmental group approach. Pretest and posttest applications to shape the education of phlebotomists in a quality management program. Preanalytical errors, quality indicators, laboratory errors, patient safety. They have previously been shown to contribute a signi. Aykal g kesapli m aydin o esen h yegin a gungor f yilmaz n. Proper blood collection and timely processing are critical preanalytical steps needed for the integrity of lab results for any analyte. The pdf file you selected should load here if your web browser has a pdf reader plugin installed for example, a recent version of adobe acrobat reader. Reliability of data for a water quality monitoring programme depends on strict adherence to a wide range of operating.
Therefore, improving the quality of laboratory testing requires a deep understanding of the many vulnerable steps involved in the total examination process tep, along with. Unfortunately, many steps in the preanalytical phase, such as specimen collection and transport to the laboratory, are often beyond the laboratory s direct control, and are not included in this study. A report by bonini and colleagues found that pre analytical errors predominated in the laboratory, ranging from 31. Minimizing preanalytical errors in blood gas testing. As with the pre analytic phase, the errors of the post analytical can occur either inside or outside of the laboratory. Closing the loop in medical diagnostic laboratory testing. Defining a roadmap for harmonizing quality indicators in. Harmonization of preanalytical quality indicators core. Pre analytical phase errors account for 50% to 75% of all laboratory errors 8. Variations in the system influencing venous blood specimen. Preanalytical, analytical, and postanalytical phases of testing the preanalytic testing phase occurs first in the laboratory process. During the 1year period, a total of 168,728 samples and.
Preanalytical errors management in the clinical laboratory. To download the pdf, click the download link below. Most errors are identified in prepreanalytic and postpostanalytic steps outside of the laboratory. An unrecorded prepreanalytical error in serum iron. The current lack of attention to extra laboratory factors is in stark contrast to the body of evidence pointing to the multitude of errors that continue to occur, particularly in the pre analytical phase. It has been reported that the preanalytical phase is errorprone, only recently has it been demonstrated that most errors occur in the prepreanalytical phase. Outline areas in the preanalytic phase where laboratory errors most commonly occur. Quality indicators in the preanalytical phase of testing in a stat. Errors in clinical laboratories or errors in laboratory.
Preanalytical issues in the haemostasis laboratory. Preanalytical laboratory errors vein tissue biology. Abstractintroduction this study describes quality indicators for the preanalytical process, grouping errors. Laboratory testing is an integral part of a cycle consisting of three phases. The intention of this brochure is to increase awareness of the possibilities for making errors and point out how errors can be avoided in preanalytics and is aimed at personnel involved with requesting and evaluating laboratory results. Effective qa detects errors at an early stage before they lead to incorrect test results. This study focuses on calibration errors in laboratory testing as they relate to the diagnosis of hypercalcemia. Feb 15, 2014 preanalytical errors contd order of draw. Most errors affecting laboratory test results occur in the pre analytical phase 4668. The total rate of sampling errors in the study period was.
Identification of the types of preanalytical errors in the clinical. The prevalence of preanalytical errors in the laboratory. Types and frequency of errors during different phases of. Most failures or mistakes occur in the pre analytical or post analytical process. Alternatively, you can also download the pdf file directly to your computer, from where it can be opened using a pdf reader. The magnitude of preanalytical errors was accurately valued. Preanalytical errors in a microbiology place lhd here ie. Briggs this chapter outlines the various techniques that may be employed in analytical quality assurance aqa, and the reasons why they should be used. The pre analytical phase thus showed the highest percentage of errors, the most frequent problems arising from mistakes in tubefilling with an incorrect blood to anticoagulant ratio for coagulation.
Rose romeo, phd, dabcc, facb redwood city, ca 94065. Laboratory errors can be defined as any defect from ordering tests to reporting results and appropriately interpreting and reacting on these. First of all, poct testing is usually performed by clinical staff i. Identify key components of pre analytic testing provide examples how preanalytic issues evolve with changes in technology compare and contrast preanalytical aspects of sample management.
Preanalytical errors paes are errors which occur prior to the analytical stage in the total testing process ttp and can occur both before and after receipt of specimens in the laboratory. Evidence demonstrates that pre and postanalytical steps of the total testing process ttp are more errorprone than the analytical phase. Managing the pre and postanalytical phases of the total testing process. Errors in the preanalytical phase, which account for 50% to 75% of all laboratory errors, have long been included in the identification and sample problems category.
Preanalytical steps, the major source of mistakes in laboratory diagnostics, arise during patient preparation, sample collection, sample transportation, sample. Abstractintroduction this study describes quality indicators for the pre analytical process, grouping errors. In this lesson, sources of errors for the pre analytic and postanalytic phases of the total testing process are discussed, along with possible solutions. Preanalytical errors and patient safety preanaliticke. Currently, pre analytical errors account for up to 70% of all mistakes made in laboratory diagnostics, most of which arise from problems in patient preparation, sample collection, transportation, and preparation for analysis and storage. Oct 11, 2012 in spite of rapid advances in laboratory science, it is still susceptible to various manual and systemic errors. As laboratory professionals we have worked tirelessly for decades to document and improve analytical performance to the point where only a very small proportion of errors actually occur during analysis. Cost, efficiency, etc are secondary to ensuring that in no way will the. Laboratory errors total testing process information technology pre analytical. Quality indicators to detect preanalytical errors in laboratory testing. Identification of the types of preanalytical errors in the. This phase may include specimen handling issues that occur even prior to the time the specimen is received in the laboratory.
Following apply indian journal of medical microbiology, 2004 22 2. This phase is part of the total laboratory procedure consisting of several stages and beginning with the physician requesting the performance of a laboratory investigation on a patient. Potential for preanalytical and analytical contributing factors. As long as your file is complete before the deadline, we do not care in what order your information arrives. To detect the percent of preanalytical errors in clinical biochemistry laboratory 2.
Preanalytical errors are quite frequent in the area of pointofcare testing poct. Various types of errors that we, as clinical biochemists, encounter in the laboratory are classified as preanalytical, analytical, and postanalytical, depending upon the time of presentation. Preanalytical, analytical, and postanalytical phases of. To evaluate the leading causes of preanalytical errors in a clinical. The medical laboratory technician will have diverse functions in areas of preanalytical, analytical, postanalytical. A recent substantial body of evidence has demonstrated that most errors in laboratory medicine occur in the pre and postanalytical phases of laboratory testing.
Pre analytical phase of the total testing process ttp is prone to more errors than analytical phase 7. The quality of all processes occurring in these phases, associated in a workflow, determine the quality of test or results e. Managing the pre and postanalytical phases of the total. Educational commentary preventing preanalytic laboratory errors learning objectives upon completion of this exercise, you should be able to. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Analysis of turnaround time during casefile and sample. Preanalytical factors affecting the results of laboratory.
In the last decades, a dramatic decrease of analytical errors has been experienced, while a relatively high frequency of errors has been documented in the pre analytical phase. An important pre analytical variable that needs to be considered in blood gas analysis. The objective of this study is to examine the frequency of errors before, during, and after analysis in a major medical laboratory. The extent and nature of these preanalytical errors in clinical settings has not been widely reported. Examples of preanalytical errors include the following. They induce increasedecrease of biochemical and hematological analyte concentrations and, as a consequence, they may cause unsuitable conclusions and decisions for animal health management and research projects. Quality indicators to detect preanalytical errors in. A presentation on preanalytical errors presented by. The preanalytical before analysis or pre examination phase of the testing process begins for the laboratory when a test is ordered and ends when testing begins.
Pdf study of preanalytical errors in a medium sized laboratory. Pre analytic phase errors should be standardized by clinicians and. An investigation in preanalytical error in a medium sized. Mario plebani department of laboratory medicine, university hospital of padova and center of biomedical research, castelfranco veneto, italy abstract laboratory testing is a highly complex process and, although laboratory services are. However, it is critical that analysts realize and remember that a measurement is only as. Lipemic samples lipemic samples are often seen following collection after heavy meals or the due to pre existing metabolic. Preanalytical errors and their impact on tests in clinical laboratory.
The preanalytical challenges of routine urinalysis. The total testing process ttp incorporates not just the analytical phase in the laboratory, but also the pre and post analytical phases 1. Of the three key processes in the clinical laboratory, the analytical phase is the most. Errors are recorded by the quality control committee in a specially. Pdf on aug 3, 2018, sharmila dudani and others published study of preanalytical errors in a medium sized laboratory find, read and cite all.
The quantity of errors in the post analytical phase makes it the second most affected in the ttp as previously stated. Pre analytical and post analytical qc often these papers play a zerosum game, emphasizing pre and post analytical quality while diminishing the importance of analytical quality. Calibration errors that positively skew calcium values in laboratory tests have the potential to significantly increase health care costs by increasing the number of followup procedures to diagnose hypercalcemia. Errors in clinical laboratories or errors in laboratory medicine. It is a challenge for the laboratory to control the steps in the preanalytical.
911 1085 402 1175 1543 763 916 59 1287 847 1231 619 117 171 995 1327 295 1193 1298 1480 427 839 186 889 382 1592 539 996 1085 1412 996 1471 407 89 424 786 1373