"Pre-pre" and "post-post" analytical error: high-incidence patient safety hazards involving the clinical laboratory. Both haemodynamic and metabolic differences between venous and arterial blood contribute to the usual finding of capillary plasma glucose being 7-10% higher than corresponding venous values. Test not reserved 31 Article Smoking, drinking and eating are not permitted during the next two hours. a. Roche b. Abbott c. Siemens d. Vitros e. Beckman f. Other? Prolonged bed, 5-CIRCADIAN VARIATION MeSH Teh BP, Ahmad N, Ibnu Rasid EN, Zolkifli NA, Sastu Zakaria UR, Mohamed Yusoff N, Zulkapli A, Japri N, Lee JC, Muhammad H. Pharmaceuticals (Basel). Before PRE AND POST ANALYTICAL ERRORS BY Rrof. collection may give errors. Errors in microbiology laboratory may occur in the pre-analytical, analytical and post analytical stage. The quality assurance system in clinical chemistry allows for the identification of errors and control actions to correct them. Google Scholar. An American pathologist program conducted a study enrolling 660 laboratories and showed that order error rate from outpatient centers was 4.8% [6]. Pre analytical and post analytical phases are as important as the analytical phase as correction in the preanalytical variables can reduce the frequency of errors in the later phases (5). No, Is the Subject Area "Spectrophotometers" applicable to this article? The samples were followed from the moment of blood withdrawal to vaccutainer transportation, centrifugation of the vaccutainers, waiting time and the time of the analysis. CLIA and Quality Assurance | AAFP Whole blood samples preserved with fluoride show an initial rapid fall in glucose up to 10% at room temperature, but subsequent decline is slow. Stark S, Jones BA, Chapman D, Well K, Krajenta R, Meier FA, Zarbo RJ. However, the paradigm of errors and quality in laboratory medicine has been questioned, analytical mistakes continuing to be a major cause of adverse clinical outcomes and patient harm. This article discusses quality management system which can ensure quality performance in histopathology laboratory. Based on these data, HbA1c testing is recommended quarterly and semi-annually, for patients with type 1 and type 2 diabetes mellitus, respectively. Types and frequency of errors in diagnostic laboratories | PLMI Question 7 revealed that 52% of the participants were interested in working with international external quality assurance EQA programs, which compare local lab results with an unknown sample obtained from an internationally accredited lab. Errors in pathology and laboratory medicine: consequences and Edition, A.S.S., Wayne, PA: Clinical and Laboratory Standards Institute, 2007, Davis MD, et al. 2009;404:326. Most analytical errors have been attributed to the analytical phase. ; The specimen receiving area that enters the full patient data and test . Outpatie haemoglobin moiety glycated on multiple sites in both the a- and b-chains). Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. intervals, that 12.5% produce wrongresults that b-Albumin Increase of ALP Any analytes observed out of range were subsequently recalibrated. Sciacovelli L, Plebani M. The IFCC working group on laboratory errors and patient safety. Would you like email updates of new search results? More importantly, many phlebotomists and lab staff should be reminded that hemolysis is one of the most common causes of pre-analytical errors, causing considerable harm to the accuracy of analytical tests. DRUGS MAY HAVE BOTH IN VIVO plasma glucose measurement immediately after intravenous administration of ascorbate). 22, 81675, Mnchen, Germany, You can also search for this author in The patient should be confortably seated or All ten diagnostic labs lacked vigorous quality control programs, and there is an urgent need to improve the quality control schemes at the selected hospitals; although internal quality controls have been used at these hospitals, the detected errors are primarily specific for the analytical phase, and the labs lack external quality control schemes. phlebotomist should estimate the volume of Pre-Analytical, Analytical and Post-Analytical Factors Influencing Citation: Najat D (2017) Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan. Laboratory errors might occur at any of these three phases, and errors are not exclusive to the analytical phase. -CK,AST,GGT are high at birth Outpatient phlebotomy success and reasons for specimen rejection: a Q-probes study. Laboratory critical values policies and procedures: a college of American pathologists Q-probe study in 623 institutions. The types and frequency of pre-analytical errors investigated in this study are shown in Fig 2. Hematology: Pre-analytical, analytical, and post-analytical The most common error was clotted samples (1332 samples, 0.28% of the total samples) followed by quantity not sufficient (328 sample, 0.06%), wrong sample (96 samples, 0.02%), without label (24 samples, 0.005%) and wrong label (22 samples, 0.005%) (Table 1). Please state. However, the initial fall is easily prevented by immediate centrifugation. insulin show similar pattern. Equipment inbuilt with calibration traceability and internal quality controls (QC) were occasionally observed, and weekly calibrations were maintained. Epub 2021 Sep 3. process, which includes all pre-,intra-, and Washington: National Academy Press; 1999. Would you like email updates of new search results? Not fulfilling all investigations needed. Diagnosis (Berl). These type of errors can have serious adverse effects or can lead to completely wrong treatment of the patient (9). Yes The survey also questioned the type of platforms and systems used in the labs and whether analytical errors were recorded or not. sharing sensitive information, make sure youre on a federal )Lack of signature (blood group 266 Accessibility We also conducted a survey to study the various aspects of the pre-analytical and analytical phases at the laboratories. These include an apparent lack of specificity for glycated proteins, lack of standardization among laboratories, difficulty in calibrating the assay and interference by urates and hyperlipidaemia. Careers. Number of rejected samples, reason for rejection and type of test ordered on monthly basis were recorded on a platform. The data were anonymously analyzed. sharing sensitive information, make sure youre on a federal The quality assurance system in clinical chemistry - PubMed Inclusion in an NLM database does not imply endorsement of, or agreement with, Web accessed February 4, 2009 at http://www.Clinical-labs.org/issues/value/index.shtml. Hematology: Pre-analytical, Analytical, and Post-analytical Processes Crystal Harper Undetected failure in quality control Equipment malfunction Figure 7 Patient Factors Sample Handling physiological variables pathological states Figure 6 storage agitation, centrifugation The trend was observed for all the QI before and after sensitisation of the staff over the period of 12months. Influence of method of specimen collection on various preanalytical sample quality indicators in EDTA blood collected for cell counting. CONDITIONS Use of quality indicators to assess and monitor the quality system of the clinical laboratory services is extremely valuable tool in keeping the total testing process under control in a systematic and transparent way. Analytes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and creatine kinase (CK), are typically overestimated when hemolytic samples are used for analysis, while other analytes, such as albumin, alkaline phosphatase (ALP), chloride, g-glutamyltransferase (GGT), glucose and sodium, were reduced when hemolytic samples were used [15]. Question 8 examined the participants interests in quality assurance indicators for the pre-analytical phase, and 63% of the participants were interested in guidance on the quality assurance indicators, while 52% of the participants responded to obtain specific quality assurance tests on laboratory information management systems (LIMS). Bethesda, MD 20894, Web Policies Module without signature 14 children who are frightened, The Fig 3 data is available as S3 Data. 2018 May 8;10(5):e2596. that are insensitiveto total testing process It is crucial to implement international external quality at these labs, and the College of American Pathologists (CAP) should monitor these labs. Overall, 1124 (58.5%) laboratory errors were detected, of which 807 (71.8%) were pre-analytical, 85 (7.6%) analytical, 232 (20.6%) post . Insulin,ACTH,Cortisol The interpretation of results is presented in Table 1. Diagnostics (Basel). 5-The circadian variation of plasma Quality indicators and specifications for the extra analytical phases in clinical laboratory management. whites while albumin is less. potassium oxalate). Epub 2017 Jul 10. Pre analytical phase is of paramount. 1-Fever provokes, B-LONG-TERM BIOLOGICAL In appropriate samples, the percentage error was as high as 39%. Tuesday to Saturday 12:00PM-8:30AM. fistula should This is a preview of subscription content, access via your institution. ALFadhalah T, Al Mudaf B, Al Tawalah H, Al Fouzan WA, Al Salem G, Alghanim HA, Ibrahim SZ, Elamir H, Al Kharji H. BMC Health Serv Res. Lazcano R, Rojas F, Laberiano C, Hernandez S, Parra ER. Diagnostic criteria for diabetes mellitus and impaired glucose tolerance. Clin Chim Acta. Epub 2011 Jun 13. https://www.definitions.net/definition/preanalytical. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. As a library, NLM provides access to scientific literature. Most quality control schemes at Sulaimani hospitals focus only on the analytical phase, and none of the pre-analytical errors were recorded. Quality assurance in the hematology laboratory is intended to ensure laboratory users of reliable test results. The haemolysed samples were not included in the study as it was difficult to identify hemolysis unless we centrifuge sample, conducted more frequently in biochemical tests. a. Analyte Change solution not bovidone-iodine which interfer However, pre-analytical errors remain a challenge for practicing pathologists. Arch Pathol Lab Med. Although most errors occur at pre-analytical stage, caution must also be exercised to eliminate errors during analytical and post . Respiratory Care 58(10): 16941703, CrossRef 6-Blindness&Travel, and stimulants or her name . Iyengar JN. 2009;404:1623. Google Scholar. The pre-analytical phase involves specimen collection, acquisition by the laboratory, labeling and coding, and preparation for analysis. most tests except for those analytes that are Implications of recent studies, including the Diabetes Control and Complications Trial, http://creativecommons.org/licenses/by-nc/4.0/. The list of quality indicators was developed for the steps of total testing process for which errors are frequent and improvements are possible. be preffered to syringes. -Higher activity of enzymes of skeletal Total proteins are higher in blacks than have : Despite advanced automation in diagnostic labs, there are still considerable error rates at clinical diagnostic labs [1]. Part 1: Diagnosis and classification of diabetes mellitus. nomber The review of results in the post-analytical phase may reveal mistakes or new problems in both the pre-analytical and analytical phases (such as sample misidentification, which is part of the pre-analytical phase but is very often recognised post-analytically). The survey showed that none of the participating laboratories recorded pre-analytical errors. normal circadian rhythm,5 days are A total of 15 types of pre-analytical errors were recorded at 10 different diagnostic labs in Sulaimani City. No, Is the Subject Area "Diagnostic medicine" applicable to this article? A laboratory error is usually defined as a defect during the entire testing process (from ordering tests to reporting results) which can influence the quality of laboratory services. Towards a new paradigm in laboratory medicine: the five rights _______________________, _______________________ ______________________, _________________________________________ ____________________, Signature Name of Person Obtaining Consent Date, Title of Research Study: Prevalence of pre-analytical errors in clinical chemistry diagnostic labs in Sulaimani City of Iraqi Kurdistan. Please enable it to take advantage of the complete set of features! Ashavaid TF, Dandekar SP, Khodaiji S, Ansari MH, Singh AP. government site. The present study has some limitations. Micro clots if present can be detected on peripheral blood smear but are usually difficult to recognize. The objective of all quality assurance measures in laboratory medicine is to produce a proper diagnosis based on conclusive findings. The site is secure. IMMOBILIZATION The College of American Pathologists, including 120 labs, concluded that misidentification is a common laboratory error [7]. constituents. Corresponding Information: Dr. Vikram Narang, Dept. 4- Specimen collection &handling However, only extremely high, non-physiological concentrations of these compounds could result into a clinically significant interference (e.g. PubMed Chawla R, Goswami B, Singh B, Chawla A, Gupta VK, Mallika V. Evaluating laboratory performance with quality indicators. (PDF) Pre-analytical, analytical, and post-analytical considerations Examples: Uprity S, Upretity S, Bansal R, JeelaniN , Bharat V. Types and Frequency of preanalytical errors in hematology lab. This site needs JavaScript to work properly. 4- Delay in transportation may cause Federal government websites often end in .gov or .mil. Clinical Chemistry 57(9): 12671271, Panpradist N, et al. with several chemistry procedures. of proper transport method In the laboratory, quality assurance involves the entire testing process: pre-analytical, analytical (testing), post-analytical processes, and staff performance. Competing interests: The authors have declared that no competing interests exist. 2008;132:166671. Bethesda, MD 20894, Web Policies 2021 Jul 30;8:661222. doi: 10.3389/fmolb.2021.661222. haemoglobin moiety glycated on multiple sites in both the a- and b-chains), a value which is not interconvertible with the haemoglobin A1c and therefore questionable in terms of clinical comparison with the DCCT data and actual clinical recommendations. patient entery. 7-Malnutrition https://doi.org/10.1371/journal.pone.0170211.g001. Epub 2009 Dec 1. Therefore, we translated the questionnaire to encourage the participation of phlebotomists, but the response rate remained low. Chawla R, Goswami V, Tayal D, Mallika V. Identification of the types of preanalytical errors in the clinical chemistry laboratory: 1 year study of GB Pant Hospital. Interestingly, none of the labs were internationally accredited; therefore, corrective actions are needed at these hospitals to ensure better health outcomes. (2015) Guidelines of the German Medical Association on quality assurance in medical laboratory testing. Quality indicators and specifications for key processes in clinical laboratories: a preliminary experience. health.. sample 8494 256 HHS Vulnerability Disclosure, Help The entire total testing process in laboratory practice can be broadly divided in to three phases; the pre-analytical, analytical and the post-analytical phase [1, 2, 5]. 2-TSH is at a maximum at 2-4 a.m.and at a Results All data were analyzed using SPSS software SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 21 for Microsoft Windows. disconnection between different areas of : The results obtained from the surveys answered by lab personnel at ten different hospitals. Dr. MOUSTAFA RIZK the contents by NLM or the National Institutes of Health. No. number and types of tubes for tests needed. Role of Intervention on Laboratory Performance: Evaluation of Quality Indicators in a Tertiary Care Hospital. 3- Patient preparation full patient data and test information The pre-analytical errors can be avoided by proper training of staff, increased automation in laboratory which may include modern robotic technologies, information systems, computerized order entry, automated phlebotomy tray preparation etc. More than you ever wanted to know (but need to know) about glycohemoglobin testing. Clipboard, Search History, and several other advanced features are temporarily unavailable. Clin Chem Lab Med. (2003) Utilization, reliability, and clinical impact of point-of-care testing during critical care transport: six years of experience. At the same time, the measurement of glycohaemoglobin (HbA1c) has been definitely identified as the most reliable tool in the assessment of intermediate (2-3 months) metabolic control and prediction of the risk for the development of late complications in patients with diabetes mellitus.