Anyone responsible for blood collection must be familiar with this local list. This is a useful measure because 1 mole of any substance contains the same number of particles, that is 6.023 1023. Laboratory Quality Assurance and Standardization Programs Rajamani S, Kayser A, Emerson E, Solarz S. Evaluation of Data Exchange Process for Interoperability and Impact on Electronic Laboratory Reporting Quality to a State Public Health Agency. The use of the term reference range in preference to normal range is recognition of this limitation. Closing the loop in medical diagnostic laboratory testing phases The pre-analytic testing phase occurs first in the laboratory process. A calm confident manner is important. Physicians and nurses preferred the manual method in requesting lab tests and obtaining lab test results as they perceived as faster than those of LIS. Attention to detail is particularly vital for blood transfusion requests. 2: SOME PRINCIPLES OF LABORATORY TESTING | Nurse Key The Three Phases of Medical Laboratory Testing - 24 Hours access EUR 36.00 GBP 32.00 USD $39.00 Rental. The swab should be gently rubbed only over the area at the back of the mouth (pharynx) and tonsils, especially inflamed areas. 1) THE PRESENCE OF URINE IN THE SPECIMEN 2) HAVING AN ENEMA BEFORE COLLECTING THE SPECIMEN USING CONDOMS FOR COLLECTION OF SEMEN SPECIMENS ? The need for a preservative is determined by the substance in urine to be measured. Aspiration of pus with a needle and syringe is more likely to result in isolation of the causative organism than a swab of the pus. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are as essential for the working of basic functionalities of the website. The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. The pre-analytical phase continues to be the major source of errors in laboratory medicine, and most pre-analytical errors result from inappropriate specimen collection and handling (5). Management Team The LIS evolved from a stand-alone system that only supports internal laboratory operations to a system with extended functions that are connected to HISs. Pre and Post Examination Aspects - PMC - National Center for Errors caused by human [4] Pathology laboratories supply a bewildering array of sample bottles and containers. Plebani M, Piva E. Medical errors: Pre-analytical issue in patient safety, Yusof M M, Kuljis J, Papazafeiropoulou A, Wisdom Center, Free Website Verification Testing Text describes which pathogenic micro-organisms have been isolated from the sample, but the sensitivity of these micro-organisms to antibiotics tested is reported semi-quantitatively. Why We Are Different? Conflict of Interest: The authors stated that they have no conflicts of interest regarding the publication of this article. The TTP-LIS framework features a comprehensive evaluation method of sociotechnical factors that can be applied flexibly in other processes and systems in a similar or different clinical settings. Most clinical laboratories have a policy of discarding leaking specimens. By testing the units in isolation, finding the cause of an issue is expedited, saving both time and energy. For a few biochemical tests, for example, blood hormone levels, it is vital that blood is sampled at a particular time of the day. Quality assurance of the preanalytical phase - acute care testing 4.5 million million) and 6 500 000 000 000 (i.e. Physician (2)
Nurse (2)
Lab head (1)
Lab staff (2)
IT staff (1), Semi structured interview questions were formulated according to the job description and role of participants, Physician (1)
Lab head (1)
Lab technician (1)
IT staff (1), Lab test request form
Statistical report of the lab test request form
Statistical report of the lab test results (non/late access, location, and test type)
Monthly/annual report
Improvement in the lab testing process
LIS improvement report (based on modules/ functions/others), Process flow of the lab test request
Lab test report process, Irrelevant text/unclear test type selection/unfriendly user interface resulting in user misunderstanding, 2. Lippi G, Betsou F, Cadamuro J, Cornes M, Fleischhacker M, Fruekilde P, Neumaier M, Nybo M, Padoan A, Plebani M, Sciacovelli L, Vermeersch P, von Meyer A, Simundic A. Preanalytical challenges: Time for solutions. The manual form saved more time. A nurse stated that although system use eased our task, our competency is low. Therapeutic drug reference range 5. INTRODUCTION. Normally, neither the nurse nor the lab head would realize the mistake until the physician checks the order before submitting it to the LIS. This work is licensed under the Creative Commons Attribution 4.0 License. Latent failure is a major challenge for management and organizational decision makers. What is pre-analytical phase in laboratory? Puncturing the ball of the finger tip is more painful. An anticoagulant that prevents blood from clotting by precipitating calcium, similar in action to EDTA. Although efforts and resources are continuously focused to achieve a satisfactory degree of analytical quality, there is clear evidence that the preanalytical phase is much more vulnerable to uncertainties and accidents, which can substantially influence patient care. The principles of patient sample collection, Units of measurement used in clinical laboratories, The concept of the normal (reference) range, The concept of test sensitivity/specificity, Difference between (blood) plasma and (blood) serum. The short duration of the observation limited the detail evaluation of possible error incident during the lab test process but this situation was offset with a briefing from the lab head. 2022 Jan 11;23(1):1326. doi: 10.4102/sajhivmed.v23i1.1326. Wang Z, Peng C, Kang H, Fan X, Mu R, Zhou L, He M, Qu B. Laboratory Testing and Interpretation Flashcards | Quizlet Baron J M, Dighe A S. Computerized Provider Order Entry in the Clinical Laboratory. QA Audit & Process Improvement official website and that any information you provide is encrypted A purposeful snowball sampling method provided in-depth information from key informants. However, monitoring is imperative at the outset [27] to ensure guideline compliance. Inclusion in an NLM database does not imply endorsement of, or agreement with, concentrated hydrochloric acid, so care must be taken. False. . Considering analytical influences alone, test methodologies affect the magnitude of false positive and false negative results. Conventionally, laboratory practice can be divided into three phases, i.e., preanalytical, analytical and post-analytical phase. Moreover [some] lab test results accessed from LIS showed unexpected analysis when the results are linked to diagnosis results from the CIS (Dr. B). The integration of heterogeneous, outsourced, and in-house developed systems with different platforms, hardware, and software resulted in many system problems, such as unreadable information, unclear images (blurred, inappropriate pixel sizes, and display of system coding), and inaccessible information. The error factors are related to system development elements, namely, latent failures that considerably affected the information quality and system use. The clinical laboratory is no longer its own limited ecosystem, as it is increasingly integrated with patient care, assisting diagnosis, monitoring therapies and predicting clinical outcomes. These cutting-edge hospitals have been leading the national health care and are recognized by accreditation bodies such as the Malaysian Society for Quality in Health, Joint Commission International (XI), and Quality Management System (MS ISO 9001: 2015). Laboratory investigation of patient samples is the sum of three distinct phases: In this chapter some general principles relating to pre- and post-testing procedures are discussed. An official website of the United States government. Human factors mainly contribute to errors in the lab testing process and LIS, as proven in other studies [7]. Nurses are however involved in sampling of cervical cells for the cervical smear test (Chapter 24). The page below is a sample from the LabCE course Risk Management in the Clinical Laboratory (retired 6/6/2018). If there is a history of fainting during blood collection, take the sample with the patient lying down. Result abnormalities are entailed for the second test, whereas erroneous request attributable to staff carelessness or inefficiency should be avoided. In fact, 1 litre = 1000.028 cm3. Yeo C P, Ng W. Automation and productivity in the clinical laboratory: Experience of a tertiary healthcare facility. Inappropriate testing is not only wasteful and costly, but also risky to patients [32]. VSM is used to illustrate the overall process to identify waste/problems and the appropriate solutions in the current and future state map, respectively. Accurate and timely test reports are the responsibility of submitted specimens are analyzed. Risk Management in the Preanalytical Phase of Laboratory Testing A lab testing process is divided into three stages: pre-analytical, analytical, and post-analytical. Foreword (from the first edition) Donald S. Young MD, Ph.D, in Accurate Results in the Clinical Laboratory (Second Edition), 2019 Factors affecting the usefulness of laboratory data may arise in any of the preanalytical, analytical or post-analytical phase of the testing cycle. Therefore 1 mole of glucose is 180 g glucose. A very brief reference to tissue sampling techniques necessary for histopathological examination has already been made in Chapter 1. This phase ensures that the individually tested units work well together in assemblies. This work was supported by the Ministry of Higher Learning Malaysia (Grant no.s FRGS/1/2018/ICT04/UKM/02/5 and ERGS/1/2011/STG/UKM/02/46). Choosing the wrong test commonly happened in critical situations where [the] physician does not have time to check [the] test requested by the nurse and the nurse forgets to verify it with the physician. A mistake is usually realized upon test completion. QA Performance Engineering & Optimization, Business Analysis & Requirement Engineering, Module & Components Integration Testing Phase, System & System Integration Testing Phase, Production Verification & Acceptance Testing Phase. For example, it is more likely that bacteria will be isolated from a large specimen of sputum than a small specimen. body weight, temperature, pulse rate), all quantitative results reported by clinical laboratories are defined by the unit of measurement. The technique, which is more hazardous and painful than venepuncture, is described in Chapter 7. Standard operating procedure manuals and job aids are written for guidance for carrying out each step of the phase: pre-analytical, analytical and post-analytical. Sometimes it is useful to know exactly how much of a particular substance (e.g. Why Outsourcing? c. pre-analytical, analytical, and post-analytical. LAB.ADM.1.006 - Laboratory Equipment Management Plan Requirements and Documentations: 1.Documentation of Statistical Analysis or Method Validation before put into use and A3 can be combined with other Lean tools, such as VSM and 5Why, to visualize and identify the root cause of problems. Reference ranges are constructed by measuring the substance in question in a large population of apparently healthy normal individuals. FOIA Reduction of preanalytical errors in laboratory by establishment and application of training system. All reports from the histopathology laboratory, for example, are qualitative; they take the form of highly technical written text, describing the appearance of tissue samples when viewed microscopically. the laboratory. After each unit has been tested, the third phase begins: Integration Testing. We illustrated the problems to aid in identifying the root cause and planning for mitigation as follows. This study contributes to the existing knowledge by proposing a new framework based on the HOT-fit and TTP frameworks, as well as concepts in error management and process improvement, namely the Lean methods. When collecting any microbiological specimen, it is important to minimise environmental contamination by using aseptic technique and replacing swabs back in sterile containers or transport medium immediately. It is vital, if results are to find their way back to the correct patient records, that specimen labels accurately and fully identify the patient. Khajouei R, Saghaeiannejad S, Jahanbakhsh M, Recurring errors also indicate ineffective and inefficient workflow and system use that negatively affects work motivation. Medical laboratory testing and reporting is a complex and arduous task,That seeks to provide answers to questions; which our clients and clinicians ask.Collecti . Challenges in Preanalytical Phase of Laboratory Medicine: Rate of Blood As a library, NLM provides access to scientific literature. Carraro P, Plebani M. Errors in a Stat Laboratory: Types and Frequencies 10 Years Later. Careers. Preanalytical quality improvement. Total testing process (TTP) [8] is a unique framework that guides the testing process as well as analyzing and minimizing testing error risk not only in the laboratory center, but also in other clinical units [7] Epub 2017 Feb 27. Most blood tests are performed on venous blood collected by a technique known as venepuncture, using either a needle and syringe or, more commonly, an evacuated tube system (Figure 2.1). We conducted a qualitative case study evaluation in two private hospitals and a medical laboratory. [32] They collaborated with a private laboratory, Lab C, which has managed most lab operations at all PH branches since 2000. analyzing and redesigning workflow according to Lean methods; establishing clear, written, and digital procedures; outlining indicators for quality monitoring;and. Basically, the three phases are the preanalytical phase, analytical phase, and post-analytical phases. The preanalytical phase of the laboratory testing process includes all of the procedures prior to the start of sample analysis, and typically involves a variety of healthcare professionals. The mole is defined as the quantity of a substance whose mass in grams is equal to its particle (i.e. Patient details, including: full name, date of birth and hospital number. Ying Li H, Yang YC, Huang WF, Li YF, Song P, Chen L, Lan Y. J Evid Based Med. Where the molecular weight of the substance being measured is precisely defined, as it is for many of the blood born chemicals measured in clinical laboratories, the mole (unit of amount) is used. Some examples include: 2014 Dec;7(4):258-62. doi: 10.1111/jebm.12125. the contents by NLM or the National Institutes of Health. Capillary blood can be recovered by a simple skin puncture with a sterile lancet, usually on the finger tip or, in the case of neonates and babies, the heel of the foot. ALL the urine passed MUST be collected. EDTA also preserves the structure of blood cells. All these specimens are destined for microbiological examination and the object is to sample only from infected sites, whilst avoiding bacterial contamination from other sites on the body or from the environment. Before Therefore the molecular weight of glucose is. and transmitted securely. Human, lab testing process, organization and technology factors are intertwined. government site. Table 2.4 Secondary SI units of length, mass (weight) and amount used in laboratory medicine. Fax:1-800-622-8645 Specimen spillages should be dealt with in accordance with local policy. As can be seen from Figure 3, the variation of stress-strain curve of samples of each group roughly went through four stages: compaction, elasticity, yield and failure.1) Compaction stage: the original cracks inside the sample were compacted to form nonlinear . Integration Testing Figure 3 shows the stress-strain curves of the samples in the conventional triaxial compression test. This category only includes cookies that ensures basic functionalities and security features of the website. Instruct the patient to take deep breaths while you continue with the blood draw. The proposed framework and Lean approach are applicable for evaluating the laboratory testing process and laboratory information systems in a rigorous, comprehensive, and structured manner. Clinical Laboratory Tests: Which, Why, and What Do The Results Mean? Figure 2.1 Collection of venous blood with Vacutainer system. There are far fewer white cells than red cells in blood and this is reflected in the unit of the white cell count, which is 109/L or the number of thousand million cells in every litre of blood. We identified participants from our initial contact with the lab director. All sample containers must be fully labelled including patients full name, date of birth and location (ward, clinic or GP). In short, system development outcomes significantly affect the system and information quality, and service quality determines the fulfillment of user requirements. This phase may include specimen handling issues that occur even prior to the time the specimen is received in the laboratory. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Erroneous results may occur if these blood volume instructions are not observed. Then, the lab test results must be printed and sent tophysicians or nurses. Haemolysis (the rupture of red cells) during blood collection may render the sample unsuitable for analysis. [29] that waste time, resources, and cost in terms of service or materials. Sonmez C, Yldz U, Akkaya N, Taneli F. Preanalytical Phase Errors: Experience of a Central Laboratory. Clinical pathology departments are now mandated to publish a manual usually available online for users (doctors and nurses) of local pathology services. Each container has specific uses; it is vital for accurate results that the correct container is used for the test requested. 27 Learn about Prezi SE Shane Richel Esterban Sat Feb 06 2016 Outline 23 frames Reader view 3 Phases of Laboratory Testing Laboratory Indicators - measures our quality performance. Post-Analytical Phase - an overview | ScienceDirect Topics However, the test type that she chose differed from that desired by the physician. The Testing Process - LabCE.com, Laboratory Continuing Education QA Manager on Demand Bethesda, MD 20894, Web Policies We collected data using interviews, observations, and document analysis methods involving physicians, nurses, an information technology officer, and the laboratory staff. Prolonged use of a tourniquet can affect laboratory results. Various efforts have been made to reduce errors in routine monitoring, particularly in the early and final phases of the lab testing process, given that both phases involve clinical instead of lab staff who are more familiar with the related process. In general, continuing technological advance serves to significantly reduce the amount of blood required for tests. 2007;45(6):728-36. doi: 10.1515/CCLM.2007.174. Every litre of blood plasma contains 9 micromoles of iron, that is (9 0.055) mg or 0.5 mg. What does the result plasma B12 300 ng/L mean? The study focused only on pre-pre-analytic and postpost-analytic phases of the TTP framework, given their high error rates [14] [21] There are six different phases used during a full software quality assurance test cycle. [9]. Leaking specimens present a major and surprisingly frequent potential hazard which can be prevented by the simple expedient of ensuring sample bottles are not overfilled and tops are well secured. The . 1 False. Recommendations for detection and management of unsuitable samples in clinical laboratories. Generally. Please complete the form and one of our QA Expert Specialists will be in contact within 24 hours.Alternatively, drop us an email at support@qamentor.com or give us a call at 212-960-3812, About Us Threshold to diagnose disease 4. By testing the units in isolation, finding the cause of an issue is expedited, saving both time and energy. Necessary cookies are absolutely essential for the website to function properly. A CSU is the urine sample collected from a patient who has an indwelling urinary catheter. Quantitation of this urinary loss can only be made by collecting all the urine passed during a 24 hour period. The laboratory testing process consist of five analysis phases featuring the total testing process framework. This mistake required the physician to report the occurrence to the management and finance, and the charge must be paid by the hospital. HHS Vulnerability Disclosure, Help However, a lean workflow is imperative prior to optimizing the process automation to improve the core issues in the workflow itself [3] blood gases) require that samples be processed immediately they are taken. Principle use of sodium fluoride: used with oxalate in tubes specifically for blood glucose measurement. The text will include a summary of the clinical significance of any deviations in appearance from that of normal tissue. Functional testing, security testing, performance testing, and database testing are examples of the multitude of tests that can be run during this busy phase. Becher E C, Chassin M R. Improving Quality, Minimizing Error: Making It Happen. official website and that any information you provide is encrypted These latent failures hinder the optimized potentials of the LIS. 2021 Sep;35(9):e23895. [26], as proposed in our error management approach. 2015 Feb;53(3):357-70. doi: 10.1515/cclm-2014-1051. The IT staff in Lab C provide training to LIS users Figure 2. illustrates the overall findings according to the proposed TTP-LIS framework. This website uses cookies to improve your experience while you navigate through the website. If the patient inadvertently discards some urine during the collection period, all the urine collected to that point must be discarded, a new container obtained and collection restarted. [23] Phlebotomy Certification: Practice Test #3 For example, a sputum specimen is intended to reflect the environment of the respiratory tract, not the mouth. This last sample must be added to the container. An error management method serves as a tool to mitigate errors identified by the system or through routine error checking at the end of a task completion. We chose to analyze four process scenarios that were recommended by the informants according to their error impact on the overall workflow in terms of additional time, increased workload, material waste, and (most importantly) delay in patient treatment. 2017 Jul;50(10-11):568-573. doi: 10.1016/j.clinbiochem.2017.02.021. What are the 3 phases of laboratory testing? - Studybuff.com The detail of collecting an MSU and CSU for microbiological examination is provided in Chapter 21. Samples for microbiological investigation are best taken before antibiotic therapy is started, since antibiotics will inhibit the growth of bacteria in culture. Correspondence to: Maryati Yusof, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia. Clinical Laboratory - StatPearls - NCBI Bookshelf Therefore 1 mole of water is 18 g of water. Important errors can occur during the pre-analytic phase with specimen handling and identification. Pitt L F, Watson R T, Kavan B C. Service Quality: A Measure of Information Systems Effectiveness. This policy, which requires integration between requirements and design, full commitment and interdepartmental cooperation, should make laboratory activity more compliant to the inalienable paradigm of total quality in the testing process. DOC Management Statement - State of Michigan There are 300 ng or 0.0000003 g of the vitamin B12 in every litre of blood plasma. We must perform the test upon receiving the sample and request form. Factors influencing the high rejection rates of HIV 1/2 serology samples at Charlotte Maxeke Johannesburg Academic Hospital and the cost implications. According to a physician, system use disrupted my task. Greke nastaju i zbog problema u razvoju samog kvaliteta informacionog sistema. The physician is responsible for rechecking requests, and the nurse must remind the physician about it before submission. The detail of good practice is included in the local safety policy. : reminder on main web/mobile LIS interface, awareness campaign, training, and poster), Physicians and staff are aware of and adhere to the procedure, System upgrade to include auto verification and alert functions, Increased efficiency and reduced turnaround time for lab test request and initializing patient treatment. We went through a relatively challenging, iterative process of constructing structured and comprehensive socio-technical factors in the TTP-LIS framework [12]. All sample containers for microbiological examination, for example, urine, swabs, blood culture bottles etc., are sterile and should not be used if seals are broken. A reliable approach to overcome this problem entails prediction of accidental events (exhaustive process analysis, reassessment and rearrangement of quality requirements, dissemination of operating guidelines and best-practice recommendations, reduction of complexity and error-prone activities, introduction of error-tracking systems and continuous monitoring of performances), an increase in and diversification of defenses (application of multiple and heterogeneous systems to identify non-conformities), and a decrease in vulnerability (implementation of reliable and objective detection systems and causal relation charts, education and training).