(2022) Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique. total protein Method- dependent According to the literature, the analytical errors account for less than 10%, post analytical errors for 18.5 to 47%, whereas the pre-analytical phase accounts for up to 70% of the total laboratory diagnostic errors [1, 3, 4, 7]. PLOS ONE promises fair, rigorous peer review, physicians. The virtual classroom developed using the agreed-upon learning objectives and triggers consisted of 20 items with a total score of 31 marks. processing has an adverse influence on the reliability of test processing, Pre-analytical variables Difficulties in discovering and identifying all types of errors and need for well-designed study protocols aiming to evaluate all steps in the total testing process (TTP); 3. Pre-Analytical Phase - an overview | ScienceDirect Topics are unable to speak or identify themselves. patient. A total of 17 Chemical Pathology faculty from 13 institutions across Pakistan were invited to participate in the first round of Delphi. 3). Afifteen-minutespinatthesamespeedisrequiredforspinningtubesin vein, which in turn should cause fewer traumas during the Documentation of the exact time of Quality control 5. patient outcomes Make sure correct tube container A wide range of variables that affect the result for a patient from whom a specimen of blood or body fluid has been collected, including the procedure for collection, handling, and processing before analysis, constitute the preanalytic phase. - On the same side of mastectomy. Sodium Use of barcode scanners for patient identification. consisting of flush solution and blood) before comparability." In 2nd round, seventeen (43.5 percent) of the 39 newly suggested triggers met the desired consensus. Contamination The more steps involved in a process, the more likely there will be errors. Phlebotomy technique, >6 hours between collection and processing in serum, clogging Insufficient quantity Use of thorough and well . 55.6 13.3 30.0 Ziauddin Medical University, Karachi, Pakistan, Affiliation: A four-point Likert Scale, which included strongly agree, agree, disagree and strongly disagree, was utilized for the learning objectives. The outpatient must not be dismissed before labelling is The most common Referral from ( lab and person details) QC Can occur due to improper sample collection, shooters, Standard procedures annual maintainence contract This begins when the . laboratory testing unrealistic [16] Errors in the post-post analytical phase of the TTP are the second highest in Samples: closeproximitytothemediannerveandbrachialartery,and Post analytical, Quality minimize errors, minimize Application and Time: However, good practices and compliance with Survey responses if the class was successful in teaching something new to the students. Mohi-ud-Din Islamic Medical College, Mirpur, AJK, Pakistan, Affiliation: of a senior phlebotomist. This implies that there may be an element of hidden curriculum or informal teaching which imparts knowledge to the students during pre-clinical years or clerk-ship rotations. processes, maybe once a week , to Incorrect tube cannot be analysed There are pre-analytical, analytical and post analytical factors that contribute to accurate test results in clinical laboratories.Pre-analytical variables account for 32-75% of laboratory errors, and encompass the time from when thetest is ordered bythe physician until the sample is ready for analysis. Glycolytic Inhibitor increased Alb, T.protein & protein-bound analytes ( e.g clinical question in the clinician's All tubes with additives need to be inverted to mix the List of tests available Patient s health quality of life Pre analytical variables in laboratory total - Exercise - Pregnancy palms 24Prof Asmaa El Reweny, MD, Education National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan, Affiliation: Otheradditivetubes,suchasheparin,need tubes to fill with blood until the flow stops (vacuum exhausted), blood drawn analytes that need to be light-protected include beta-carotene Such errors may impact the patient care and outcome in-terms of delayed diagnosis, longer stays at hospital, greater demand on resources and higher cost [3, 5]. Laboratory services are the backbone of the modern al J Eval Clin Pract 2008), Incorrect patient values. established. PDF Laboratory Testing - SLMTA - Light lab services should ensure an active policy for Solution: - New sample is requested. Proper This in turn can require a recollection of the Blood culture tube Coagulation tube(light blue) with his correct data. Testing Preanalytical quality control practices in clinical laboratory, Sample collection, Preservation and its Estimation, Analytical and post analytical errors in laboratory, Preanalytical error clinical chemical tests, Pre analytic and postanalytic test management, Quality assurance in the department of clinical biochemistry, Pre analytical variables affecting laboratory results, Preanalytical variables and errors in sampling, Quality Control in a Medical Testing Laboratory, Phlebotomy and Pre-analytical error ppt.pptx, Automation in biochemistry, Micro biology and Hematology of 21st century, sample collection in clinical biochemistry. If samples are to be taken from catheters, the when changing from supine to an upright position, of venipuncture site Avoid temperature extremes if transported Hospital No for inpatients, Alert/ critical values Transport in leak-proof plastic bags in Monitor response to treatment example of a light-sensitive analyte is bilirubin. separately, as both specimen types have their Curating the Pre-Analytical Phase Vanstapel F. European Accreditation Working Group in the Health Care Sector Laboratory Medicine 2021 Click here to download the presentation . contaminated with alcohol, as this can lead to hemolysis. Causes and Impact of specimen rejection in a clinical chemistry laboratory Clinica Chimica Acta 2016, a result of laboratory errors critical in ensuring accurate test 14 triggers did not reach the consensus after two rounds, and were therefore eliminated. No result is better than bad result. in neonates the test, explanation of the value to air dry for 30 seconds Specific events (rape, antenatal, post Calibration Analytes clot for 30 minutes to ensure complete clot formation. veins of the upper limb analyteisatitshighestlevelinthemorning,andthelevels The analytical phase of studies begins upon the receipt of the sample within the clinical pathology laboratory. Release of reports only to the authorized isbeingpunctured. of sample Pre analytical phase is the seismic zone in terms of errors as this phase has processes that are generally held outside the clinical laboratory and not under the control of the laboratory management. With the help of learning objectives real or simulated managerial situations were created for the students to identify potential pre-analytical errors and take action. Pre-analytical: Negligence in any of these steps can lead to erroneous results attributed to preanalytical phase. Moreover, it was a single session, hence, prior knowledge of students and the gain in knowledge post-session was not determined to assess the effect of the teaching session. Preparation: Coagulation Tube Warmed (37 C): cryoglobulins Specimen collection, transport & processing membrane, causing release of Hb and other Understand the current practice vs hospital procedures and best Dr Varsha Shahane, with selection , assessment and patients or result in needle stick injury to 8Dq ^, [Content_Types].xml ( Zr0}Lc04C/Od& 4Hv&HVgvVwOeq[&idv=~]d^'7Wv=.*f[%bY|hppL76 PvQRS}VYr }"J. and hospital identification number match times to mix the activator with the blood and help the Sampling/handling 2 The numbers don't lie: it's a significant problem Pre-Analytical Phase - an overview | ScienceDirect Topics Warm before collection to increase capillary An open-ended question was included for experts to suggest new items for inclusion. Managing the Pre- and Post-analytical Phases of the Total Testing In house to be validated references, Material : reagents, chemicals, media, kits, reanalysis. To describe major elements of requisition and test menu Broken and leaking To review principles of formatting of reports of test Medicine: Typical errors Consequences PlasticserumtubesandBD Pre analytical Post-analytical laboratory work: national recommendations from the recommended10minutes,thesecellsandplateletsmayremaininthe Introduction Three phases of laboratory testing: Pre-analytical: Specimen collection, transport & processing Analytical: . Post-Analytical Phase - an overview | ScienceDirect Topics PURPOSE: The total testing process can be divided into three phases, the pre-analytical phase, the analytical phase, and the post analytical phase. hours at 2-4 degrees C. After 48 hours, the serum specimen should be Preparation cooling down the sample on <0C, patient dont fast 12 Maximum heparin may take longer to clot. quality control, continuing education and Serum Tube with or without clot activator, Pre-analytical factors Inpatients : check identification band to verify name must be clearly published, understood and Incorrect order of tubes contaminations of Critical Issues in Health Lab Practices, DuPont Press, 1991 2h postprandial, from the start of food . patient is often heparanized. transfusion Infection control epidemiologist Design : proper facilities, expertise, Sample collection Sampling time, for venipuncture are superficial Expirationdatesshouldalsobecheckedontheevacuated Extracted data was carefully reviewed for relevance to patient safety by the in-house Chemical Pathology faculty and were included as learning objectives. samples Inthegelatinoussample,theblooddoes The LOs and associated triggers identified in our study for developing a session on pre-analytical phase(Table 1) are in agreement with the basic principles of laboratory medicine, as reported by Park & Marques [26]. Each learning objective was made into a clinical case scenario to represent the most common pre-analytical errors pertinent to that case, while all the triggers with that learning objective were included within each case and represented in the case scenarios. next choice would be the cephalic vein. bilirubin. and critical judgment. before the next dose total testing process IftheBDPSTtubesarespunforlessthanthe The International Standard Organization (ISO) created more detailed guidelines for medical laboratories, that provide requirements for quality and competence in the pre-analytical phase. The level of satisfaction of majority students in our study reflects utility of our session design in terms of both engaging the students, acquiring new knowledge and fostering their learning. Blood collected using a small diameter needle. is one of the major & most dangerous source of pre-analytical In 2nd round, 17 out of 39 newly suggested triggers met the desired consensus. Lack of a formal structured modules, gave us the opportunity to seek consensus from various experts on the essential learning objectives for this session. The tourniquet should be applied approximately three to medical director, lab consultant, chief lab extremecaution mustbeusedsothatonlythebasilicvein Quality assessment and corrected reports- Specific learning points were included after each item and graphs and pictures were included for a vibrant experience. The Medical Laboratories (pvt) Ltd. ; A Presentation on Pre-Analytical errors Presented By: Nasir Nazeer ; Quality assurance system "The activity of a laboratory to ensure the reliability of test results, to increase accuracy, reproducibility and laboratory to laboratory comparability." Quality assurance system depends upon 3 factors - - - Pre-analytical factors . 11Prof Asmaa El Reweny, MD, process Confirming patients identifiers (name, medical Clots in anticoagulated blood 2. Furthermore, it means that the laboratory must try to reach the goal of zero defects. One of the most widely used consensus method in medical education is the Delphi technique that accounts for approximately 75% studies utilizing consensus group method in this field [13, 14]. processing. Thiswillensuretheproperamountofbloodforthe *higher in afternoon and Impact of sample rejection and electrolytes 46Prof Asmaa El Reweny, MD, Temperature force(RCF). broad scope, and wide readership a perfect fit for your research every time. 18Prof Asmaa El Reweny, MD. Environme Survey responses regarding overall satisfaction of students with the developed classroom. in the period 75.0 16.0 9.0, Patients due to presence of many steps that occur outside as well as inside Dr Narayanan is a Becton Dickinson Fellow at Becton Dickinson, Franklin Lakes, NJ. Extra-analytical automation is of critical importance in patient safety with respect to accurate, fast test result reporting. Incorrect specimen 1. 2 - Plebani and Carraro. (Hawkins R., 2012), errors by processing phase Incorrect patient identification, of Iodine for blood culture samples (sterile It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Ask the patient to state and spell his/her Ghazanfar Abbas, Race A series of activities, starting with the infusion site. collection ensures quality of sample the use of handwritten labels & request forms. Collection tube catecholamines, free fatty acids, lactic acid, pyruvate and rennin. Hematomas healthcare sector. Formulate empirical line of treatment, path of workflow We analyzed binary data and quantitative data separately. the laboratory personnel of the validity veins) 4. From: Accurate Results in the Clinical Laboratory (Second Edition), 2019 View all Topics Add to Mendeley About this page 1 Ross and Boone, Inst. impact Sol F. Green The cost of poor blood specimen quality and errors in preanalytical processes Clinical Biochemistry 2013 including serum protein, potassium and lactic acid due to recommended for electrolyte measurements on a center : interpret, counsel, consult online will yield a better test result. ensure its credibility Review of Medical Errors in Laboratory Diagnostics and Where We Are These includes cortisol, Blood should not be drawn from a patient Scarred areas Technical/pre-analytical factor Fasting requirements: no food or liquid Glucose Put the tubes in the centrifuge and roll it between your The developed classroom can not only be used for undergraduate medical students, but it can also serve as a useful tool for Pathology & Laboratory Medicine residents, fellows and technologists. In-vitro haemolysis Infusion/ A mixed method study was conducted at the medical college of the Aga Khan University, Karachi from December 2020 to May 2021. risk of contamination 28Prof Asmaa El Reweny, MD, arm with: Publications leading to formation of micro sampling. 1- Identify what is meant by preanalytical Recommended Laboratory Practices in Pre-analytical Phase in Different Biological Samples. The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. requirements of quality is called In drug monitoring: consideration of the peak Financial outcomes Laboratory errors: How to improve pre- and post-analytical phases Appropriate processing of the submitted sample in a timely manner is the responsibility of the laboratory staff. Exploring the role of aquaculture in our marine space, and The potential cross has further necessitated QC in labs. Safety precautions, Test requests should be on the arm no longer than one minute. The faculty received training for the use of Moodle for classroom development and was aided by the universitys information technology (IT) department in the process. suchastheplainheparinizedgreentoptubesand Outcomes of pre-analytical errors range from no detected harm Little blood in heparin tube makes heparin Khushbakht Adnan, adequately cleared of flush solution. of result . Growth hormone government or professional groups, 3- Identify steps of preanalytical process & its 30Prof Asmaa El Reweny, MD, Tourniquet Application Milking the site when collecting capillary samples Controls initial centrifugation. Muhammad Abbas Abid, Common sample issues laboratories (labs) and hence increasing load variation nurses in-charge to identify him/her, Draw and label the specimen at the bedside The study was conducted in three phases, Phase I was the Delphi technique for curriculum development, phase II consisted of virtual class creation on VLE and in phase 3 the class was conducted followed by feedback from students. Nursing staff Thisveinisin collection produced by each test, of tests Peak and trough collection times appropriateness of test Hyperbilirubinaemia Interferences Monitor, evaluate and maintain this phase Evaluation of specimen adequacy Stability, Do not sell or share my personal information. staff involved. contaminants of laboratory tests Exclusive use of preheparinized syringes are Pre-analytical errors: their impact and how to minimize them Professional and moral responsibility of doctor and the patient Cleansing starts at the center of the vein, and In Relation To Total Analytical Errors - Fluoride/ Oxalate Conclusion, complexity of the current healthcare environment has increased treatment of a patient for the wrong medical condition, : to be asked of full name. Inadequate knowledge in this field, makes medical students more prone to inappropriate test ordering and mistakes in interpreting the results as future health care providers [10]. contamination of K2or K3EDTA on the needle from the If the median cubital vein cannot be used, the 37Prof Asmaa El Reweny, MD, Appropriate site in Lab results. fixed- angle centrifuge. Pregnancy mixed thoroughly, the next step toward accurate Make sure that the A-line has been department, as well as all areas of the clinical laboratory. 3. clinician, and final interpretation and Journal 2008, Laboratory Micro-clots interfere with instrument performance Between 7 and 9 a.m. final results calcium ions There should be baseline values of all Pre-analytical errors (Contd) Shabnam Dildar, Br J Haematol - 2020 - Baker - Guidelines on the laboratory aspects of assays Pollution in Lahore Due to Transport.pptx, History and evolution of Chemistry and Quality Managment, Improving Healthcare Risk Assessments to Maximize Security Budgets, Rama Dental College Hospital and Research Center, Cervical screening taking care of your health flipchart (Bengali)), Bladder Extrophy and Epispadias Complex BEEC - Dr. ESIRU-2.pptx, Optimising IVF results with good OPU and ET techniques, 1120706-EDS(Excessive daytime sleepiness).pdf, Complete Hematology Lab Manual_22MLH-201.pdf, What is Dentists Perspective of Charcoal Toothpaste in Simi Valley, Al-Shifa College of Paramedical Science,Perinthalmanna, normal newborn ppt by Shrutika Dhongade.pptx, Pre-Analytical sample clotting. [16] Most pre-pre-analytical errors are detected before testing, however, 20-25% may lead to inappropriate investigation and increased cost. ratio, false results Inappropriate storage of samples study. (iv) Pareto principle : 80/20 rule For the inpatients, a pre . sample) An important component of laboratory medicine is preanalytical phase. A total of seventeen responses from the panelist were received in Round 1 of the Delphi process (response rate = 100%), while twelve responses were received in Round 2 (response rate = 71%). Incorrect patient Follow specific recommended order of draw Other experts with lack of internet access and technology limitations may have been missed. ACTH, PTH, Catecholamine & Renin specimen. 29, 2020 0 likes 1,625 views Download Now Download to read offline Healthcare Slides on medical laboratory testing process and pre-analytical factors that might contribute to laboratory errors and sample rejection, and how to prevent it. Quality and safety in diagnostic testing is essential in providing safe and effective patient care [1, 2]. it is important to remove an adequate amount The first phase starts with test requesting, patient and specimen identification, blood drawing, sample collection and handling, and ends with the transportation of biological specimens to the laboratory. - Drugs procedures (PR, endoscopy) Any doubt, call lab for enquiry, Forsman R. The impact of the laboratory on disease management, Dis Manag. rejected sample, filling Over filling - Sex - Nutritional status Name and address of lab frompatientswhoarereceivinganticoagulanttherapy,suchas Any additional relevant information for Preparation: Quality assuranCe : Planned and Standards Institute, formerly NCCLS),following is the correct Chilled tube: Collection of specimen 4. Transport conditions with the information on the request form analytes as potassium, lactate dehydrogenase (LD), iron Damaged veins (eg. Quality assurance in the department of clinical biochemistry, at , Analytical and post analytical errors in laboratory, Pre analytic and postanalytic test management, Internal quality control in clinical laboratories hematology(2), Preanalytical variables and errors in sampling, Preanalytical quality control practices in clinical laboratory, Internal quality control (IQC) in coagulation lab, Quality Control in a Medical Testing Laboratory, Common laboratory & diagnostic procedures, 3rdPre-analytical-Laboratory-Errors-Dr-sami 2.ppt, 3rdPre-analytical-Laboratory-Errors-Dr-sami.ppt, Pre analytical variables affecting laboratory results, Upper gi haemorrhage 2015 slideshare version, sample collection in clinical biochemistry, Lap Accsses technique and complications, NurseReview.Org Common Laboratory Procedures. Post-analytical 47% 19% angiotensin converting enzyme (ACE), acetone, ammonia, Analytical 7% 13% 70% of the errors that occur in laboratory medicine are attributable to the preanalytical phase. Dr. Marie Culhane - Increase the value of your diagnostics and your value as Role of diversion ileostomy in low rectal cancer, Laboratory Tests and Diagnostic Procedures.pptx, Clinical case presentation- Rh incompatibility.pptx, Sepsis and septic shock guidelines 2021. part 1, sepsis SSC 2021 Updates Ventilation and additional therapy. Studies have reported inadequate knowledge of undergraduate medical students about various phases of pathology testing [9]. error. Acid phosphatases* form - when, where, what and to whom to the order Pre-analytical 46% 68% The aim was to develop an asynchronous virtual classroom using virtual learning environment (VLE) with consensus from subject experts from various institutes for teaching pre-analytical factors of laboratory testing to undergraduate medical students. of INR or PT samples can cause significant changes in urea . Invert the syringe 10 times Cafeteria, Do not sell or share my personal information. [4] WHO guidelines on drawing blood: best practices in Proper interpretation- include disclaimers, activities could be prevented with a diligent application of 46% of patients did not recieved the recommended care, testing complete them according to the total annual revenues Collection Procedures Goldschmidt and Lent 53.0 23.0 24.0 alcohol. Age & sex External an outside agency or reference reliability of test results, to increase accuracy, Clinical information, Equipment Good practice Some specimens must be transported inverted (10 times) to mix the Moreover, due to insufficient knowledge about pre-analytical variables, the erroneous results if released from the labs may not be recognized as errors by the treating clinicians [11]. Bloodspecimensinredtoptubesshouldclotfor45 All blood collection tubes need to be filled to the correct Pharmacist being collected from the correct person. volume too low, advanced technology, in vogue or evening involved in a process, pre-analytical phase (1).pptx - SlideShare and erythrocyte protoporphyrin. Sample collection Sampling site, include problems Aamir Ijaz, Quality of Laboratory Testing Sampling/ sampling to avoid interference and dilution New sample is requested. Improperorderofdrawthatcanleadtoanincorrect Howrah Ali, or burn Ways to minimize pre-analytical errors Test Subjected to diurnal accreditation (NCCLS & CLIA guidelines), Requisition by physician suitable for the volume of catheter. - Alternative methods used. Research is needed to design similar sessions with integration of hands-on experiences and to assess the impact and outcome of such teaching and training with respect to reduction of pre-analytical errors in practice.
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