Perfection

When I was in school I learned a lot about science and the laboratory science body of knowledge. The one thing that was emphasized over and over was accuracy and precision. It wasn’t until I secured my first position and started training did I realize just how important those two words were. Not only are we counted on for our accuracy, we are counted on for the repeated accuracy of everything we report to physicians. I have heard some statistics reported that up to 80% of physician decisions on courses of treatment are based on lab results. I really do not get caught up in that number because if you think about it every single value we report is going into a patient’s clinical picture and can affect a decision on a treatment one way or another. So the question always comes up, how do we deal with errors? This question is multifaceted and as a supervisor/administrator we are responsible for much more than just the correction of the error.

I wrote this in my 5 year progress report article but I think it deserves repeating. Everyone makes mistakes, but, it is how you recover and learn from your mistake that is most important. Everyone has had that sinking feeling in their stomach when they learned they have either reported out an incorrect result or have mislabeled a specimen. As a laboratory professional it is our biggest fear and each and every day we sit down at the bench and are expected to be absolutely perfect. Zero errors are a standard that not even the most efficient manufacturers know is possible yet we are expected to perform on this level each and every day. Errors happen to everyone, and when they do it is what happens afterwards that is key to inhibiting that error to occur again. Especially with newer technologists it is important to teach them so that they are able to recover and not make the mistakes again.

The first thing I do when an error is discovered is address it with the technologist. Ask them, “do you remember this sample or this patient? Do you remember what you were doing at the time this error happened?” One thing to watch is how much the technologist can remember. If they cannot remember too many details, were they trying to do too much at once? If they mislabeled did they have a pile of tube and labels while also trying to result specimens? With mislabels I found it helpful for myself to read the name in my head as I was labeling the tube. That way if what I was reading in my head did not match the label underneath I would stop to look. If it is a procedural error why did the technologist deviate from the actual process? Did they learn a shortcut but that shortcut actually increases the chances of error? Going over this with the technologist also will help them with their problem solving skills. Especially with new technologists building problem solving skills is vital to the success or failure of a young technologist. We know humans are not perfect, but when you work in an industry that accepts nothing less, each error made is amplified but also that much more important.

 

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

Improving Patient Safety: What is Your Laboratory’s Preanalytical Error Rate?

Errors can occur at any point in the preanalytical process: during patient preparation; the ordering process; sample collection; sample transportation, preparation, and storage. Some common errors include wrong test orders, missing specimens, improper mixing, and specimens contaminated with line fluid. Use of laboratory automation has reduced preanalytical errors within the laboratory, but what about those errors made outside of the laboratory’s four walls?

One way to decrease errors would be to implement computerized physician order entry. Due to the increased number and complexity of lab tests along with minimal training in medical schools, improper testing ordering is not uncommon. It would be wise for the core laboratory to provide adequate technical information on those commonly misunderstood tests by clinicians that could be accessed readily, such as an intranet website. Placing additional guards on high-priced molecular testing (such as requiring additional information at order entry) would be prudent. Making pathologists and laboratory professionals available to consult with clinicians about test ordering is also one way to reduce this sort of error.

As more facilities centralize their laboratory operations as a way to cut costs, preanalytical errors due to specimen transportation issues could be rise. Currently, there are no specific regulatory constraints on monitoring temperature and/ or humidity during sample transportation; however, studies show that depending upon the length of time and pressure and humidity involved, these external environment could influence the integrity, and therefore the result accuracy, of transported samples. Inaccurate test results could lead to delay in treatment or treatment errors that might harm patients, which also increase the organization’s liability and threaten the medical licensure and/ or the organization livelihood.

Quality Improvement or Performance Improvement program addressing these pre-analytical errors combined with appropriate training and tools to mitigate the errors by tracking the time points related to the sample transportation would improve patient care quality and safety. As part of a good quality management system, laboratories should track the preanalytical errors made each month and categorize them to make designing improvement efforts easier.

Suggested reading:

Felder, R. A. (2011). Preanalytical errors introduced by sample-transportation systems: A means to assess them. Clinical Chemistry, 57(10):1349-1350.

Plebani, M., & Piva, E. (2010). Medical errors: Pre-analytical issue in patient safety. Journal of Medical Biochemistry, 29(4):310.

Carraro, P., Zago, T., & Plebani, M. (2012). Exploring the initial steps of the testing process: Frequency and nature of pre-preanalytic errors. Clinical Chemistry, 58(3):638-42.

Plebani, M. (2012). Pre-analytical errors and patient safety. Journal of Medical Biochemistry, 31(4):265.

Tiwari AK, Pandey P, Dixit S, Raina V (2011). Speed of sample transportation by a pneumatic tube system can influence the degree of hemolysis. Clin Chem Lab Med. Nov 10;50(3):471-4.

Zaninotto, M (2012) Effect of Sample Transportation on Commonly Requested Laboratory Tests. Clinical Chemistry and Laboratory Medicine, 50(10):1755-1760

 

Information on policies or practices are solely from my personal experience ONLY and have NO relation to my affiliation with any regulatory or government agency.

satyadi

-Caroline Satyadi, MT(ASCP), SM, DLM, SLS, MBA, MS, CQA (ASQ) has been a laboratory management professional for over 25 years. She has worked with several different medical industries for CLIA/CMS, FDA/ICH/ISO, TJC/CAP/COLA/HFAP accreditation survey readiness.